Prognostic value of perfusion defect volume at dual energy CTA in patients with pulmonary embolism

• Verfasst von: Apfaltrer, Paul [VerfasserIn]
• Verfasst von: Bachmann, Valentin [VerfasserIn]
• Verfasst von: Meyer, Mathias [VerfasserIn]
• Verfasst von: Henzler, Thomas [VerfasserIn]
• Verfasst von: Grüttner, Joachim [VerfasserIn]
• Verfasst von: Walter, Thomas [VerfasserIn]
• Verfasst von: Schönberg, Stefan [VerfasserIn]
• Verfasst von: Fink, Christian [VerfasserIn]
• Titel: Prognostic value of perfusion defect volume at dual energy CTA in patients with pulmonary embolism
• Titelzusatz: correlation with CTA obstruction scores, CT parameters of right ventricular dysfunction and adverse clinical outcome
• Verf.angabe: Paul Apfaltrer, Valentin Bachmann, Mathias Meyer, Thomas Henzler, John M. Barraza, Joachim Gruettner, Thomas Walter, U. Joseph Schoepf, Stefan O. Schoenberg, Christian Fink
• Jahr: 2012
• Umfang: 6 S.
• Fussnoten: Gesehen am 29.06.2018
• Titel Quelle: Enthalten in: European journal of radiology
• Ort Quelle: Amsterdam [u.a.] : Elsevier Science, 1990
• Jahr Quelle: 2012
• Band/Heft Quelle: 81(2012), 11, Seite 3592-3597
• ISSN Quelle: 1872-7727
• DOI: doi:10.1016/j.ejrad.2012.02.008
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Adult
• Sach-SW: Aged
• Sach-SW: Aged, 80 and over
• Sach-SW: Angiography
• Sach-SW: Comorbidity
• Sach-SW: Female
• Sach-SW: Germany
• Sach-SW: Humans
• Sach-SW: Male
• Sach-SW: Middle Aged
• Sach-SW: Myocardial Perfusion Imaging
• Sach-SW: Prevalence
• Sach-SW: Prognosis
• Sach-SW: Pulmonary Embolism
• Sach-SW: Radiography, Dual-Energy Scanned Projection
• Sach-SW: Reproducibility of Results
• Sach-SW: Risk Factors
• Sach-SW: Sensitivity and Specificity
• Sach-SW: Statistics as Topic
• Sach-SW: Survival Analysis
• Sach-SW: Survival Rate
• Sach-SW: Tomography, X-Ray Computed
• Sach-SW: Ventricular Dysfunction, Right
• Sach-SW: Young Adult
• K10plus-PPN: 1577030516

Abstract

PURPOSE: To investigate the prognostic value of perfusion defect volume (PDvol) at dual-energy-CT-angiography (DE-CTA) in patients with acute pulmonary embolism (PE) by correlating PDvol with CTA-obstruction-scores (OS), CT parameters of right-ventricular-dysfunction (RVD), and adverse-clinical-outcome. MATERIALS AND METHODS: DE-CTA of 60 patients (mean age: 65±14.4 years) with PE were analyzed. Iodine maps were generated, and normalized PDvol--defined as volume of perfusion defects/total lung volume--was quantified. Furthermore, established prognostic parameters (Qanadli and Mastora-OS, and CT parameters of RVD) were obtained. CT parameters of RVD--namely the right ventricle/left ventricle (RV/LV) diameter ratio measured on transverse sections (RV/LVtrans), four-chamber views (RV/LV4ch), and RV/LV volume ratios (RV/LVvol)--were assessed. PDvol was correlated with OS, CT parameters of RVD and adverse clinical outcome (defined as the need for intensive care treatment or death). RESULTS: 10 of 60 patients with PE experienced adverse clinical outcome. Patients with adverse clinical outcome showed significantly higher PDvol (35±11% vs. 23±10%, p=0.002), RV/LV ratios (RV/LV4ch 1.46±0.32 vs. 1.18±0.26, p=0.005; RV/LVvol 2.25±1.33 vs. 1.19±0.56, p=0.002) and higher Mastora global scores (52 vs. 13, p=0.02) compared to those without adverse clinical outcome. A weak correlation was observed between PDvol and the Mastora global score (r=0.5; p=0.0003), as well as between PDvol and RV/LV4Ch (r=0.432, p=0.0006). No correlation was found between PDvol and the Qanadli score or the remainder of the RVD-CT parameters. CONCLUSION: The extent of perfusion defects as assessed by DE-CTA correlates with adverse clinical outcome in patients with PE. Therefore, volumetric quantification of perfusion defects at DE-CTA allows the identification of low-risk patients who do not require intensified monitoring and treatment.