CT肺动脉成像评价慢性血栓栓塞性肺动脉高压栓塞指数及右心功能

目的：以选择性肺动脉造影及右心导管为标准,探讨多层螺旋计算机断层肺动脉成像（CTPA）评价慢性血栓栓塞性肺动脉高压（CTEPH）及右心功能的价值。方法：回顾性收集确诊CTEPH的患者24例,均行右心导管及肺动脉造影、CTPA及超声心动图检查。结果：CT Qanadli栓塞指数为（37.16±8.77）%,CT Mastora栓塞指数为（38.14±21.56）%,Qanadli栓塞指数高于Mastora栓塞指数（Z=-4.107,P=0.000）,且二者正相关（r=0.734,P=0.000）。CTPA测得主肺动脉/升主动脉直径比与右心导管测定肺动脉平均压（mean pulmonary arterial pressure,mPAP）正相关（r=0.461,P=0.036）。CTPA测定右心室前壁厚度与mPAP成正相关（r=0.515,P=0.018）。CTPA测得肺动脉直径大于超声测肺动脉内径（t=3.485,P=0.002）,且正相关（r=0.588,P=0.002）。CTPA测得右心室最大短轴直径大于超声测右室横径（t=2.647,P=0.016）,且正相关（r=0.429,P=0.031）。CTPA测定右室前壁厚度小于超声测值（t=3.768,P=0.001）,且成正相关（r=0.551,P=0.004）。CTPA测室间隔厚度略低于超声测室间隔厚度（t=2.941,P=0.007）,两组资料正相关（r=0.751,P=0.000）。Qanadli栓塞指数和Mastora栓塞指数与肺动脉压、主肺动脉直径、肺动脉/主动脉直径比、右室横径、右室前壁厚度等参数均无相关性（P〉0.05）。结论：CT肺动脉造影不仅能够明确诊断慢性血栓性肺栓塞,而且能够提供肺动脉树的阻塞程度、右心功能改变信息,为临床决策和治疗提供更多的信息,但慢性血栓性肺动脉高压肺栓塞程度与右心功能无关。     

CT肺血管造影对急性肺栓塞患者右室功能障碍的评价

目的 利用CT肺血管造影(CTPA)上的心血管参数定量评价急性肺栓塞(APE)患者的右室功能障碍,并确定CTPA诊断严重APE的准确性.方法 根据APE患者的临床表现,把APE患者分为2组:严重APE组(19例)和非严重APE组(45例).在CTPA上,根据肺动脉内栓子阻塞部位和程度计算CT阻塞指数.测量心血管径线,包括:右室短轴最大径、左室短轴最大径、右室与左室短轴最大径比值(RVGA955LV)、主肺动脉直径、奇静脉直径和上腔静脉直径.记录室间隔左突、下腔静脉对比剂返流、奇静脉对比剂返流及支气管动脉扩张情况.使用Mann-Whitney U检验、χ2检验法评价严重APE组和非严重APE组之间的心血管参数的差异;使用Spearman等级相关系数评价CT阻塞指数和心血管测量值之间的相关性;使用ROC曲线确定CTPA诊断APE严重性的敏感度和特异度,计算和比较ROC曲线下的面积.结果 严重APE组的CT阻塞指数(中位数42.5%)高于非严重APE组的CT阻塞指数(中位数20%),P=0.000.严重APE组和非严重APE组之间的心血管参数中,有显著统计学差异的指标为:右室短轴最大径(P=0.021)、左室短轴最大径(P=0.000)、RVGA955LV(P=0.000)、右室壁厚(P=0.014)、主肺动脉直径(P=0.002)、奇静脉直径(P=0.001)、室间隔左突(P=0.000)及支气管动脉扩张(P=0.019).CT阻塞指数和心血管测量值之间的相关性都有统计学意义,其中RVGA955LV与CT阻塞指数之间的相关系数最高(0.687).阻塞指数、左室短轴最大径、RVGA955LV、主肺动脉直径及奇静脉直径的Az值均高于0.5.结论 通过测量心血管参数可以评价APE患者右室功能障碍,进而确定APE的严重性.CTPA是评价右室功能障碍的一种快速、实用而准确的方法.     

