Role of Helical CT in Detecting Right Ventricular Dysfunction Secondary to Acute Pulmonary Embolism

Abstract

CT may be useful in detecting RVD in patients with acute PE.

Reproducibility of CT Signs of Right Ventricular Dysfunction in Acute Pulmonary Embolism

“…However, this aspect has been investigated in prior work [15][16][17][18][19][20][21][22][23][24][25][26], and our cohort would be too small to meaningfully contribute to existing data. In this study, we solely aimed at analyzing the observer dependence of establishing the CT signs of RV dysfunction that have hitherto been described in the literature to identify the most robust and reproducible method.…”

“…Contractor et al [18] and Lim et al [38] found a RVD/LVD ratio of greater than 1 measured on axial sections indicative of RV strain at pulmonary CTA, whereas others have proposed a threshold of greater than 1.5 [17,20,26]. However, the axial CT acquisition plane differs from the standard imaging planes of other cardiac imaging techniques, such as echocardiography [18][19][20][21][22]. Ventricular measurements on four-chamber views reconstructed from routine pulmonary CTA imaging data were shown to be superior to those from axial views for predicting adverse events.…”

“…Pulmonary CTA not only allows direct visualization of emboli but provides information regarding the status of the right heart [15,16]. In several studies, the ratio of the RV to left ventricle (LV) diameters on pulmonary CTA has been proposed as a sign for RV dysfunction [17][18][19]. Other signs have been described, including bowing of the interventricular septum and reflux of contrast medium into the inferior vena cava (IVC) [20,21].…”

“…Other signs have been described, including bowing of the interventricular septum and reflux of contrast medium into the inferior vena cava (IVC) [20,21]. However, a variety of different methods for the quantitative assessment of RV dysfunction on pulmonary CTA have been proposed [17][18][19][20][21][22][23][24] and the literature shows variable results for the prognostic power of pulmonary CTA signs of RV dysfunction to predict adverse outcomes. This variability may in part be explained by the somewhat subjective nature of diagnosing RV dysfunction on pulmonary CTA because formal criteria for es- AJR 2010; 194:1500-1506 0361-803X/10/1946-1500 © American Roentgen Ray Society A cute pulmonary embolism (PE) is a common disease with a 3-month mortality rate of up to 17.4% [1][2][3][4].…”

Update on pulmonary hypertension complicating chronic obstructive pulmonary disease

“…The sensitivity of CT chest for detecting right ventricle dysfunction was 78% and specificity 100%, with a positive predictive value of 100%. 50 Although, this was a retrospective study of 25 patients, chest CT may provide an option for evaluating right ventricle dysfunction in COPD patients especially when ECHO Doppler proves inadequate.…”