Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지
DOI QR코드

DOI QR Code

The Ratio of Descending Aortic Enhancement to Main Pulmonary Artery Enhancement Measured on Pulmonary CT Angiography as a Finding to Predict Poor Outcome in Patients with Massive or Submassive Pulmonary Embolism

  • Park, Chi-Young (Department of Diagnostic Radiology, Bundang CHA Hospital, CHA University School of Medicine) ;
  • Yoo, Seung-Min (Department of Diagnostic Radiology, Bundang CHA Hospital, CHA University School of Medicine) ;
  • Rho, Ji-Young (Department of Diagnostic Radiology, Bundang CHA Hospital, CHA University School of Medicine) ;
  • Ji, Young-Geon (Department of Preventive Medicine, CHA University School of Medicine) ;
  • Lee, Hwa-Yeon (Department of Diagnostic Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine)
  • Received : 2011.12.23
  • Accepted : 2012.02.07
  • Published : 2012.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The purpose of this study was to evaluate whether measuring the ratio of descending aortic enhancement (DAE) to main pulmonary artery enhancement (MPAE) on pulmonary computed tomography angiography (PCTA) can predict poor outcome in patients with acute massive or submassive pulmonary embolism (PE). Methods: We retrospectively, reviewed computed tomgraphy findings and charts of 37 patients with acute PE and right ventricular dysfunction. We divided the enrolled patients into 3 groups; group Ia (n=8), comprised of patients with major adverse event (MAE); group Ib (n=5), consisted of those with PE-related MAE; and group II (n=29), those without MAE. We analyzed the right ventricular diameter (RVD)/left ventricular diameter (LVD) and DAE/MPAE on PCTA. Results: For observer 1, RVD/LVD in group Ia ($1.9{\pm}0.36$ vs. $1.44{\pm}0.38$, p=0.009) and group Ib ($1.87{\pm}0.37$ vs. $1.44{\pm}0.38$, p=0.044) were significantly higher than that of group II. For observer 2, RVD/LVD in group Ia ($1.71{\pm}0.18$ vs. $1.41{\pm}0.47$, p=0.027) was significantly greater than that of group II, but RVD/LVD of group Ib was not ($1.68{\pm}0.2$ vs. $1.41{\pm}0.47$, p=0.093). For both observers, there was a significant difference of DAE/MPAE between group Ib and group II ($0.32{\pm}0.15$ vs. $0.64{\pm}0.24$, p=0.005; $0.34{\pm}0.16$ vs. $0.64{\pm}0.22$, p=0.004), but no significant difference of DAE/MPAE between group Ia and group II ($0.51{\pm}0.3$ vs. $0.64{\pm}0.24$, p=0.268; $0.53{\pm}0.29$ vs. $0.64{\pm}0.22$, p=0.302). Intra-class correlation coefficient (ICC) for the measurement of DAE/MPAE (ICC=0.97) was higher than that of RVD/LVD (ICC=0.74). Conclusion: DAE/MPAE measured on PCTA may predict PE-related poor outcomes in patients with massive or submassive PE with an excellent inter-observer agreement.

