Tuberc Respir Dis.  2012 Apr;72(4):352-359.

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 CY
• Yoo SM
• Rho JY
• Ji YG
• Lee HY

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+/-0.36 vs. 1.44+/-0.38, p=0.009) and group Ib (1.87+/-0.37 vs. 1.44+/-0.38, p=0.044) were significantly higher than that of group II. For observer 2, RVD/LVD in group Ia (1.71+/-0.18 vs. 1.41+/-0.47, p=0.027) was significantly greater than that of group II, but RVD/LVD of group Ib was not (1.68+/-0.2 vs. 1.41+/-0.47, p=0.093). For both observers, there was a significant difference of DAE/MPAE between group Ib and group II (0.32+/-0.15 vs. 0.64+/-0.24, p=0.005; 0.34+/-0.16 vs. 0.64+/-0.22, p=0.004), but no significant difference of DAE/MPAE between group Ia and group II (0.51+/-0.3 vs. 0.64+/-0.24, p=0.268; 0.53+/-0.29 vs. 0.64+/-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.

Keyword

Tomography, X-Ray Computed; Pulmonary Embolism; Prognosis; Angiography

MeSH Terms

Angiography
Humans
Prognosis
Pulmonary Artery
Pulmonary Embolism
Retrospective Studies
Tomography, X-Ray Computed
Ventricular Dysfunction, Right

Figure

• 

  Figure 1 An example measuring the ratio of the descending aorta enhancement to the main pulmonary artery enhancement. Enhancement of the main pulmonary artery is measured at the level of bifurcation point of both main pulmonary arteries (A). Enhancement of the descending aorta is measured at the same level (B). Region of interest cursor is carefully placed to avoid beam hardening artifact caused by contrast material in the superior vena cava.

• 

  Figure 2 An example measuring the ratio of the right ventricular diameter to the left ventricular diameter. Diameter of the right and left ventricle is measured perpendicular to the long axis of the heart at a plane which has the largest diameter from one endocardial margin to the other. RVD: right ventricle diameter; LVD: left ventricle diameter.

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