CT肺动脉造影对急性肺栓塞严重程度的评估价值

目的 探讨CT肺动脉造影(CTPA)的影像学特征与肺栓塞严重指数(PESI)之间的相关性。方法 共有150例确诊为肺栓塞(PE)的患者纳入本研究。CTPA影像学特征包括阻塞指数(Qanadli指数)、肺动脉干直径、下腔静脉对比剂返流、室间隔形态、右心室(RV)和左心室(LV)直径以及RV/LV比值。应用PESI评分评估PE的严重程度,检验CTPA影像学特征与PESI评分之间的相关性,P<0.05为差异具有统计学意义。结果 阻塞指数与PESI评分呈正相关(r=0.45,P<0.05),肺动脉干直径越大者PESI评分越高(r=0.20,P<0.05)。在PESI评分较高的患者中,下腔静脉对比剂返流和室间隔形态异常更为常见(P<0.05)。在RV及LV直径、RV/LV比值和PESI评分之间无显著相关性。肺动脉干扩张是高危PE患者的最佳预测因素,其优势比为4.4。结论 较高的阻塞指数、肺动脉主干扩张、对比剂返流、异常的室间隔形态与较高的PESI评分相关。     

CT阻塞指数对肺栓塞的评价及其与D-二聚体相关性分析

目的：探讨肺动脉CT阻塞指数对肺栓塞(PE)高危性的评价及其与D-二聚体之间的关系。方法收集经 CT肺动脉成像(CTPA)及D-二聚体检查的125例PE病例。将其分为高危PE组和非高危PE组,比较分析2组在 CT阻塞指数、D-二聚体、主肺动脉直径间的差异,以及肺动脉 CT 阻塞指数与 D-二聚体、主肺动脉直径之间的相关性(Spearman相关性评价)。结果高危PE组的CT阻塞指数明显高于非高危PE组(P=0.000),高危PE组主肺动脉直径较非高危PE组增粗,差异有统计学意义(P=0.000),而高危PE组和非高危PE组D-二聚体差异无统计学意义(P=0.103)。CT阻塞指数与D-二聚体无相关性(P=0.71)。结论血浆D-二聚体指标可以提示PE,不能评价PE的高危性;肺动脉CT阻塞指数在一定程度上可以反映PE的严重性,其与 D-二聚体间无相关性。     

64排CT评估肺动脉栓塞严重程度的价值

目的:探讨64排螺旋CT定量评估肺动脉栓塞(PE)严重程度的价值.材料和方法:根据临床的严重性和治疗方法的选择,将95例怀疑PE的患者分为3组:严重肺动脉栓塞(SPE)组、非严重肺动脉栓塞(NSPE)组、无肺动脉栓塞(WPE)组.分别阅读各组的CTPA图像,采用CT动脉阻塞指数定量分析栓塞肺动脉的范围及程度,测量舒张期左、右心室短轴最大径及中央肺动脉直径,并观察室间隔形态.结果:与肺动脉严重程度显著相关的因素有:血管阻塞指数(SPE组:74.7;NSPE组:23.0;WPE组:0)、左室短轴最大径(SPE组:31.2mm;NSPE组:35.3mm;WPE组:36.6mm)、右室/左室短轴比(SPE组:1.24;NSPE组:1.04;WPE组:0.93)、中央肺动脉直径(SPE组:31.8mm;NSPE组:28.1mm;WPE组:25.9mm)和1、2级室间隔(SPE组:53.3%,13.3%;NSPE组:16.3%,0%).结论:64排螺旋CT不仅能正确诊断可疑的PE,而且能定量评估PE的严重程度,从而为临床治疗提供更多的信息.     

