J Korean Soc Emerg Med.  2009 Feb;20(1):40-49.

Usefulness of Quantitative Analysis of Computed Tomography Pulmonary Angiography as a Predictor of Prognosis of Acute Pulmonary Embolism

• Song SW
• Park JS
• Je HJ
• Lee HJ
• Park EA
• Shin SD
• Jeong SK
• Kwak YH
• Seo GJ

Abstract

PURPOSE
We evaluated the usefulness of quantitative analysis of computed tomography (CT) pulmonary angiography as a predictor of the prognosis of acute pulmonary embolism (PTE).
METHODS
We performed a retrospective analysis of 55 patients who visited our emergency department from January 2000 to November 2007 who were confirmed with PTE by CT pulmonary angiography. Two radiologists blinded to patient outcome measured CT parameters including the diameter of vessels and chambers, and the quantified pulmonary artery (PA) clot load score on the basis of embolus size and location. CT parameters and other clinical predictors were analyzed to determine their ability to predict major adverse event (MAE).
RESULTS
Of the 55 patients, 16 (29.1%) had a MAE PTE related shock, intubation, death, thrombolysis, right ventricular (RV) dysfunction within 30 days). Geneva score (odds ratio 2.5, 95% CI 1.18-5.29, p=0.02) and PA clot load score (odds ratio 1.64, 95% CI 1.18-2.27, p<0.01) were strong independent predictors of MAE. The cut-off value of Geneva and PA clot load scores were 4.5 and 19.0, respectively, and the area under the ROC curve were 0.697 (0.546~0.848) and 0.908 (0.828-0.988), respectively.
CONCLUSION
Geneva and PA clot load score are significant predictors of PTE related shock, intubation, death, thrombolysis, and RV dysfunction within 30 days. CT pulmonary angiography is a useful predictor for the prognosis of PTE as well as a useful diagnostic tool.

Keyword

Pulmonary embolism; Pulmonary arteries; angiography; Prognosis

MeSH Terms

Angiography
Embolism
Emergencies
Humans
Intubation
Prognosis
Pulmonary Artery
Pulmonary Embolism
Retrospective Studies
ROC Curve
Shock