Abstract
In the present study, we evaluated computed tomography pulmonary angiography (CTPA) in guiding therapeutic decisions and monitoring patients undergoing percutaneous catheter fragmentation in acute massive pulmonary embolism. From Jan 2003 to Dec 2009, 35 patients were diagnosed with acute massive pulmonary embolism by CTPA (T0) and treated with percutaneous catheter fragmentation. The severity was assessed by CT obstruction index (Qanadli index) and compared with Miller index. CTPA, oxygen saturation (SaO 2) and pulmonary artery pressure were performed as follow-up index. The mean percentage of Qanadli index was (55±13)% (range, 40%-75%), and Miller index was (62±15)% (range, 45%-85%). Correlations between them were statistically significant ( r = 0.867, P < 0.0001). The Qanadli index showed significant reduction [T0: (55±13)%; T1: (12±10)%; P < 0.001] in 33 patients. Significant correlation was observed between the Qanadli index, SaO 2 ( r = 0.934), and pulmonary artery pressure ( r = 0.813). The Qanadli index provides an accurate method for distinguishing massive pulmonary embolism from sub-massive pulmonary embolism. It can be used to determine therapeutic options and monitor clinical outcomes.
Highlights
Computed tomography pulmonary angiography (CTPA) has become the first-line technique for the detection of emboli in pulmonary arteries[1,2,3,4], especially with the introduction of multi-detector CT (MDCT) techniques. It has been routinely used as an accurate method to diagnose pulmonary embolism (PE) in many institutions
93 were men (56.4%) and 72 women (43.6%), with a mean age of 64 years. These patients had a high clinical suspicion of PE according to the Wells score[21,22] and were referred clinically for CTPA within the 24 h after admission
There was a high correlation coefficient between scores obtained by both investigators (r = 0.924, P < 0.01, Table 1)
Summary
Computed tomography pulmonary angiography (CTPA) has become the first-line technique for the detection of emboli in pulmonary arteries[1,2,3,4], especially with the introduction of multi-detector CT (MDCT) techniques. It has been routinely used as an accurate method to diagnose pulmonary embolism (PE) in many institutions. The usefulness of Qanadli index for stratifying the risk of patients especially in distinguishing massive PE from sub-massive PE, determining therapeutic decisions and monitoring clinical outcomes in follow-up studies of PE remains underinvestigated.
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