CT肺动脉造影评价慢性血栓栓塞性肺动脉高压的血流动力学

目的 探讨多层螺旋CT肺动脉造影 (CT pulmonary angiography,CTPA)与慢性血栓性肺动脉高压血流动力学关系.方法 回顾性纳入2006-01-2009-10慢性肺栓塞患者55例,评价CT肺动脉栓塞指数(CT pulmonary artery obstruction index, CTPAOI)及CTPA参数.根据CTPA图像采用Qanadli栓塞指数和Mastora栓塞指数计算 CTPAOI.CTPA参数均在轴位图像测量,包括主肺动脉直径、主肺动脉与升主动脉直径比、右室左室直径比等.结果 55例CTEPH患者Qanadli栓塞指数为(37.60±15.22)%,Mastora栓塞指数为(30.02±16.43)%,Qanadli 栓塞指数高于Mastora栓塞指数, Z=-6.296,P=0.000;但二者显著正相关,r =0.875,P=0.000.无论Qanadli栓塞指数还是Mastora栓塞指数与血流动力学参数之间均无显著相关性(P>0.05).CTPA参数与血流动力学参数相关分析显示右室左室直径比与肺动脉收缩压(r=0.240,P=0.021)、肺动脉舒张压(r=0.255,P=0.014)、平均肺动脉压(r=0.217,P=0.037)、肺毛细血管嵌压(r=0.318,P=0.002)、肺血管阻力(r=0.369,P=0.000)呈正相关;右肺动脉干直径、右室与左室比、右室前壁厚度为平均肺动脉压的独立因素.结论 采用Qanadli栓塞指数和Mastora栓塞指数不能反映慢性血栓性肺动脉高压血流动力学变化,但CTPA参数能够从不同方面反映血流动力学状态.     

CT肺动脉成像对急性肺栓塞患者肺动脉高压严重程度的评估

目的:探讨CT肺动脉成像(CTPA)对急性肺栓塞(APE)肺动脉高压严重程度的诊断价值。方法:根据多普勒超声心动图估算肺动脉收缩压(PASP),将APE患者分为2组:中重度(45例)和轻度肺动脉高压组(29例)。在CTPA上测量心血管径线,包括主肺动脉、左肺动脉、右肺动脉直径、右下肺动脉和升主动直径以及右室和左室短轴最大径。计算主肺动脉直径与升主动脉直径比值(rPA)、右室与左室短轴最大径比值(RV/LV)。使用t检验评价中重度与轻度肺动脉高压组之间心血管参数的差异;使用ROC曲线确定CTPA诊断中重度肺动脉高压的敏感度和特异度,计算和比较ROC曲线下面积(AUC值);使用Pearson等级相关系数评价肺动脉压与心血管测量值之间的相关性。结果:轻度和中重度肺动脉高压组之间差异有统计学意义的指标为主肺动脉直径(P<0.001)、左肺动脉直径(P=0.001)、右肺动脉直径(P=0.001)、右室短轴最大径(P<0.001)、左室短轴最大径(P<0.001)、rPA(P<0.001)、RV/LV(P<0.001)。主肺动脉直径、rPA、RV/LV的AUC值均高于0.8(P<0.01)。PASP与主肺动脉直径(r=0.160)、左肺动脉直径(r=0.258)、右肺动脉直径(r=0.264)、右心室短轴最大径(r=0.401)、左心室短轴最大径(r=-0.511)、rPA(r=0.670)、RV/LV(r=0.644)之间的相关性均有统计学意义,其中rPA与PASP之间的相关系数最高(r=0.670)。结论:CTPA不仅可以诊断PE,并且可以通过rPA、RV:LV等指标评估肺动脉高压严重程度,有助于临床判断预后及治疗方案的选择。     

