Skip to main content
Top
Published in: International Journal of Emergency Medicine 1/2020

Open Access 01-12-2020 | Angiography | Original Research

The assessment of acute pulmonary embolism severity using CT angiography features

Authors: Azin Shayganfar, Somayeh Hajiahmadi, Mohsen Astaraki, Shadi Ebrahimian

Published in: International Journal of Emergency Medicine | Issue 1/2020

Login to get access

Abstract

Background

This study was conducted to detect the association between radiologic features of CT pulmonary angiography (CTPA) and pulmonary embolism severity index (PESI).

Methods

A total of 150 patients with a definite diagnosis of PE entered the study. The CTPA feature including obstruction index, pulmonary trunk size, presence of backwash contrast, septal morphology, right ventricular (RV) and left ventricular (LV) dimensions, and RV/LV ratio were examined. The severity of the PE was estimated using PESI. The association between CTPA indices and PESI was measured. Statistical analysis was conducted using the SPSS software. P value < 0.05 was considered as statistically significant.

Results

A positive correlation was detected between the obstruction index and PESI (r = 0.45, P < 0.05). Moreover, PESI was significantly higher in patients with a more dilated pulmonary trunk (r = 0.20, P < 0.05). The backwash contrast and abnormal septal morphology were significantly more common among patients with higher PESI (P < 0.05). However, no significant correlation was detected between RV, LV, RV/LV, and PESI. The most predictor of high-risk PE was dilated pulmonary trunk with an odds ratio of 4.4.

