Abstract
The purpose of the study was to investigate whether Dual Energy CT (DECT) can be used as a diagnostic tool to assess the severity of acute pulmonary embolism (PE) by correlating parenchymal perfusion defect volume, obstruction score and right ventricular-to-left ventricular (RV/LV) diameter ratio using CT angiography (CTA) and DECT perfusion imaging. A total of 43 patients who underwent CTA and DECT perfusion imaging with clinical suspicion of acute PE were retrospectively included in the study. In total, 25 of these patients had acute PE findings on CTA. DECT assessed perfusion defect volume (PDvol) were automatically and semiautomatically quantified. Overall, two CTA methods for risk assessment in patients with acute PE were assessed: the RV/LV diameter ratio and the Modified Miller obstruction score. Automatic PDvol had a weak correlation (r = 0.47, p = 0.02) and semiautomatic PDvol (r = 0.68, p < 0.001) had a moderate correlation to obstruction score in patients with confirmed acute PE, while only semiautomatic PDvol (r = 0.43, p = 0.03) had a weak correlation with the RV/LV diameter ratio. Our data indicate that PDvol assessed by DECT software technique may be a helpful tool to assess the severity of acute PE when compared to obstruction score and RV/LV diameter ratio.
Highlights
Pulmonary embolism (PE) is a common clinical condition being third on the list of cardiovascular causes of death [1]
A total of 64 were excluded, 46 patients due to underlying lung pathology and 18 patients due to reduced image quality of the Dual Energy CT (DECT) or Computed tomography angiography (CTA) scan that potentially could affect the evaluation of pulmonary perfusion, obstruction score, or right ventricular-to-left ventricular (RV/LV) diameter ratio, e.g., artifacts, insufficient vascular enhancement, metastatic pulmonary neoplasm, pulmonary infection, and pleural effusion
Automatic perfusion defect volume (PDvol), semiautomatic PDvol and RV/LV diameter ratio were significantly higher in the acute PE group compared with the group without acute PE findings using modified Miller (MM) score as the reference (Automatic PDvol p < 0.01; semiautomatic PDvol p < 0.001; RV/LV diameter ratio p < 0.002)
Summary
Pulmonary embolism (PE) is a common clinical condition being third on the list of cardiovascular causes of death [1]. Two methods for risk assessment in patients with acute PE with CTA are right ventricular-to-left ventricular (RV/LV) diameter ratio as an indicator of RVD and obstruction score as an indicator of clot burden [3]. The RV/LV diameter ratio has been shown to correlate well with both PE severity and mortality [5], while there is conflicting evidence regarding correlation of CTA obstruction score with RVD and outcome severity [6,7]. Because of this uncertainty, interpersonal variation and increased reading times, CTA obstruction score is rarely used in clinical practice [2]
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