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Journal of The Korean Society of Emergency Medicine 2009;20(1): 40-49. |
| Usefulness of Quantitative Analysis of Computed Tomography Pulmonary Angiography as a Predictor of Prognosis of Acute Pulmonary Embolism |
| Sung Wook Song, Jin Sik Park, Hwan Jun Je, Hyun Ju Lee, Eun Ah Park, Sang Do Shin, Seong Ku Jeong, Young Ho Kwak, Gil Joon Seo |
1Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea. pjsheart@gmail.com
2Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul, Korea.
3Department of Radiology, Seoul National University Hospital, Seoul, Korea. |
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| ABSTRACT |
PURPOSE:
We evaluated the usefulness of quantitative analysis of computed tomography (CT) pulmonary angiography as a predictor of the prognosis of acute pulmonary embolism (PTE).
METHODS:
We performed a retrospective analysis of 55 patients who visited our emergency department from January 2000 to November 2007 who were confirmed with PTE by CT pulmonary angiography. Two radiologists blinded to patient outcome measured CT parameters including the diameter of vessels and chambers, and the quantified pulmonary artery (PA) clot load score on the basis of embolus size and location. CT parameters and other clinical predictors were analyzed to determine their ability to predict major adverse event (MAE).
RESULTS:
Of the 55 patients, 16 (29.1%) had a MAE PTE related shock, intubation, death, thrombolysis, right ventricular (RV) dysfunction within 30 days). Geneva score (odds ratio 2.5, 95% CI 1.18-5.29, p=0.02) and PA clot load score (odds ratio 1.64, 95% CI 1.18-2.27, p<0.01) were strong independent predictors of MAE. The cut-off value of Geneva and PA clot load scores were 4.5 and 19.0, respectively, and the area under the ROC curve were 0.697 (0.546~0.848) and 0.908 (0.828-0.988), respectively.
CONCLUSION:
Geneva and PA clot load score are significant predictors of PTE related shock, intubation, death, thrombolysis, and RV dysfunction within 30 days. CT pulmonary angiography is a useful predictor for the prognosis of PTE as well as a useful diagnostic tool. |
| Key words:
Pulmonary embolism, Pulmonary arteries, angiography, Prognosis |
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