CT肺血管成像对急性大面积肺栓塞患者的动态分析价值

目的 探讨CT肺血管成像(CTPA)对大面积肺栓塞患者的动脉栓塞程度及右心功能的动态分析价值.方法 回顾性分析23例大面积肺栓塞患者的CTPA资料,分析治疗前、治疗后24 h及14 d时的CTPA肺动脉栓塞指数及右心功能参数,采用单因素方差分析、LSD检验和X2检验分析治疗前后的变化,并采用Pearson法分析肺动脉栓寨指数与右心功能参数之间的相关性.结果 CTPA肺动脉栓塞指数在溶栓治疗后逐渐减小,Qanadli和Mastora评分在治疗前(分别为50.0、46.5分)与治疗后24 h(分别为42.5、12.1分)比较差异有统计学意义(t值分别为2.830、6.493,P值均<0.01);治疗后24 h与治疗后14 d(分别为25.0、8.4分)比较差异有统计学意义(t值分别为4.640、4.299,P值均<0.01).治疗后24 h,右心室最大短轴直径(4.58 cm)及横截面积(23.10 cm2)明显减小,左心室最大短轴直径(4.41 cm)及横截面积(26.37 cm2)明显增大,双侧心室最大直径比(1.07)和面积比(0.94)明显减小,与上述各指标治疗前相比(分别为5.07 cm、25.42 cm2、3.57 cm、20.17 cm2、1.59,1.38)差异有统计学意义(t=2.081～4.959,P值均<0.05);治疗后24 h,肺动脉收缩压(40.92 mm Hg)明显变小,与治疗前(58.61 mm Hg)相比差异有统计学意义(t=2.824,P<0.01);治疗前与治疗后24 h,CTPA肺动脉栓塞指数与右心功能参数间均有不同程度的相关性(r=0.034～0.598,P值均<0.01).结论 CTPA可以动态观察急性肺栓塞的肺动脉阻塞程度及右心功能的变化,为临床治疗提供重要的信息.     

急性肺栓塞程度及其与右心功能相关性的多层螺旋CT肺动脉造影评价

目的 探讨128层螺旋CT肺动脉造影(CTPA)评价急性肺栓塞患者栓塞程度及其与右心功能的相关性以及临床价值.方法 43例急性肺栓塞患者行CTPA检查,根据死亡风险评估将患者分为高危组(18例)和非高危组(25例).在CTPA图像上分析2组CT阻塞指数及右心功能参数的差异及二者间的关系.结果 高危组CT阻塞指数(中位数23.87%)高于非高危组 (中位数9.72%).2组间右心功能参数8项有统计学差异,3项无统计学差异.肺动脉CT阻塞指数与右心功能计量指标间相关性均有统计学差异.CT阻塞指数、右心室短轴最大径(RVMSA)、左心室短轴最大径(LVMSA)、RVMSA/LVMSA(RVLV)、主肺动脉直径及奇静脉直径Az值均＞0.5.结论 CTPA能够较准确地评价急性肺栓塞程度及其与右心功能的相关性,为临床治疗提供重要的信息.     

多层螺旋CT对肺栓塞影像表现及与其严重性关系的评价

目的 评价多层螺旋CT肺栓塞影像表现及与其严重性的关系.资料与方法 回顾性分析104例临床诊断肺栓塞患者的临床及影像学资料,测量心血管参数:主肺动脉直径、右心室短轴最大径(RVMSA)、左心室短轴最大径(LVMSA)及RVMSA/LVMSA比值,计算CT肺动脉成像(CTPA)阻塞指数,评价CTPA上栓子的形态和与双能量CT(DECT)上灌注缺损的关系及CTPA阻塞指数与心血管测量参数的关系.结果 104例中,32例因图像丢失(n=10)、CTPA图像欠佳,不满足测量要求(n=9)或未行CTPA检查(n=13),故只对72例患者的影像学资料进行分析评价.完全闭塞型肺栓塞DECT表现为整个肺叶灌注降低或某个肺段灌注缺损,部分闭塞型DECT表现为灌注降低或正常.CT阻塞指数与心血管测量参数具有一定的相关性(P<0.05),以CT阻塞指数与RVMSA/LVMSA比值相关性最高(r=0.519,P<0.001).结论 肺灌注异常与否取决于肺动脉栓塞的程度;CT肺动脉阻塞指数可用于评价肺栓塞的严重性.     

