Estimation of prognostic value of computed tomography (CT) procedure in pulmonary embolism
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II Department of Radiology, Medical University, Lublin, Poland
Witold Krupski   

MD, PhD, II Department of Radiology, Medical University, Staszica 16, 20-081 Lublin, Poland.
J Pre Clin Clin Res. 2009;3(1):49–53
Due to the fact that the signs and symptoms of pulmonary embolism (PE) are nonspecific, its diagnosis continues to pose a challenge for both clinicians and radiologists. Helical computed tomography (CT) of the pulmonary arteries is deemed accurate test for the detection of PE and is gaining increasing acceptance in daily clinical practice as a first-line test for diagnosing acute PE. The purpose of this work is to estimate the prognostic value of CT procedure in patients with diagnosed pulmonary embolism. Retrospective estimation of the embolic pulmonary index (PE index - Quanadli), diameter of pulmonary trunk (dAP), diameter of the aorta (dA), ratio dAP/dA, dimension of the right heart ventricle (dRV), left heart ventricle (dLV), and the ratio dRV/dLV were performed using sequential angio-CT procedures in patients with diagnosed pulmonary embolism. The research embraced a group of 43 patients with CT diagnosed pulmonary embolism (24 women, 19 men), aged from 26 - 91 years (mean age 66.9: women 72.2, men 60.1). In the tested material, the value of the Quanadli index ranged from 15 - 77, the diameter of the arteria pulmonalis trunk from 1.8 - 4 cm, the diameter of the aorta from 2.38 - 4.99 cm, the ratio of the pulmonary trunk diameter and the diameter of the aorta from 0.54 - 1.11, the dimension of the right heart ventricle from 2.24 - 5.93 cm, the dimension of the left heart ventricle from 2.04 - 5.58 cm and the ratio of both heart ventricles measurements ranged between 0.6 - 2.55. Three persons from the analyzed group of patients died during the hospitalization period (1 woman and 2 men aged 47, 64 and 61). The Quanadli index for these persons amounted to: 57.5, 42.5 and 50, accordingly. In conclusion, the Quanadli index is an objective and repeatable indicator which is easy to utilize in a standard way when dealing with patients suffering from pulmonary embolism diagnosed using CT examination. High values of the Quanadli index – above 40% – should be a signal to consider fibrynolytic treatment. The Quanadli index is not useful in assessing the risk of death of patients suffering from pulmonary embolism.
Anderson FA Jr, Wheeler HB, Goldberg RJ, Hosmer DW, Patwardhan NA, Jovanovic B, Forcier A, Dalen JE: A population-based perspective of the hospital incidence and case fatality rates of deep vein thrombosis and pulmonar embolism: the Worcester DVT study. Arch Intern Med 1991, 151, 933 938.
Patel S, Kazerooni EA: Helical CT for the evaluation of acute pulmonary embolism. Am J Roentgenol 2005, 185, 135-149.
Giuntini C, Di Ricco G, Marini C, Mellilo E, Palla A: Pulmonary embolism: epidemiology. Chest 1995, 107 (Suppl. 1), 3-9.
Schoepf UJ, Goldhaber SZ, Costello P: Spiral computed tomography for acute pulmonary embolism. Circulation 2004, 109, 2160-2167.
Silverstein MD, Heit JA, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ 3rd: Trends in the incidence of deep venous thrombosis and pulmonary embolism. A 25-year population-based study. Arch Intern Med 1998, 158, 585-593.
Moser KM: Venous thromboembolism. Am Rev Respir Dis 1990, 141, 235-249.
Carson JL, Kelley MA, Duff A, Weg JG, Fulkerson WJ, Palevsky HI, Schwartz JS, Thompson BT, Popovich J Jr, Hobbins TE, et al: The clinical course of pulmonary embolism. N Engl J Med 1992, 326,1240-1245.
Goldhaber SZ, Visani I, de Rosa M: Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999, 353, 1386-1389.
McFarlane MJ, Imperiale TF: Use of the alveolar-arterial oxygen gradient in the diagnosis of pulmonary embolism. Am J Med 1994, 96, 57-62.
Goldhaber SZ, Hennekens CH, Evans DA, Newton EC, Godleski JJ: Factors associated with correct antemortem diagnosis of major pulmonary embolism. Am J Med 1982, 73, 822-826.
van Strijen MJ, de Monye W, Kieft GJ, Pattynama PM, Prins MH, Huisman MH: Accuracy of single-detector spiral CT in the diagnosis of pulmonary embolism: a prospective multicenter cohort study of consecutive patients with abnormal perfusion scintigraphy. J Thromb Haemost 2005, 3, 17-25.
Ghaye B, Ghuysen A, Bruyere PJ, D’ Orio V, Dondelinger RF: Can CT pulmonary angiography allow assessment of severity and prognosis in patients presenting with pulmonary embolism? What the radiologist needs to know. Radiographics 2006, 26, 23-40.
Raptopoulos V, Boiselle P: Multi-detector row spiral CT pulmonary angiography: comparison with single-detector row spiral CT. Radiology 2001, 221, 606-613.
Wildberger JE, Mahnken AH, Das M, Kuttner A, Lell M, Gunther RW: CT imaging in acute pulmonary embolism:diagnostic strategies. Eur Radiol 2005, 15, 919-929.
van Strijen MJ, de Mony W, Schiereck J, Kieft GJ, Prins MH, Huisman MV, Pattynama PM, Advances in New Technologies Evaluating the Localisation of Pulmonary Embolism Study Group: Single-detector helical computed tomography as the primary diagnostic test in suspected pulmonary embolism: a multicenter clinical management study of 510 patients. Ann Intern Med 2003, 138, 307-314.
Wittram C, Maher MM, Yoo AJ, Kalra MK, Shepard JA, McLoud TC: CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis. Radiographics 2004, 24, 1219-1238.
Uhland H, Goldberg LM: Pulmonary embolism: a commonly missed clinical entity. Dis Chest 1964, 45, 533-536.
Patel S, Kazerooni EA: Helical CT for the evaluation of acute pulmonary embolism Am J Roentgenol 2005, 185, 135-149.
Qanadli S, El Hajjam M, Vieillard-Baron A, Joseph T, Mesurolle B, Oliva VL, Barre O, Bruckert F, Dubourg O, Lacombe P: New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic Index and Echocardiography Am J Roentgenol 2001, 176, 1415-1420.
Wu AS, Pezzullo JA, Cronan JJ, Hou DD, Mayo-Smith WW: CT pulmonary angiography: quantifi cation of pulmonary embolus as a predictor of patient outcome-initial experience. Radiology 2004, 230, 831-835.
Ghanima W, Abdelnoor M, Holmen LO, Nielssen BE, Sandest PM: The association beetwen the proximal extension of the clot and the severity of pulmonary embolism PE: a proposal for a new radiological score for PE. J Intern Med 2007, 261, 74-81.
van der Meer RW, Pattynama PM, van Strijen MJ, van den Berg- Huijsmans AA, Hartmann IJ, Putter H, de Ross A, Huisman MV: 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. Radiology 2005, 235, 798-803.
Ghuysen A, Ghaye B, Willems V, Lambermont B, Gerard P, Dondelinger RF, D’Orio V: Computed tomographic pulmonary angiography and prognostic signifi cance in patients with acute pulmonary embolism. Thorax 2005, 60, 956-961.