TY - JOUR
T1 - Enhancement Characteristics of the Computed Tomography Pulmonary Angiography Test Bolus Curve and Its Use in Predicting Right Ventricular Dysfunction and Mortality in Patients with Acute Pulmonary Embolism
AU - Li, Caiying
AU - Lin, Cheng Ting
AU - Kligerman, Seth J.
AU - Hong, Susie N.
AU - White, Charles S.
N1 - Publisher Copyright:
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2015/7/14
Y1 - 2015/7/14
N2 - Purpose: The purpose of the study was to evaluate the relationship between computed tomography pulmonary angiography (CTPA) test bolus curve data and mortality in patients with pulmonary embolism (PE) in comparison with conventional methods of right ventricular (RV) dysfunction. Materials and Methods: The study was approved by our institutional review board and is HIPAA-compliant. We retrospectively evaluated consecutive CTPA studies performed with a test bolus technique in a 2-year period. A time-density curve was derived from each test bolus. For comparison, left ventricular (LV) and RV dimensions (area, diameter) and PE load score (Qanadli method) were measured using CT data. A cardiologist blinded to the clinical and other imaging data reviewed a subset of the corresponding echocardiographic images to assess for RV dysfunction. Demographic data, mode of treatment, and patient outcome information were gathered using electronic medical records. Test bolus and anatomic data were correlated with PE-related mortality. Results: A total of 71 patients (34 men and 37 women, average age 54.4 y) who had a CTPA performed using a test bolus technique were diagnosed with acute PE. Factors that significantly correlated with PE-related mortality on univariate analysis were: age above 60 years (odds ratio 19.1, P=0.05), RV/LV diameter >1.5 (odds ratio 48.8, P<0.001), RV/LV area >1 (odds ratio 8.6, P=0.06), bolus curve upslope time >6 seconds (odds ratio 23.3, P=0.04), 50% downslope time >6 seconds (odds ratio 20, P=0.01), and embolus load score >15 (odds ratio 25, P=0.03). The predictive value of upslope time (Exp(B) 1.65, P=0.05), RV/LV diameter (Exp(B) 43.8, P=0.01), and RV/LV area (Exp(B) 16.7, P=0.01) were confirmed to be statistically significant in multivariate analyses. Conclusions: Data from the CTPA timing bolus curve provide prognostic value similar to the best conventional methods for predicting PE-related mortality.
AB - Purpose: The purpose of the study was to evaluate the relationship between computed tomography pulmonary angiography (CTPA) test bolus curve data and mortality in patients with pulmonary embolism (PE) in comparison with conventional methods of right ventricular (RV) dysfunction. Materials and Methods: The study was approved by our institutional review board and is HIPAA-compliant. We retrospectively evaluated consecutive CTPA studies performed with a test bolus technique in a 2-year period. A time-density curve was derived from each test bolus. For comparison, left ventricular (LV) and RV dimensions (area, diameter) and PE load score (Qanadli method) were measured using CT data. A cardiologist blinded to the clinical and other imaging data reviewed a subset of the corresponding echocardiographic images to assess for RV dysfunction. Demographic data, mode of treatment, and patient outcome information were gathered using electronic medical records. Test bolus and anatomic data were correlated with PE-related mortality. Results: A total of 71 patients (34 men and 37 women, average age 54.4 y) who had a CTPA performed using a test bolus technique were diagnosed with acute PE. Factors that significantly correlated with PE-related mortality on univariate analysis were: age above 60 years (odds ratio 19.1, P=0.05), RV/LV diameter >1.5 (odds ratio 48.8, P<0.001), RV/LV area >1 (odds ratio 8.6, P=0.06), bolus curve upslope time >6 seconds (odds ratio 23.3, P=0.04), 50% downslope time >6 seconds (odds ratio 20, P=0.01), and embolus load score >15 (odds ratio 25, P=0.03). The predictive value of upslope time (Exp(B) 1.65, P=0.05), RV/LV diameter (Exp(B) 43.8, P=0.01), and RV/LV area (Exp(B) 16.7, P=0.01) were confirmed to be statistically significant in multivariate analyses. Conclusions: Data from the CTPA timing bolus curve provide prognostic value similar to the best conventional methods for predicting PE-related mortality.
KW - computed tomography pulmonary angiography
KW - mortality
KW - pulmonary embolism
KW - right ventricular dysfunction
KW - test bolus curve
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U2 - 10.1097/RTI.0000000000000141
DO - 10.1097/RTI.0000000000000141
M3 - Article
C2 - 25635705
AN - SCOPUS:84937073535
SN - 0883-5993
VL - 30
SP - 274
EP - 281
JO - Journal of thoracic imaging
JF - Journal of thoracic imaging
IS - 4
ER -