Right ventricular dysfunction and pulmonary obstruction index at helical CT: Prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism
Right ventricular dysfunction and pulmonary obstruction index at helical CT: Prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism
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DOI：
10.1148/radiol.2353040593
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发表时间：
2005-06-01
期刊：
影响因子：
19.7
通讯作者：
Huisman, MV
中科院分区：
文献类型：
--
作者：
van der Meer, RW;Pattynama, PMT;Huisman, MV
目的：在文献提出的各种标准基础上，回顾性量化螺旋计算机断层扫描（CT）右心室功能障碍（RVD）和肺动脉阻塞指数，并评估这些CT参数对肺栓塞（PE）初诊后3个月内死亡率的预测价值。材料和方法：回顾性研究已获得机构审查委员会批准，不需要知情同意。在连续120例确诊为PE的患者中（男性55例，女性65例，平均年龄标准差59岁，18岁），两名读者通过量化右心室与左心室短轴直径（RV/LV）和肺动脉与升主动脉直径的比例、室间隔形状和肺动脉循环阻塞程度来评估RVD的程度，这些螺旋CT图像在一致阅读中对临床结果进行盲法分析。使用回归分析将这些参数与患者预后相关联。结果：69例（57.5%）患者出现RVD的CT征象（RV/LV比值> 1.0）。随访期间，7例患者死于PE。右室/左室比和梗阻指数均为3个月内死亡的重要危险因素（P = 0.04和P = 0.04）。分别为01)。肺动脉与升主动脉直径之比（P = 0.66）或室间隔形状（P = 0.20）没有发现这种关系。RV/LV比值大于1.0时pe相关死亡率的阳性预测值为10.1%（95%可信区间[Cl]: 2.9%, 17.4%）。对于RV/LV比值小于等于1.0的平稳结局，阴性预测值为100% （95% CI: 94.3%, 100%）。梗阻指数为40%或更高的患者死于肺动脉栓塞的风险增加11.2倍（95% CI: 1.3, 93.6）。结论：螺旋CT基线评估RVD和肺血管阻塞标志物有助于预测随访期间的死亡率。RSNA, 2005年。
PURPOSE: To retrospectively quantify right ventricular dysfunction (RVD) and the pulmonary artery obstruction index at helical computed tomography (CT) on the basis of various criteria propose in the literature an to assess the predictive value of these CT parameters for mortality within 3 months after the initial diagnosis of pulmonary embolism (PE).MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was not required for retrospective study. In 120 consecutive patients (55 men, 65 women; mean age standard deviation, 59 years 18) with proved PE, two readers assessed the extent of RVD by quantifying the ratio of the right ventricle to left ventricle short-axis diameters (RV/LV) and the pulmonary artery to ascending aorta diameters, the shape of the interventricular septum, and the extent of obstruction to the pulmonary artery circulation on helical CT images, which were blinded for clinical outcome in consensus reading. Regression analysis was used to correlate these parameters with patient outcome.RESULTS: CT signs of RVD (RV/LV ratio, > 1.0) were seen in 69 patients (57.5%). During follow-up, seven patients died of PE. Both the RV/LV ratio and the obstruction index were shown to be significant risk factors for mortality within 3 months (P =.04 and.01, respectively). No such relationship was found for the ratio of the pulmonary artery to ascending aorta diameters (P =.66) or for the shape of the interventricular septum (P =.20). The positive predictive value for PE-related mortality with an RV/LV ratio greater than 1.0 was 10.1% (95% confidence interval [Cl]: 2.9%, 17.4%). The negative predictive value for an uneventful outcome with an RV/LV ratio of 1.0 or less was 100% (95% CI: 94.3%, 100%). There was a 11.2-fold increased risk of dying of PE for patients with an obstruction index of 40% or higher (95% CI: 1.3, 93.6).CONCLUSION: Markers of RVD and pulmonary vascular obstruction, assessed with helical CT at baseline, help predict mortality during follow-up. RSNA, 2005.