Diagnostic Strategies Incorporating Computed Tomography Angiography for Pulmonary Embolism

2014 ◽  
Vol 29 (4) ◽  
pp. 209-216 ◽  
Author(s):  
Adam J.N. Raymakers ◽  
John Mayo ◽  
Carlo A. Marra ◽  
Mark FitzGerald
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Computed Tomography Angiography ◽  
Diagnostic Strategies

Computed tomography angiography with pulmonary artery thrombus burden and right-to-left ventricular diameter ratio after pulmonary embolism

Vascular ◽  
2016 ◽  
Vol 25 (1) ◽  
pp. 54-62 ◽  
Author(s):  
Kenneth Ouriel ◽  
Richard L Ouriel ◽  
Yeun J Lim ◽  
Gregory Piazza ◽  
Samuel Z Goldhaber
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Computed Tomography Angiography ◽  
Intraclass Correlation ◽  
Left Ventricular ◽  
Observer Agreement ◽  
Left Ventricular Diameter ◽  
The Right

Purpose Computed tomography angiography is used for quantifying the significance of pulmonary embolism, but its reliability has not been well defined. Methods The study cohort comprised 10 patients randomly selected from a 150-patient prospective trial of ultrasound-facilitated fibrinolysis for acute pulmonary embolism. Four reviewers independently evaluated the right-to-left ventricular diameter ratios using the standard multiplanar reformatted technique and a simplified (axial) method, and thrombus burden with the standard modified Miller score and a new, refined Miller scoring system. Results The intraclass correlation coefficient for intra-observer variability was .949 and .970 for the multiplanar reformatted and axial methods for estimating right-to-left ventricular ratios, respectively. Inter-observer agreement was high and similar for the two methods, with intraclass correlation coefficient of .969 and .976. The modified Miller score had good intra-observer agreement (intraclass correlation coefficient .820) and was similar to the refined Miller method (intraclass correlation coefficient .883) for estimating thrombus burden. Inter-observer agreement was also comparable between the techniques, with intraclass correlation coefficient of .829 and .914 for the modified Miller and refined Miller methods. Conclusions The reliability of computed tomography angiography for pulmonary embolism was excellent for the axial and multiplanar reformatted methods for quantifying the right-to-left ventricular ratio and for the modified Miller and refined Miller scores for quantifying of pulmonary artery thrombus burden.

scholarly journals Loss of Pulmonary Vascular Volume as a Predictor of Right Ventricular Dysfunction and Mortality in Acute Pulmonary Embolism

2021 ◽  
Vol 14 (9) ◽  
Author(s):  
Jasleen Minhas ◽  
Pietro Nardelli ◽  
Syed Moin Hassan ◽  
Nadine Al-Naamani ◽  
Eileen Harder ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Relative Risk ◽  
Computed Tomography Angiography ◽  
Acute Pulmonary Embolism ◽  
Hazard Ratio ◽  
Cardiac Biomarkers ◽  
Clinical Biomarkers ◽  
Increased Risk ◽  
Venous Volume

Background: In acute pulmonary embolism, chest computed tomography angiography derived metrics, such as the right ventricle (RV): left ventricle ratio are routinely used for risk stratification. Paucity of intraparenchymal blood vessels has previously been described, but their association with clinical biomarkers and outcomes has not been studied. We sought to determine if small vascular volumes measured on computed tomography scans were associated with an abnormal RV on echocardiography and mortality. We hypothesized that decreased small venous volume would be associated with greater RV dysfunction and increased mortality. Methods: A retrospective cohort of patients with intermediate risk pulmonary embolism admitted to Brigham and Women’s Hospital between 2009 and 2017 was assembled, and clinical and radiographic data were obtained. We performed 3-dimensional reconstructions of vasculature to assess intraparenchymal vascular volumes. Statistical analyses were performed using multivariable regression and cox proportional hazards models, adjusting for age, sex, lung volume, and small arterial volume. Results: Seven hundred twenty-two subjects were identified of whom 573 had documented echocardiography. A 50% reduction in small venous volume was associated with an increased risk of RV dilation (relative risk: 1.38 [95% CI, 1.18–1.63], P <0.001), RV dysfunction (relative risk: 1.62 [95% CI, 1.36–1.95], P <0.001), and RV strain (relative risk: 1.67 [95% CI, 1.37–2.04], P <0.001); increased cardiac biomarkers, and higher 30-day and 90-day mortality (hazard ratio: 2.50 [95% CI, 1.33–4.67], P =0.004 and hazard ratio: 1.84 [95% CI, 1.11–3.04], P =0.019, respectively). Conclusions: Loss of small venous volume quantified from computed tomography angiography is associated with increased risk of abnormal RV on echocardiography, abnormal cardiac biomarkers, and higher risk of 30- and 90-day mortality. Small venous volume may be a useful marker for assessing disease severity in acute pulmonary embolism.

Computed tomography angiography and pulmonary embolism

2012 ◽  
Vol 37 (10) ◽  
pp. 10-11
Author(s):  
Cathy R. Kessenich ◽  
Robert C. Erigo-Backman
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Computed Tomography Angiography
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