Acute right ventricular dilatation: a new helical CT sign of massive pulmonary embolism

Reid, John H.; Murchison, John T

doi:10.1016/s0009-9260(98)80297-3

Cited by 149 publications

(82 citation statements)

References 16 publications

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“…CT scans were considered to show no right ventricle dysfunction if the ratio of RV/LV was 1.0 or less, moderate right ventricle dysfunction if the ratio was greater than 1.0 but less than or equal to 1.5 and severe right ventricle dysfunction if the ratio was greater than 1.5; as recommended in the literature (16).…”

Section: Discussionmentioning

confidence: 99%

Investigation of relationship between the D-dimer and ischemia-modified albumin levels with the radiological imaging-based pulmonary embolism severity score in acute pulmonary embolism

Türedi¹,

Karahan²,

Menteşe³

et al. 2010

Anadolu Kardiyol Derg

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ÖZETAmaç: İki farklı radyolojik parametre, pulmoner arter obstrüksiyon indeksi (PAOI) ve sağ ventrikül/sol ventrikül oranı (RV/LV) temel alınarak, radyolojik görüntüleme-esaslı pulmoner embolizm şiddet skoru ile D-dimer ve iskemi modifiye albümin (IMA) düzeyleri arasındaki muhtemel ilişkiyi incelemek. Yöntemler: Bu prospektif kohort çalışmasında, acil servise başvuran ve spiral bilgisayarlı tomografi (CT) ile PE kesin tanısı konulan kırk yedi hasta çalış-maya dahil edildi. D-dimer ve IMA düzeyleri sırasıyla immuno-turbidimetrik ve kolorimetrik metodlarla belirlendi. Bilgisayarlı tomografi görüntülerinden PAOI ve RV/LV oranları hesaplandı. Biyokimyasal parametrelerin gruplar arasındaki seviyeleri Mann-Whitney U test ve Kruskal-Wallis test kullanılarak karşılaştırıldı ve radyolojik skorlar ile ilişkileri Spearman korelasyon testi kullanılarak belirlendi. Bulgular: Hesaplanan PAOI ve RV/LV oranlarının analizi aralarında belirgin bir ilişki olduğunu yansıttı (r=0.036, p=0.023). PAOI temelinde oluşturulan hafif (< %40), orta (%40 -%60) ve şiddetli (> %60) PE grupları arasında D-dimer düzeyleri göze çarpan oranda farklıydı (p=0.039). Bu fark hafif grup, PAOI< %40, ile şiddetli grup, PAOI> %60 arasındaki D-dimer seviyelerindeki farklılıktan kaynaklanıyordu (p=0.02; Z= -2.328). Aynı zamanda, D-dimer düzeyleri ile PAOI pozitif bir korelasyon gösteriyordu, fakat D-dimer düzeyleri ile RV/LV oranı arasında benzer bir korelasyon yoktu. İskemi modifiye albümin düzeyleri ile D-dimer düzeyleri, PAOI ve RV/LV oranı arasında anlamlı bir korelasyon yoktu. Sonuç: Radyolojik parametreler temelinde PE'nin şiddetinin biyokimyasal olarak belirlenmesinde D-dimer, yeni bir marker olarak önerilen IMA'ya göre daha uygun bir marker olabilir. (Anadolu Kardiyol Derg 2010; 10: 346-52) Anah tar ke li me ler: D-dimer, iskemi modifiye albümin, pulmoner embolizm, pulmoner arter obstrüksiyon indeksi, radyolojik ciddiyet, spiral bilgisayarlı tomografi ABS TRACTObjective: To investigate possible relationship between the D-dimer and ischemia-modified albumin (IMA) levels and radiological imagingbased severity scores in pulmonary embolism (PE) based on two different radiological characteristics; the pulmonary arterial obstruction index (PAOI) and the right ventricle/left ventricle (RV/LV) ratio. Methods: In this prospective cohort study, forty-seven patients presenting to the emergency department and definitively diagnosed with PE using spiral computerized tomography (CT) were initially enrolled in the study. Levels of IMA and D-dimer were assessed colorimetrical and immuno-turbidimetric methods, respectively. The PAOI and RV/LV ratios were calculated from CT images. The levels of biochemical parameters between the groups were compared with use of Mann-Whitney U and Kruskal-Wallis tests and relationship between the radiological scores were assessed using the Spearman correlation test. Results: Analysis of the calculated PAOI and RV/LV ratio revealed a significant correlation between them (r=0.36, p=0.023). D-dimer levels differed considerably among the...

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Section: Discussionmentioning

confidence: 99%

Investigation of relationship between the D-dimer and ischemia-modified albumin levels with the radiological imaging-based pulmonary embolism severity score in acute pulmonary embolism

Türedi¹,

Karahan²,

Menteşe³

et al. 2010

Anadolu Kardiyol Derg

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“…RV dysfunction can also be recognized on CT, e.g., by measuring the ratio of RV/LV diameters (8,9) or by volumetric measurements, that can be obtained with or without electrocardiography (ECG)-gating (69,70). Several multidetector CT studies have shown the prognostic value of RV dysfunction that may help to identify those patients at risk and may facilitate selecting therapeutic strategies (9).…”

