双能 CT 血管造影灌注缺损体积对肺栓塞患者的预后价值：与 CTA 阻塞评分、右心室功能障碍的 CT 参数及不良临床结局的相关性。
Prognostic value of perfusion defect volume at dual energy CTA in patients with pulmonary embolism: correlation with CTA obstruction scores, CT parameters of right ventricular dysfunction and adverse clinical outcome.
机构信息
Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
出版信息
Eur J Radiol. 2012 Nov;81(11):3592-7. doi: 10.1016/j.ejrad.2012.02.008. Epub 2012 Apr 9.
PURPOSE
To investigate the prognostic value of perfusion defect volume (PDvol) at dual-energy-CT-angiography (DE-CTA) in patients with acute pulmonary embolism (PE) by correlating PDvol with CTA-obstruction-scores (OS), CT parameters of right-ventricular-dysfunction (RVD), and adverse-clinical-outcome.
MATERIALS AND METHODS
DE-CTA of 60 patients (mean age: 65±14.4 years) with PE were analyzed. Iodine maps were generated, and normalized PDvol--defined as volume of perfusion defects/total lung volume--was quantified. Furthermore, established prognostic parameters (Qanadli and Mastora-OS, and CT parameters of RVD) were obtained. CT parameters of RVD--namely the right ventricle/left ventricle (RV/LV) diameter ratio measured on transverse sections (RV/LVtrans), four-chamber views (RV/LV4ch), and RV/LV volume ratios (RV/LVvol)--were assessed. PDvol was correlated with OS, CT parameters of RVD and adverse clinical outcome (defined as the need for intensive care treatment or death).
RESULTS
10 of 60 patients with PE experienced adverse clinical outcome. Patients with adverse clinical outcome showed significantly higher PDvol (35±11% vs. 23±10%, p=0.002), RV/LV ratios (RV/LV4ch 1.46±0.32 vs. 1.18±0.26, p=0.005; RV/LVvol 2.25±1.33 vs. 1.19±0.56, p=0.002) and higher Mastora global scores (52 vs. 13, p=0.02) compared to those without adverse clinical outcome. A weak correlation was observed between PDvol and the Mastora global score (r=0.5; p=0.0003), as well as between PDvol and RV/LV4Ch (r=0.432, p=0.0006). No correlation was found between PDvol and the Qanadli score or the remainder of the RVD-CT parameters.
CONCLUSION
The extent of perfusion defects as assessed by DE-CTA correlates with adverse clinical outcome in patients with PE. Therefore, volumetric quantification of perfusion defects at DE-CTA allows the identification of low-risk patients who do not require intensified monitoring and treatment.
目的
通过将双能 CT 血管造影（DE-CTA）中的灌注缺损体积（PDvol）与 CTA 阻塞评分（OS）、右心室功能障碍（RVD）的 CT 参数以及不良临床结果相关联，来探讨 DE-CTA 中 PDvol 在急性肺栓塞（PE）患者中的预后价值。
材料和方法
对 60 例（平均年龄：65±14.4 岁）PE 患者的 DE-CTA 进行分析。生成碘图，并量化标准化 PDvol——定义为灌注缺陷体积/肺总量。此外，还获得了既定的预后参数（Qanadli 和 Mastora-OS 以及 RVD 的 CT 参数）。通过横轴位（RV/LVtrans）、四腔心视图（RV/LV4ch）和 RV/LV 容积比（RV/LVvol）测量的右心室/左心室（RV/LV）直径比评估 RVD 的 CT 参数。将 PDvol 与 OS、RVD 的 CT 参数和不良临床结局（定义为需要重症监护治疗或死亡）进行相关性分析。
结果
60 例 PE 患者中有 10 例发生不良临床结局。发生不良临床结局的患者 PDvol 明显更高（35±11%比 23±10%，p=0.002）、RV/LV 比值（RV/LV4ch 1.46±0.32 比 1.18±0.26，p=0.005；RV/LVvol 2.25±1.33 比 1.19±0.56，p=0.002）和 Mastora 整体评分更高（52 比 13，p=0.02），与无不良临床结局的患者相比。PDvol 与 Mastora 整体评分之间存在弱相关性（r=0.5；p=0.0003），PDvol 与 RV/LV4Ch 之间也存在弱相关性（r=0.432，p=0.0006）。PDvol 与 Qanadli 评分或其余 RVD-CT 参数之间无相关性。
结论
DE-CTA 评估的灌注缺损程度与 PE 患者的不良临床结局相关。因此，DE-CTA 中灌注缺损的容积定量可识别无需强化监测和治疗的低危患者。
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