Severe pulmonary embolism:pulmonary artery clot load scores and cardiovascular parameters as predictors of mortality

PURPOSE: To retrospectively evaluate pulmonary artery (PA) clot load scores and computed tomographic (CT) cardiovascular parameters as predictors of mortality in patients with severe pulmonary embolism (PE). MATERIALS AND METHODS: Institutional review board approval was obtained with waiver of informed consent. A total of 82 consecutive patients (42 women, 40 men; mean age+/-standard deviation, 61 years+/-15) were admitted to the intensive care unit for PE-related conditions and were evaluated by using CT pulmonary angiography. Two independent readers who were blinded to clinical outcome quantified PA clot load by using four scoring systems. Cardiovascular measurements included right ventricular (RV) and left ventricular (LV) short-axis measurements; RV short axis to LV short axis (RV/LV) ratios; main PA, ascending aorta, azygos vein, and superior vena cava diameters; and main PA diameter to aorta diameter ratios. Reflux of contrast medium into the inferior vena cava, leftward bowing of the interventricular septum, pleural or pericardial effusion, pulmonary consolidation, infarct, platelike atelectasis, and mosaic ground-glass opacity were also recorded. Results were correlated with patient outcome during hospital stay by using the Wilcoxon rank sum and chi2 tests. RESULTS: Twelve patients died within 1-14 days. RV and LV short axis; RV/LV ratio; azygos vein, superior vena cava, and aorta diameters; and contrast medium reflux into the inferior vena cava were significantly different between survivors and nonsurvivors (P<.05). No significant relationship was found between PA clot load and mortality rate. RV/LV ratio and azygos vein diameter allowed correct prediction of survival in 89% of patients (P<.001). CONCLUSION: RV/LV ratio and azygos vein diameter are predictors of mortality in patients with severe PE.     

回顾性心电门控多层螺旋CT对急性肺栓塞右心室功能障碍及溶栓前后右心室功能变化的评价

目的 应用ECG门控MSCT前瞻性对中心型急性肺动脉栓塞(APE)患者右心功能障碍及静脉溶栓前后右心功能变化进行评价.方法 96名可疑APE患者进行了ECG门控MSCT胸痛三联检查,25例确诊为中心型肺栓塞.行胸痛三联检查无心肺疾患且性别、年龄匹配的25例作为对照组.APE患者于静脉溶栓后复查MSCT,评价右心功能恢复情况.测量参数包括横断面舒张期的右心室(RV)及左心室(LV)短轴最大内径,RV及LV舒张末期容积(EDV)、收缩末期容积(ESV)、射血分数(EF)、主肺动脉/主动脉直径比.应用单因素方差分析,如果有统计学意义,则采用两两组间q检验.结果 对照组的右心室EDV、ESV、EF值、收缩末期RV/LV容积比、横断面RV/LV内径比及主肺动脉/主动脉直径比分别为(15O.5±24.1)ml、(71.5±18.5)ml、(53.5±4.2)%、1.08±0.04、1.01±0.04及0.99±0.02,中心型APE患者溶栓前以上各值分别为(190.3±16.2)ml、(128.1±13.2)ml、(32.7±3.6)%、2.00±0.26、1.30±0.09及1.34±0.11,溶栓后分别为(159.2±21.5)ml、(80.7±9.4)ml、(49.2±5.9)%、1.22±0.25、1.02±0.02及1.02±0.11.中心型APE患者与对照组比较,右心室ESV(q=6.28,P<0.01)及EDV均增大(q=7.59,P<0.01),EF减小(q=4.82,P<0.01),收缩末期RV/LV容积比增大(q=6.04,P<0.01),横断面RV/LV内径比(q=4.43,P<0.01)及主肺动脉/主动脉直径比增大(q=4.36,P<0.01),左心室EDV减小.中心型APE患者静脉溶栓后,与溶栓前比较,右心室ESV(q=5.03,P<0.01)及EDV减小(q=6.11,P<0.01),EF增加(q=6.29,P<0.01),收缩末期RV/LV容积比减小(q=4.74,P<0.01),横断面RV/LV内径比(q=3.83,P<0.01)及主肺动脉/主动脉直径比减小(q=3.46,P<0.01),左心室EDV增大(q=4.01,P<0.01).结论 回顾性ECG门控MSCT胸痛三联检查可同时检测APE和测量左右心功能,排除其他胸痛疾病,评价溶栓疗效.     

Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism

PURPOSE: To retrospectively quantify right ventricular dysfunction (RVD) and the pulmonary artery obstruction index at helical computed tomography (CT) on the basis of various criteria proposed in the literature and to assess the predictive value of these CT parameters for mortality within 3 months after the initial diagnosis of pulmonary embolism (PE). MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was not required for retrospective study. In 120 consecutive patients (55 men, 65 women; mean age +/- standard deviation, 59 years +/- 18) with proved PE, two readers assessed the extent of RVD by quantifying the ratio of the right ventricle to left ventricle short-axis diameters (RV/LV) and the pulmonary artery to ascending aorta diameters, the shape of the interventricular septum, and the extent of obstruction to the pulmonary artery circulation on helical CT images, which were blinded for clinical outcome in consensus reading. Regression analysis was used to correlate these parameters with patient outcome. RESULTS: CT signs of RVD (RV/LV ratio, >1.0) were seen in 69 patients (57.5%). During follow-up, seven patients died of PE. Both the RV/LV ratio and the obstruction index were shown to be significant risk factors for mortality within 3 months (P = .04 and .01, respectively). No such relationship was found for the ratio of the pulmonary artery to ascending aorta diameters (P = .66) or for the shape of the interventricular septum (P = .20). The positive predictive value for PE-related mortality with an RV/LV ratio greater than 1.0 was 10.1% (95% confidence interval [CI]: 2.9%, 17.4%). The negative predictive value for an uneventful outcome with an RV/LV ratio of 1.0 or less was 100% (95% CI: 94.3%, 100%). There was a 11.2-fold increased risk of dying of PE for patients with an obstruction index of 40% or higher (95% CI: 1.3, 93.6). CONCLUSION: Markers of RVD and pulmonary vascular obstruction, assessed with helical CT at baseline, help predict mortality during follow-up.     

Prediction of short term outcome of pulmonary embolism: Parameters at 16 multi-detector CT pulmonary angiography

Purpose

To evaluate the accuracy of computed tomography pulmonary angiography (CTPA) parameters, for predicting short-term mortality in patients with acute pulmonary embolism (PE).

Materials and methods

Thirty-two patients with proven PE had CT pulmonary angiography were included in the study. The clot burden using the Qanadli score (QS), and the right ventricular dysfunction (RVD) parameters were assessed on CT by calculating right ventricular/left ventricular (RV/LV) diameter ratios, interventricular septum abnormality, inferior vena cava contrast reflux, azygous vein and superior vena cava measures. Contrast density in pulmonary artery and descending aorta was evaluated for all patients. Patients were followed up for 30 days and then classified as survivors or non survivors.

Results

Thirty-two patients were included in the study, 23 (71.8%) of them were classified as survivors, and the other nine (28.1%) patients died within the first month (non survivors). There was a positive, but weak correlation between the Qanadli score and the short term mortality (P value = 0.05). There was a statistically significant relationship between the RV/LV ratio and PE-related mortality, with a P value < 0.001. Also, there was a good correlation between degree of IVC reflux and PE outcome (P < 0.001). The PA/AO diameter ratio, SVC diameter and azygous vein diameter showed no statistically significant difference between survivors and non survivors.

Conclusions

CTPA findings that may predict short term mortality are the high grades of inferior vena cava reflux, RV/LV diameter ratio more than 1.2, and clot burden >18 according to the Qanadli score and to a lesser degree the interventricular septum abnormality.     

