Acute Pulmonary Embolism: Prognostic Role of Computed Tomography Pulmonary Angiography (CTPA).

Giulia Zantonelli,Vincenza Granata,Giulia Grazzini,Vittorio Miele,Edoardo Cavigli,Silvia Luvarà,Ginevra Danti,Chiara Moroni,Alessandra Bindi,Diletta Cozzi

doi:10.3390/tomography8010042

Giulia Zantonelli, Vincenza Granata + Show 8 more

Open Access

https://doi.org/10.3390/tomography8010042

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Journal: Tomography (Ann Arbor, Mich.)	Publication Date: Feb 14, 2022
Citations: 16	License type: CC BY 4.0

Abstract

Computed Tomography Pulmonary Angiography (CTPA) is considered the gold standard diagnostic technique in patients with suspected acute pulmonary embolism in emergency departments. Several studies have been conducted on the predictive value of CTPA on the outcomes of pulmonary embolism (PE). The purpose of this article is to provide an updated review of the literature reporting imaging parameters and quantitative CT scores to predict the severity of PE.

Highlights

Pulmonary embolism (PE) is defined by embolic occlusion of the pulmonary arterial system
Right ventricular dysfunction (RVD), defined as a rapidly progressive congestion syndrome resulting from impaired filling and/or reduced flow out of the right ventricle, triggered by acute pressure overload, is the leading cause of death in severe PE [3]
In the European Society of Cardiology guidelines, Computed Tomography Pulmonary Angiography (CTPA) is indicated as Class IC in patients with high suspicion of PE, even if hemodynamically unstable [5]

Summary

Introduction

Pulmonary embolism (PE) is defined by embolic occlusion of the pulmonary arterial system. Signs of RVD and hemodynamic instability, such as tachycardia, low systolic blood pressure, respiratory failure, and syncope, are associated with a poor prognosis and a high risk of early mortality (within 30 days) [3]. Among imaging tests, Computed Tomography Pulmonary Angiography (CTPA) is considered the first-line diagnostic technique in patients with suspected PE with sensitivity and specificity values between 96 and 100% and between 89 and 98%, respectively [4]. In the European Society of Cardiology guidelines, CTPA is indicated as Class IC in patients with high suspicion of PE, even if hemodynamically unstable [5]. If the CTPA is regular in patients with low or intermediate clinical probability, the diagnosis of PE can be ruled out without further testing (Class IA) [5]. Several studies have been performed on the potential role of CTPA as an ancillary tool in establishing patient prognosis in PE [9,10,11,12]

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