Korean J Radiol.  2020 Sep;21(9):1095-1103. 10.3348/kjr.2019.0645.

Prognostic Value of Dual-Energy CT-Based IodineQuantification versus Conventional CT in AcutePulmonary Embolism: A Propensity-Match Analysis

• Im DJ
• Hur J
• Han K
• Suh YJ
• Hong YJ
• Lee HJ
• Kim YJ
• Choi BW

• KMID: 2505750
• DOI: http://doi.org/10.3348/kjr.2019.0645

Abstract

Objective
The present study aimed to investigate whether quantitative dual-energy computed tomography (DECT) parametersoffer an incremental risk stratification benefit over the CT ventricular diameter ratio in patients with acute pulmonary embolism(PE) by using propensity score analysis.
Materials and Methods
This study was conducted on 480 patients with acute PE who underwent CT pulmonary angiography(CTPA) or DECT pulmonary angiography (DE CT-PA). This propensity-matched study population included 240 patients with acutePE each in the CTPA and DECT groups. Altogether, 260 (54.1%) patients were men, and the mean age was 64.9 years (64.9 ±13.5 years). The primary endpoint was all-cause death within 30 days. The Cox proportional hazards regression model was usedto identify associations between CT parameters and outcomes and to identify potential predictors. Concordance (C) statisticswere used to compare the prognoses between the two groups.
Results
In both CTPA and DECT groups, right to left ventricle diameter ratio ≥ 1 was associated with an increased risk of allcausedeath within 30 days (hazard ratio: 3.707, p< 0.001 and 5.573, p< 0.001, respectively). However, C-statisticsshowed no statistically significant difference between the CTPA and DECT groups for predicting death within 30 days(C-statistics: 0.759 vs. 0.819, p= 0.117).
Conclusion
Quantitative measurement of lung perfusion defect volume by DECT had no added benefit over CT ventriculardiameter ratio for predicting all-cause death within 30 days.

Keyword

Acute pulmonary embolism; Dual-energy computed tomography (DECT); Ventricular diameter; Lung perfusion