Pulmonary embolism: prognostic CT findings

PURPOSE: To retrospectively determine whether three computed tomographic (CT) findings-ventricular septal bowing (VSB), ratio between the diameters of right ventricle (RV) and left ventricle (LV), and embolic burden-are associated with short-term death, defined as in-hospital death or death within 30 days of CT, whichever was longer, due to acute pulmonary embolism (PE). MATERIALS AND METHODS: Institutional Review Board approval was obtained, and patient information was reviewed in compliance with HIPAA regulations. A total of 1193 patients with CT scans positive for PE from January 1, 1997, to December 31, 2002, who had given authorization for retrospective research were included. Scans were independently reviewed by two observers. CT findings were compared with risk of death by using univariate analysis (chi(2) statistic) and multivariate logistic regression. Interobserver variability (kappa statistic or intraclass correlation coefficient), sensitivity, and specificity of CT findings for predicting death were calculated. A third observer reviewed discrepant cases post hoc. RESULTS: Fifty-four percent of patients were women and 46% were men (mean age, 63 years +/- 16). For observer 1, VSB was associated with death in univariate (odds ratio [OR], 1.98; P = .04) and multivariate modeling (OR, 1.97; P = .05). Interobserver variability was only fair (kappa = 0.54) for VSB, and observer 2 found no association with death (OR, 1.52; P = .22). For both observers, VSB had low sensitivity (21% and 18%) and high specificity (88% and 87%) for predicting death. Neither RV/LV diameter ratio nor embolic burden was associated with increased risk of death. For observer 3, VSB was associated with death in univariate (OR, 2.10; P = .05) and multivariate analyses (OR, 2.18; P = .05). CONCLUSION: CT-depicted VSB is predictive of death due to PE, but with low sensitivity and high interobserver variability. RV/LV diameter ratio and embolic burden are not associated with short-term death due to PE.     

Role of helical CT in detecting right ventricular dysfunction secondary to acute pulmonary embolism

OBJECTIVE: The purpose of this study was to evaluate the role of helical CT in detecting right ventricular dysfunction (RVD) after acute pulmonary embolism (PE). METHODS: This was a retrospective study consisting of 25 patients with CT scans positive for acute pulmonary embolism who had either follow-up echocardiography (23 patients) or pulmonary angiography (2 patients). CT scans were reviewed for findings suggestive of RVD. Scans were considered positive for RVD if the right ventricle (RV) was dilated or if the interventricular septum was deviated towards the left ventricle. Results were then correlated with the results of echocardiography or pulmonary angiography to estimate the sensitivity and specificity of CT in detecting RVD associated with PE. RESULTS: Within this group of 25 patients with PE, CT demonstrated sensitivity of 78% (7/9), specificity of 100% (16/16), and positive predictive value of 100% (7/7) in detection of RVD. CONCLUSION: CT may be useful in detecting RVD in patients with acute PE.     

Non-severe pulmonary embolism: Prognostic CT findings

The goal of this study was to retrospectively evaluate CT cardiovascular parameters and pulmonary artery clot load score as predictors of 3-month mortality in patients with clinically non-severe pulmonary embolism (PE). We included 226 CT positive for PE in hemodynamically stable patients (112 women; mean age 67.1 years ±16.9). CT were independently reviewed by two observers. Results were compared with occurrence of death within 3 months using Cox regression. Twenty-four (10.6%) patients died, for whom 9 were considered to be due to PE. Interobserver agreement was moderate for the shape of interventricular septum (κ = 0.41), and for the ratio between the diameters of right and left ventricle (RV/LV) (κ = 0.76). Observers found no association between interventricular septum shape and death. A RV/LV diameter ratio >1 was predictive of death (OR, 3.83; p < 0.01) only when we also took into account the value of the embolic burden (<40%). In a multivariate model, CT cardiovascular parameters were not associated with death. Concomitant lower limb DVT and comorbid conditions were important predictors of death. In clinically non-severe PE, a RV/LV diameter ratio >1 is predictive of death when the embolic burden is low (<40%).     