Keywords

References

  1. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999;353:1386-9. https://doi.org/10.1016/S0140-6736(98)07534-5
  2. Sanchez O, Trinquart L, Colombet I, Durieux P, Huisman MV, Chatellier G, et al. Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review. Eur Heart J 2008;29:1569-77. https://doi.org/10.1093/eurheartj/ehn208
  3. Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Massive pulmonary embolism. Circulation 2006;113:577-82. https://doi.org/10.1161/CIRCULATIONAHA.105.592592
  4. Kasper W, Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser KD, et al. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol 1997;30:1165-71. https://doi.org/10.1016/S0735-1097(97)00319-7
  5. Piazza G, Goldhaber SZ. Management of submassive pulmonary embolism. Circulation 2010;122:1124-9. https://doi.org/10.1161/CIRCULATIONAHA.110.961136
  6. Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galie N, Pruszczyk P, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008;29:2276-315. https://doi.org/10.1093/eurheartj/ehn310
  7. Schoepf UJ, Kucher N, Kipfmueller F, Quiroz R, Costello P, Goldhaber SZ. Right ventricular enlargement on chest computed tomography: a predictor of early death in acute pulmonary embolism. Circulation 2004;110:3276-80. https://doi.org/10.1161/01.CIR.0000147612.59751.4C
  8. Collomb D, Paramelle PJ, Calaque O, Bosson JL, Vanzetto G, Barnoud D, et al. Severity assessment of acute pulmonary embolism: evaluation using helical CT. Eur Radiol 2003;13:1508-14. https://doi.org/10.1007/s00330-002-1804-5
  9. Ghaye B, Ghuysen A, Willems V, Lambermont B, Gerard P, D'Orio V, et al. Severe pulmonary embolism: pulmonary artery clot load scores and cardiovascular parameters as predictors of mortality. Radiology 2006;239:884-91. https://doi.org/10.1148/radiol.2392050075
  10. van der Meer RW, Pattynama PM, van Strijen MJ, van den Berg-Huijsmans AA, Hartmann IJ, Putter H, et al. 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. Radiology 2005;235:798-803. https://doi.org/10.1148/radiol.2353040593
  11. Kang DK, Sun JS, Park KJ, Lim HS. Usefulness of combined assessment with computed tomographic signs of right ventricular dysfunction and cardiac troponin T for risk stratification of acute pulmonary embolism. Am J Cardiol 2011;108:133-40. https://doi.org/10.1016/j.amjcard.2011.03.009
  12. Jung SK, Kim WY, Lee CW, Seo DW, Lee YS, Lee JH, et al. Chest CT parameters to predict the major adverse events in acute submassive pulmonary embolism. Tuberc Respir Dis 2010;69:184-90. https://doi.org/10.4046/trd.2010.69.3.184
  13. Araoz PA, Gotway MB, Harrington JR, Harmsen WS, Mandrekar JN. Pulmonary embolism: prognostic CT findings. Radiology 2007;242:889-97. https://doi.org/10.1148/radiol.2423051441
  14. Ghaye B, Ghuysen A, Bruyere PJ, D'Orio V, Dondelinger RF. Can CT pulmonary angiography allow assessment of severity and prognosis in patients presenting with pulmonary embolism? What the radiologist needs to know. Radiographics 2006;26:23-39. https://doi.org/10.1148/rg.261055062
  15. Remy-Jardin M, Pistolesi M, Goodman LR, Gefter WB, Gottschalk A, Mayo JR, et al. Management of suspected acute pulmonary embolism in the era of CT angiography: a statement from the Fleischner Society. Radiology 2007;245:315-29. https://doi.org/10.1148/radiol.2452070397
  16. Ozsu S, Karaman K, Mentese A, Ozsu A, Karahan SC, Durmus I, et al. Combined risk stratification with computerized tomography/echocardiography and biomarkers in patients with normotensive pulmonary embolism. Thromb Res 2010;126:486-92. https://doi.org/10.1016/j.thromres.2010.08.021
  17. Quiroz R, Kucher N, Schoepf UJ, Kipfmueller F, Solomon SD, Costello P, et al. Right ventricular enlargement on chest computed tomography: prognostic role in acute pulmonary embolism. Circulation 2004; 109:2401-4. https://doi.org/10.1161/01.CIR.0000129302.90476.BC
  18. Kang DK, Thilo C, Schoepf UJ, Barraza JM Jr, Nance JW Jr, Bastarrika G, et al. CT signs of right ventricular dysfunction: prognostic role in acute pulmonary embolism. JACC Cardiovasc Imaging 2011;4:841-9. https://doi.org/10.1016/j.jcmg.2011.04.013
  19. Kang DK, Ramos-Duran L, Schoepf UJ, Armstrong AM, Abro JA, Ravenel JG, et al. Reproducibility of CT signs of right ventricular dysfunction in acute pulmonary embolism. AJR Am J Roentgenol 2010;194:1500-6. https://doi.org/10.2214/AJR.09.3717

Cited by

  1. Automatic segmentation and analysis of the main pulmonary artery on standard post-contrast CT studies using iterative erosion and dilation vol.11, pp.3, 2012, https://doi.org/10.1007/s11548-015-1265-3
  2. The Prognostic Value of Descending Aorta Enhancement in Maining Pulmonary Artery Enhancement Ratio in Massive or Sub-Massive Acute Pulmonary Embolism vol.15, pp.4, 2012, https://doi.org/10.5812/iranjradiol.57896