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

Meer, R.W. van der; Pattynama, Peter M. T.; Strijen, M.J.L. van; Berg-Huijsmans, Annette A van den; Hartmann, Ieneke J. C.; Putter, Hein; Roos, Albert de; Huisman, Menno V.

doi:10.1148/radiol.2353040593

Cited by 464 publications

(361 citation statements)

References 19 publications

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“…Several previous studies have suggested that pulmonary arterial embolic burden assessed by CT as well as by RV/LV ratio is also a predictor for APTE patients (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). On the other hand, Ghaye et al (19) suggested that RV/LV diameter ratio and azygos vein diameter were significant predictors, and that pulmonary arterial embolic burden was not.…”

Section: Discussionmentioning

confidence: 98%

“…According to the past literatures (14)(15)(16)(17)(18)(19)(20), the scans were evaluated by measuring the minor axes of the right and left ventricles of the heart in the transverse plane at their widest points between the inner surface of the free wall and the surface of the interventricular septum. These maximum dimensions may be found at different levels.…”

Section: Contrast-enhanced Ctmentioning

confidence: 99%

“…Currently, multidetector-row CT (MDCT) pulmonary angiography can be used to identify clots within distal pulmonary arteries (PAs) with high sensitivity and specificity, and can indicate alternative diagnoses and underlying lung diseases. In addition, some investigators have used several parameters to evaluate the accuracy of CT scoring systems for PA clot assessment as well as right ventricular (RV) failure assessment (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). MDCT has therefore become the first imaging examination for suspected acute PTE (APTE) patients (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

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confidence: 99%

“…In addition, some investigators have used several parameters to evaluate the accuracy of CT scoring systems for PA clot assessment as well as right ventricular (RV) failure assessment (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). MDCT has therefore become the first imaging examination for suspected acute PTE (APTE) patients (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). In addition, the ratio between the diameter of the RV and of the left ventricle (LV), the RV/LV ratio, and embolic burden have been associated with patient outcome (11,(16)(17)(18)(19)(20).…”

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confidence: 99%

“…MDCT has therefore become the first imaging examination for suspected acute PTE (APTE) patients (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). In addition, the ratio between the diameter of the RV and of the left ventricle (LV), the RV/LV ratio, and embolic burden have been associated with patient outcome (11,(16)(17)(18)(19)(20).…”

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confidence: 99%

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Dynamic MR perfusion imaging: Capability for quantitative assessment of disease extent and prediction of outcome for patients with acute pulmonary thromboembolism

Ohno

Koyama

Matsumoto

et al. 2010

Magnetic Resonance Imaging

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Purpose: To compare directly the capabilities of multidetector-row computed tomography (MDCT) and MRI for disease severity assessment and outcome prediction for acute pulmonary thromboembolism (APTE) patients. Materials and Methods:Fifty consecutive APTE patients underwent MDCT, MR angiography, dynamic perfusion MRI, treatment and follow-up examination. Pulmonary blood flow (PBF), pulmonary blood volume, and mean transit time maps were generated from perfusion MRI, and all segmental parameters were determined by using region of interest measurements. Receiver operator curve analyses were used to determine the most accurate parameter for diagnosis of the APTE segment. Then, APTE index from perfusion MRI (PE perfusion MRI index), right ventricle/left ventricle (RV/LV) diameter ratio and APTE indexes from embolic burdens observed on MDCT (PE CT index) and MR angiography (PE MRA index) were calculated. Finally, ability to differentiate mortality (n ¼ 8) from survival (n ¼ 42) groups and to predict patient outcome were statistically assessed.Results: PBF was a significantly more accurate parameter than others (P < 0.05). When feasible threshold value was applied, specificity and accuracy of RV/LV diameter ratio and PE Perfusion MRI index were significantly higher than those of PE CT and PE MRA indexes (P < 0.05). Logistic regression analysis demonstrated that each index was a significant predictor (P < 0.05).Conclusion: Dynamic perfusion MRI can be effective for disease extent assessment and outcome prediction for APTE patients.

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Section: Discussionmentioning

confidence: 98%

Section: Contrast-enhanced Ctmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Dynamic MR perfusion imaging: Capability for quantitative assessment of disease extent and prediction of outcome for patients with acute pulmonary thromboembolism

Ohno

Koyama

Matsumoto

et al. 2010

Magnetic Resonance Imaging

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Submassive Pulmonary Embolism

Piazza¹

2013

JAMA

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The US Surgeon General estimates that 100,000 to 180,000 deaths occur annually from acute pulmonary embolism (PE) in the United States. The case of Ms A, a 60-year-old woman with acute PE and right ventricular dysfunction (submassive PE), illustrates the clinical challenge of identifying this high-risk patient population and determining when more aggressive immediate therapy should be pursued in addition to standard anticoagulation. The clinical examination, electrocardiogram, cardiac biomarkers, chest computed tomography, and echocardiography can be used to risk stratify patients with acute PE. Current options for more aggressive intervention in the treatment of patients with acute PE who are at increased risk of an adverse clinical course include systemic fibrinolysis, pharmacomechanical catheter-directed therapy, surgical pulmonary embolectomy, and inferior vena cava filter insertion. Determination of the optimal duration of anticoagulation and lifestyle modification to reduce overall cardiovascular risk are critical components of the long-term therapy of patients with acute PE.

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Prognosis in Acute Pulmonary Embolism Based on Right Ventricular Enlargement, Prognostic Models, and Biochemical Markers

Stein

2007

Pulmonary Embolism

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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

Abstract: Markers of RVD and pulmonary vascular obstruction, assessed with helical CT at baseline, help predict mortality during follow-up.

Cited by 464 publications

References 19 publications

Dynamic MR perfusion imaging: Capability for quantitative assessment of disease extent and prediction of outcome for patients with acute pulmonary thromboembolism

Dynamic MR perfusion imaging: Capability for quantitative assessment of disease extent and prediction of outcome for patients with acute pulmonary thromboembolism

Submassive Pulmonary Embolism

Prognosis in Acute Pulmonary Embolism Based on Right Ventricular Enlargement, Prognostic Models, and Biochemical Markers

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