Conclusion

Higher Obstruction index, dilated pulmonary trunk, presence of backwash contrast, and an abnormal septal morphology can be associated with a higher PESI.
Literature
1.
go back to reference Agnelli G, Becattini C. Acute pulmonary embolism. N Engl J Med. 2010;363(3):266–74.CrossRef Agnelli G, Becattini C. Acute pulmonary embolism. N Engl J Med. 2010;363(3):266–74.CrossRef
2.
go back to reference Moroni C, Bartolucci M, Vanni S, Peiman N, Bartolini M, Miele V, editors. Prognostic value of CT pulmonary angiography (CTPA) parameters in acute pulmonary embolism (CTPA) parameters in acute pulmonary embolism (APE)2017: European Congress of Radiology 2017. Moroni C, Bartolucci M, Vanni S, Peiman N, Bartolini M, Miele V, editors. Prognostic value of CT pulmonary angiography (CTPA) parameters in acute pulmonary embolism (CTPA) parameters in acute pulmonary embolism (APE)2017: European Congress of Radiology 2017.
3.
go back to reference Albrecht MH, Bickford MW, Nance JW Jr, Zhang L, De Cecco CN, Wichmann JL, et al. State-of-the-art pulmonary CT angiography for acute pulmonary embolism. Am J Roentgenol. 2017;208(3):495–504.CrossRef Albrecht MH, Bickford MW, Nance JW Jr, Zhang L, De Cecco CN, Wichmann JL, et al. State-of-the-art pulmonary CT angiography for acute pulmonary embolism. Am J Roentgenol. 2017;208(3):495–504.CrossRef
4.
go back to reference Bryce YC, Perez-Johnston R, Bryce EB, Homayoon B, Santos-Martin EG. Pathophysiology of right ventricular failure in acute pulmonary embolism and chronic thromboembolic pulmonary hypertension: a pictorial essay for the interventional radiologist. Insights into imaging. 2019;10(1):18.CrossRef Bryce YC, Perez-Johnston R, Bryce EB, Homayoon B, Santos-Martin EG. Pathophysiology of right ventricular failure in acute pulmonary embolism and chronic thromboembolic pulmonary hypertension: a pictorial essay for the interventional radiologist. Insights into imaging. 2019;10(1):18.CrossRef
5.
go back to reference Jeebun V, Doe S, Singh L, Worthy S, Forrest I. Are clinical parameters and biomarkers predictive of severity of acute pulmonary emboli on CTPA? QJM. 2009;103(2):91–7.CrossRef Jeebun V, Doe S, Singh L, Worthy S, Forrest I. Are clinical parameters and biomarkers predictive of severity of acute pulmonary emboli on CTPA? QJM. 2009;103(2):91–7.CrossRef
6.
go back to reference Nural M, Elmali M, Findik S, Yapici O, Uzun O, Sunter A, et al. Computed tomographic pulmonary angiography in the assessment of severity of acute pulmonary embolism and right ventricular dysfunction. Acta Radiol. 2009;50(6):629–37.CrossRef Nural M, Elmali M, Findik S, Yapici O, Uzun O, Sunter A, et al. Computed tomographic pulmonary angiography in the assessment of severity of acute pulmonary embolism and right ventricular dysfunction. Acta Radiol. 2009;50(6):629–37.CrossRef
7.
go back to reference Bach AG, Nansalmaa B, Kranz J, Taute B-M, Wienke A, Schramm D, et al. CT pulmonary angiography findings that predict 30-day mortality in patients with acute pulmonary embolism. Eur J Radiol. 2015;84(2):332–7.CrossRef Bach AG, Nansalmaa B, Kranz J, Taute B-M, Wienke A, Schramm D, et al. CT pulmonary angiography findings that predict 30-day mortality in patients with acute pulmonary embolism. Eur J Radiol. 2015;84(2):332–7.CrossRef
8.
go back to reference Vedovati M, Germini F, Agnelli G, Becattini C. Prognostic role of embolic burden assessed at computed tomography angiography in patients with acute pulmonary embolism: systematic review and meta-analysis. J Thromb Haemost. 2013;11(12):2092–102.CrossRef Vedovati M, Germini F, Agnelli G, Becattini C. Prognostic role of embolic burden assessed at computed tomography angiography in patients with acute pulmonary embolism: systematic review and meta-analysis. J Thromb Haemost. 2013;11(12):2092–102.CrossRef
9.
go back to reference Qanadli SD, El Hajjam M, Vieillard-Baron A, Joseph T, Mesurolle B, Oliva VL, et al. New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. Am J Roentgenol. 2001;176(6):1415–20.CrossRef Qanadli SD, El Hajjam M, Vieillard-Baron A, Joseph T, Mesurolle B, Oliva VL, et al. New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. Am J Roentgenol. 2001;176(6):1415–20.CrossRef
10.
go back to reference Donzé J, Le Gal G, Fine MJ, Roy P-M, Sanchez O, Verschuren F, et al. Prospective validation of the pulmonary embolism severity index. Thromb Haemost. 2008;100(05):943–8.CrossRef Donzé J, Le Gal G, Fine MJ, Roy P-M, Sanchez O, Verschuren F, et al. Prospective validation of the pulmonary embolism severity index. Thromb Haemost. 2008;100(05):943–8.CrossRef
11.
go back to reference 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(3):884–91.CrossRef 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(3):884–91.CrossRef
12.
go back to reference Moroni A-L, Bosson J-L, Hohn N, Carpentier F, Pernod G, Ferretti GR. Non-severe pulmonary embolism: prognostic CT findings. Eur J Radiol. 2011;79(3):452–8.CrossRef Moroni A-L, Bosson J-L, Hohn N, Carpentier F, Pernod G, Ferretti GR. Non-severe pulmonary embolism: prognostic CT findings. Eur J Radiol. 2011;79(3):452–8.CrossRef
13.
go back to reference Furlan A, Aghayev A, Chang C-CH, Patil A, Jeon KN, Park B, et al. Short-term mortality in acute pulmonary embolism: clot burden and signs of right heart dysfunction at CT pulmonary angiography. Radiology. 2012;265(1):283–93.CrossRef Furlan A, Aghayev A, Chang C-CH, Patil A, Jeon KN, Park B, et al. Short-term mortality in acute pulmonary embolism: clot burden and signs of right heart dysfunction at CT pulmonary angiography. Radiology. 2012;265(1):283–93.CrossRef
14.