Section: Rv Dysfunctionmentioning

confidence: 99%

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Doğan

A²,

Geleijins³

et al. 2015

Diagn Interv Radiol

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A cute pulmonary embolism (PE) is the third most common cardiovascular condition, after coronary artery disease and stroke (1). Due to lack of specific sets of symptoms that accurately predict or exclude the diagnosis of acute PE, the diagnosis strongly relies on noninvasive imaging techniques. Diagnostic strategies for evaluating PE have undergone important changes over the past decades (2). Due to rapid technical advances in speed and spatial resolution, the utility of computed tomography (CT) angiography has been recognized in vascular imaging. Particularly, after the development of multidetector row CT in 1998 (3), CT pulmonary angiography (CTPA) has become the imaging method of choice in the diagnosis of acute PE (4). CTPA has advantages over conventional invasive X-ray pulmonary angiography and nuclear ventilation-perfusion (V/Q) imaging. CT is a widely available, fast and noninvasive technique, has the capability to directly visualize emboli, and may provide alternative diagnoses (4).Despite adequate diagnosis and anticoagulant therapy, death rate after a diagnosis of acute PE is still 8%-15% (5, 6). The prognosis of acute PE mainly depends on residual pulmonary circulation and the severity of right ventricular (RV) dysfunction (7). Recent studies have shown that CT permits the assessment of acute right-sided heart failure. Furthermore, CT can predict adverse clinical outcome by using the RV/left ventricular (LV) diameter ratio (8, 9) or RV ejection fraction in patients with PE (10).The aim of this review is to discuss the developments of CT in PE diagnosis, and to analyze the added value of CT in estimating PE severity and prognosis. Furthermore, CT findings of chronic thromboembolic pulmonary arterial hypertension (CTEPH) as a complication of acute PE will be discussed. CT developments in PE diagnosisHistorically, pulmonary angiography and nuclear planar V/Q-imaging were the main imaging methods used for diagnosing PE. Both methods have recognized limitations. Pulmonary angiography has previously been regarded as reference standard, but the method CHEST IMAGING REVIEW ABSTRACT Pulmonary embolism (PE) is a potentially life threatening condition requiring adequate diagnosis and treatment. Computed tomography pulmonary angiography (CTPA) is excellent for including and excluding PE, therefore CT is the first-choice diagnostic imaging technique in patients suspected of having acute PE. Due to its wide availability and low invasiveness, CTPA tends to be overused. Correct implementation of clinical decision rules in diagnostic workup for PE improves adequate use of CT. Also, CT adds prognostic value by evaluating right ventricular (RV) function. CT-assessed RV dysfunction and to lesser extent central emboli location predicts PE-related mortality in normotensive and hypotensive patients, while PE embolic obstruction index has limited prognostic value. Simple RV/left ventricular (LV) diameter ratio measures >1.0 already predict risk for adverse outcome, whereas ratios <1.0 can safely exclude adverse outcome. Con...

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“…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].…”

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confidence: 99%

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

Kang

Ramos-Duran

Schoepf

et al. 2010

American Journal of Roentgenology

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Contrast medium-enhanced pulmonary CT angiography (CTA) is increasingly used as the first-line imaging test in suspected PE and is available 24 hours a day at most institutions [10][11][12][13][14]. 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]. 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]. Even if PE is properly treated with anticoagulation, the mortality rate in hemodynamically stable patients varies from 8.1% to 15.1% [4,5]. Death is usually caused by acute right heart failure [4][5][6][7][8][9]. Acute PE increases the pressure of the pulmonary arterial system and right ventricle (RV) resulting in RV dysfunction, which may progress to right heart failure and circulatory collapse [5,6]. Patients with RV dysfunction have a higher mortality rate than those without, even if they are initially hemodynamically stable [6,7]. Thus, the presence of RV dysfunction is a marker for adverse clinical outcome in patients with acute PE [6][7][8]. Echocardiography is the most common first-line examination to diagnose the signs of RV dysfunction [6][7][8][9]. However, this test has limited off-hour availability at many institutions, and occasionally the RV may be difficult to image with the trans thoracic approach. OBJECTIVE. The purpose of our study was to determine the interobserver reproducibility of CT findings of right ventricular (RV) dysfunction in pulmonary embolism (PE). Reproducibility of CT C a r d io p u lm o n a r y I m ag i ng • O r ig i n a l R e s e a rc hMATERIALS AND METHODS. Two experienced observers independently and retrospectively evaluated pulmonary CT angiography (CTA) studies of 50 patients with acute PE for the following signs: bowing of the interventricular septum, inferior vena cava (IVC) contrast medium reflux, RV diameter (RVD)/left ventricular diameter (LVD) ratio on axial sections and four-chamber (4-CH) views, and RV volume (RVV)/left ventricular volume (LVV) ratio. Analysis used kappa statistics, Spearman's rank correlation, and Bland-Altman statistics.RESULTS. The two observers had fair to moderate agreement (κ = 0.32-0.44)...

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Acute right ventricular dilatation: a new helical CT sign of massive pulmonary embolism

Cited by 149 publications

References 16 publications

Investigation of relationship between the D-dimer and ischemia-modified albumin levels with the radiological imaging-based pulmonary embolism severity score in acute pulmonary embolism

Investigation of relationship between the D-dimer and ischemia-modified albumin levels with the radiological imaging-based pulmonary embolism severity score in acute pulmonary embolism

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

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

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