Role of multidetector CT in predicting patient outcome in cases of pulmonary embolism: correlation between imaging findings, ICU admissions and mortality rate

Heba Ibrahim,Samar M El-Maadawy

doi:10.1186/s43055-021-00593-z

Abstract

BackgroundPulmonary embolism (PE) is a critical medical condition that requires prompt diagnosis and treatment to avoid serious morbidity and mortality risk. Multidetector CT pulmonary angiography (CTPA) is considered the first-line imaging modality for suspected acute PE. The presence of right heart strain, which supports the diagnosis, requires special attention. The aim of our retrospective study is to assess the reliability of CTPA hemodynamic indices in predicting patients’ outcome in cases of PE.ResultsSixty patients were included in our study. CTPA parameters including main pulmonary artery (MPA) diameter, left ventricle (LV) diameter, right ventricle (RV)/LV ratio, and septal deviation had a clinical prognostic value for short-term 30-day mortality and ICU admission. Statistically significant relationship between MPA diameter > 29 mm, LV diameter, RV/LV ratio > 1, left-sided septal deviation and contrast reflux into the IVC/distal hepatic veins with ICU admission was observed with p values 0.031, 0.000, 0.000, 0.005 and 0.028 respectively. There was a statistically significant correlation between MPA diameter > 29 mm, LV diameter, RV/LV > 1 ratio and septal deviation with 30-day mortality with p values of < 0.001, 0.001, < 0.001 and 0.015 respectively. No significant correlation was found between 30-day mortality and contrast reflux to IVC with p value of 0.070.ConclusionsCTPA measurements including MPA diameter, RV/LV ratio and septal deviation were found to be significantly correlated to ICU admission and 30-day mortality as predictors for PE severity. CT contrast reflux was found to be correlated to ICU admission; however, it was not significantly correlated to 30-day mortality.

Highlights

Pulmonary embolism (PE) is a critical medical condition that requires prompt diagnosis and treatment to avoid serious morbidity and mortality risk
CT pulmonary angiography (CTPA) was used to assess the cardiac complications of PE through evaluation of Right ventricular dysfunction (RVD) and hemodynamic stability based on measurements of main pulmonary artery (MPA) diameter, right ventricle (RV)/left ventricle (LV) ratio, septal deviation, and contrast reflux into inferior vena cava (IVC)/distal hepatic veins
Our study showed that CTPA parameters including MPA diameter, RV/LV ratio > 1, and septal deviation have a clinical prognostic value for short-term 30-days mortality as well as intensive care unit (ICU) admission

Summary

Introduction

Pulmonary embolism (PE) is a critical medical condition that requires prompt diagnosis and treatment to avoid serious morbidity and mortality risk. Multidetector CT pulmonary angiography (CTPA) is considered the first-line imaging modality for suspected acute PE. The aim of our retrospective study is to assess the reliability of CTPA hemodynamic indices in predicting patients’ outcome in cases of PE. Pulmonary embolism (PE) is a serious life-threatening illness that necessitates immediate diagnosis and treatment to avoid its associated high mortality and morbidity risk [1]. The death from acute pulmonary embolism usually occurs within the first four hours of hospital admission. Some patients present with shock and require immediate thrombolysis, whereas other patients can be handled well with anticoagulation alone in an outpatient setting [3]. Echocardiography findings, electrocardiography (ECG) alterations, haemodynamic measures, cardiac biomarkers and blood gas analysis are all useful clinical parameters in assessing the risk of PE [4]

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