Zhao Dian-Jiang, Ma Da-Qing, He Wen, Wang Jian-Jun, Xu Yan, Guan Chun-Shuang
Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Acta Radiol. 2010 May;51(4):413-9. doi: 10.3109/02841851003649266.
Computed tomographic pulmonary angiography (CTPA) has been established as a first-line test in the acute pulmonary embolism (APE) diagnostic algorithm, but the assessment of the severity of APE by this method remains to be explored.
To retrospectively evaluate right ventricular (RV) dysfunction and severity in patients with APE without underlying cardiopulmonary disease using helical computed tomography (CT).
Seventy-three patients (35 men and 38 women) were divided into two groups according to the clinical findings: severe APE (n=22) and non-severe APE (n=51). Pulmonary artery CT obstruction index was calculated according to the location and degree of clots in the pulmonary arteries. Cardiovascular parameters including RV short axis and left ventricular (LV) short axis, RV short axis to LV short axis (RV/LV) ratio, main pulmonary artery, azygos vein, and superior vena cava diameters were measured. Leftward bowing of the interventricular septum, reflux of contrast medium into the inferior vena cava and azygos vein, and bronchial artery dilatation were also recorded. The results were analyzed by Mann-Whitney U test, chi(2) test, Spearman's rank correlation coefficient, and the area under the receiver operating characteristic curve (A(z)).
CT obstruction index in patients with severe APE (median 43%) was higher than that of patients with non-severe APE (median 20%). Comparison of cardiovascular parameters between patients with severe and non-severe pulmonary embolism showed significant differences in RV short axis, LV short axis, RV/LV ratio, RV wall thickness, main pulmonary artery diameter, azygos vein diameter, leftward bowing of the interventricular septum, and bronchial artery dilatation. The correlation between CT obstruction indexes and cardiovascular parameters was significant. Spearman's rank correlation coefficient was highest between RV/LV ratio and CT obstruction index. A(z) values were significantly higher than 0.5 for CT obstruction index, LV short axis, RV/LV ratio, main pulmonary artery diameter, and azygos vein diameter.
These results suggest that CTPA is a practical and accurate means for evaluating RV dysfunction of pulmonary embolism in patients without any underlying cardiopulmonary disease and can discriminate between severe and non-severe APE.
计算机断层扫描肺动脉造影（CTPA）已被确立为急性肺栓塞（APE）诊断流程中的一线检查方法，但通过该方法评估APE的严重程度仍有待探索。
使用螺旋计算机断层扫描（CT）对无基础心肺疾病的APE患者的右心室（RV）功能障碍及严重程度进行回顾性评估。
根据临床表现将73例患者（35例男性和38例女性）分为两组：重度APE组（n = 22）和非重度APE组（n = 51）。根据肺动脉内血栓的位置和程度计算肺动脉CT阻塞指数。测量心血管参数，包括RV短轴和左心室（LV）短轴、RV短轴与LV短轴之比（RV/LV）、主肺动脉、奇静脉和上腔静脉直径。还记录室间隔向左弯曲、造影剂反流至下腔静脉和奇静脉以及支气管动脉扩张情况。结果采用Mann-Whitney U检验、卡方检验、Spearman等级相关系数和受试者操作特征曲线下面积（A(z)）进行分析。
重度APE患者的CT阻塞指数（中位数43%）高于非重度APE患者（中位数20%）。重度与非重度肺栓塞患者心血管参数比较显示，RV短轴、LV短轴、RV/LV比值、RV壁厚度、主肺动脉直径、奇静脉直径、室间隔向左弯曲和支气管动脉扩张存在显著差异。CT阻塞指数与心血管参数之间存在显著相关性。RV/LV比值与CT阻塞指数之间的Spearman等级相关系数最高。CT阻塞指数、LV短轴、RV/LV比值、主肺动脉直径和奇静脉直径的A(z)值显著高于0.5。
这些结果表明，CTPA是评估无任何基础心肺疾病患者肺栓塞RV功能障碍的实用且准确的方法，并且能够区分重度和非重度APE。