go back to reference Lyhne MD, Schultz JG, MacMahon PJ, Haddad F, Kalra M, Tso DM-K, et al. Septal bowing and pulmonary artery diameter on computed tomography pulmonary angiography are associated with short-term outcomes in patients with acute pulmonary embolism. Emerg Radiol. 2019;26(6):623–30.CrossRef Lyhne MD, Schultz JG, MacMahon PJ, Haddad F, Kalra M, Tso DM-K, et al. Septal bowing and pulmonary artery diameter on computed tomography pulmonary angiography are associated with short-term outcomes in patients with acute pulmonary embolism. Emerg Radiol. 2019;26(6):623–30.CrossRef
15.
go back to reference Collomb D, Paramelle P, Calaque O, Bosson J, Vanzetto G, Barnoud D, et al. Severity assessment of acute pulmonary embolism: evaluation using helical CT. Eur Radiol. 2003;13(7):1508–14.CrossRef Collomb D, Paramelle P, Calaque O, Bosson J, Vanzetto G, Barnoud D, et al. Severity assessment of acute pulmonary embolism: evaluation using helical CT. Eur Radiol. 2003;13(7):1508–14.CrossRef
16.
go back to reference Konstam MA, Kiernan MS, Bernstein D, Bozkurt B, Jacob M, Kapur NK, et al. Evaluation and management of right-sided heart failure: a scientific statement from the American Heart Association. Circulation. 2018;137(20):e578–622.CrossRef Konstam MA, Kiernan MS, Bernstein D, Bozkurt B, Jacob M, Kapur NK, et al. Evaluation and management of right-sided heart failure: a scientific statement from the American Heart Association. Circulation. 2018;137(20):e578–622.CrossRef
17.
go back to reference Chaosuwannakit N, Makarawate P. Prognostic value of right ventricular dysfunction and pulmonary obstruction index by computed tomographic pulmonary angiography in patients with acute pulmonary embolism. J Med Assoc Thai. 2012;95(11):1457.PubMed Chaosuwannakit N, Makarawate P. Prognostic value of right ventricular dysfunction and pulmonary obstruction index by computed tomographic pulmonary angiography in patients with acute pulmonary embolism. J Med Assoc Thai. 2012;95(11):1457.PubMed
18.
go back to reference Terluk AD, et al. Echocardiographic Predictors of Long-Term Mortality in Patients Presenting With Acute Pulmonary Embolism. Am J Cardiol. 2019;124(2):285–91. Terluk AD, et al. Echocardiographic Predictors of Long-Term Mortality in Patients Presenting With Acute Pulmonary Embolism. Am J Cardiol. 2019;124(2):285–91.
19.
go back to reference Gupta R, Fortman DD, Morgenstern DR, Cooper CJ. Short-and long-term mortality risk after acute pulmonary embolism. Curr Cardiol Rep. 2018;20(12):135.CrossRef Gupta R, Fortman DD, Morgenstern DR, Cooper CJ. Short-and long-term mortality risk after acute pulmonary embolism. Curr Cardiol Rep. 2018;20(12):135.CrossRef
20.
go back to reference 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(1):133–40.CrossRef 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(1):133–40.CrossRef
21.
go back to reference Hefeda MM, Elmasry MM. Prediction of short term outcome of pulmonary embolism: parameters at 16 multi-detector CT pulmonary angiography. Egypt J Radiol Nuclear Med. 2014;45(4):1089–98.CrossRef Hefeda MM, Elmasry MM. Prediction of short term outcome of pulmonary embolism: parameters at 16 multi-detector CT pulmonary angiography. Egypt J Radiol Nuclear Med. 2014;45(4):1089–98.CrossRef
22.
go back to reference Singanayagam A, Chalmers JD, Scally C, Akram AR, Al-Khairalla MZ, Leitch L, et al. Right ventricular dilation on CT pulmonary angiogram independently predicts mortality in pulmonary embolism. Respir Med. 2010;104(7):1057–62.CrossRef Singanayagam A, Chalmers JD, Scally C, Akram AR, Al-Khairalla MZ, Leitch L, et al. Right ventricular dilation on CT pulmonary angiogram independently predicts mortality in pulmonary embolism. Respir Med. 2010;104(7):1057–62.CrossRef
23.
go back to reference Meinel FG, Nance JW Jr, Schoepf UJ, Hoffmann VS, Thierfelder KM, Costello P, et al. Predictive value of computed tomography in acute pulmonary embolism: systematic review and meta-analysis. Am J Med. 2015;128(7):747–59. e2.CrossRef Meinel FG, Nance JW Jr, Schoepf UJ, Hoffmann VS, Thierfelder KM, Costello P, et al. Predictive value of computed tomography in acute pulmonary embolism: systematic review and meta-analysis. Am J Med. 2015;128(7):747–59. e2.CrossRef
24.
go back to reference Horlander KT, Leeper KV. Troponin levels as a guide to treatment of pulmonary embolism. Curr Opin Pulm Med. 2003;9(5):374–7.CrossRef Horlander KT, Leeper KV. Troponin levels as a guide to treatment of pulmonary embolism. Curr Opin Pulm Med. 2003;9(5):374–7.CrossRef
25.
go back to reference Kline JA, Hernandez-Nino J, Newgard CD, Cowles DN, Jackson RE, Courtney DM. Use of pulse oximetry to predict in-hospital complications in normotensive patients with pulmonary embolism. Am J Med. 2003;115(3):203–8.CrossRef Kline JA, Hernandez-Nino J, Newgard CD, Cowles DN, Jackson RE, Courtney DM. Use of pulse oximetry to predict in-hospital complications in normotensive patients with pulmonary embolism. Am J Med. 2003;115(3):203–8.CrossRef
26.
go back to reference Lerche M, Bailis N, Akritidou M, Meyer HJ, Surov A. Pulmonary vessel obstruction does not correlate with severity of pulmonary embolism. J Clin Med. 2019;8(5):584.CrossRef Lerche M, Bailis N, Akritidou M, Meyer HJ, Surov A. Pulmonary vessel obstruction does not correlate with severity of pulmonary embolism. J Clin Med. 2019;8(5):584.CrossRef
Metadata
Title
The assessment of acute pulmonary embolism severity using CT angiography features
Authors
Azin Shayganfar
Somayeh Hajiahmadi
Mohsen Astaraki
Shadi Ebrahimian
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Keyword
Angiography
Published in
International Journal of Emergency Medicine / Issue 1/2020
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI
https://doi.org/10.1186/s12245-020-00272-2

Other articles of this Issue 1/2020

International Journal of Emergency Medicine 1/2020 Go to the issue