Right ventricular function in patients with acute pulmonary embolism: analysis with electrocardiography-synchronized multi-detector row CT

PURPOSE: To prospectively assess electrocardiography (ECG)-synchronized multi-detector row computed tomography (CT) for the evaluation of right ventricular (RV) function in patients suspected of having pulmonary embolism (PE). MATERIALS AND METHODS: All patients gave informed consent after the study details, including radiation exposure, were explained; institutional ethical committee approval was obtained. Nonsynchronized multi-detector row CT of the chest was performed in 66 consecutive patients (29 men, 37 women; mean age, 58 years+/-15 [standard deviation]) who were suspected of having PE. ECG-synchronized cardiac multi-detector row CT was performed to assess cardiac function. Dimension ratios for the RV and left ventricle (LV) were measured on nonsynchronized transverse and angulated four-chamber views. Furthermore, the RV end-diastolic and end-systolic volumes were measured on ECG-synchronized multi-detector row CT scans. An independent samples t test was performed to compare the mean value of different groups. An analysis of variance post hoc test was performed to investigate whether the values of the variables varied between groups. RESULTS: PE was detected in 29 of 66 patients. The location of PE was categorized as central (n=17) or peripheral (n=12). The RV/LV dimension ratio was larger on the four-chamber view (P=.002), and RV end-systolic volume was larger (P=.01) and ejection fraction was lower (P=.01) in patients with PE. The RV end-systolic volumes and RV/LV volume ratios, as assessed by using ECG-synchronized multi-detector row CT, showed significant differences (P<.005) between patients with central PE and those with peripheral PE. However, the RV/LV dimensions on nonsynchronized images revealed no significant differences. CONCLUSION: Retrospective ECG-synchronized multi-detector row CT facilitates detection of RV dysfunction, depending on pulmonary embolus location.     

The use of axial diameters and CT obstruction scores for determining echocardiographic right ventricular dysfunction in patients with acute pulmonary embolism

Purpose

To evaluate the accuracy of cardiac computed tomography (CT) parameters and pulmonary artery (PA) obstruction (OS) scores in determining the echocardiographic right ventricular dysfunction (RVD) in hemodynamically stable patients with acute pulmonary embolism (PE).

Materials and methods

A total of 120 patients with acute PE were included in the study. Right ventricle/left ventricle ratio (RV/LV); PA axial diameter; superior vena cava (SVC) axial diameter; and Ghanima, Miller, Qanadli, and Mastora obstruction scores were obtained using CT. RVD was assessed by echocardiography. The patients were divided into two groups based on the presence or absence of RVD.

Results

RV/LV ratio, SVC axial diameter, PA axial diameter, and Miller, Qanadli, and Mastora scores were significantly increased in the RVD group. Multivariate logistic regression analysis showed that RV/LV ratio [OR 6.36 (2.02–279.46 95 % CI), p = 0.01] and PA axial diameter [OR 5.02 (1.02–1.26 95 % CI), p = 0.03] were independent predictors of echocardiographic RVD. Predictive values of these parameters were improved when combined with other intragroup cutoff values. A cutoff value for the RV/LV ratio of >1.08 had 81.43 % sensitivity, 52.08 % specificity, 71.3 PPV, and 65.8 NPV for prediction of RVD.

Conclusion

Tomographic axial diameters enable more accurate predictions of RVD than OS scores do.     

平静呼吸轻屏气在改善肺动脉CT强化效果中的应用研究

目的:探讨"深吸气后屏气"肺动脉CTA(CTPA)扫描发生短暂性对比剂中断(TIC)后,"平静呼吸轻屏气"在改善肺动脉强化效果中的应用价值.方法:回顾分析2774例"深吸气后屏气"状态下完成CTPA检查的患者,筛选因发生TIC导致肺动脉强化不佳并立即行"平静呼吸轻屏气"CTPA重复扫描者.对两次扫描的肺动脉段级及以上分...