CT 肺动脉造影中急性肺栓塞的短期死亡率：血栓负荷和右心功能障碍的征象。
Short-term mortality in acute pulmonary embolism: clot burden and signs of right heart dysfunction at CT pulmonary angiography.
机构信息
Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213, USA.
出版信息
Radiology. 2012 Oct;265(1):283-93. doi: 10.1148/radiol.12110802.
PURPOSE
To assess the correlation between volumetric measurements of clot, semiquantitative clot burden indexes, and signs of right heart dysfunction at computed tomographic (CT) pulmonary angiography in patients with acute pulmonary embolism (PE) and to determine whether clot burden and signs of right heart dysfunction are associated with short-term mortality.
MATERIALS AND METHODS
This retrospective study was institutional review board approved and HIPAA compliant. CT pulmonary angiographic studies (January 2007 through December 2007) with findings positive for PE were retrieved. Two readers evaluated signs of right heart dysfunction at CT pulmonary angiography, measured clot volume using a dedicated software program, and assessed clot burden using semiquantitative scores (Qanadli and Mastora). Spearman rank coefficient was used to investigate correlation between clot burden measures and signs of right heart dysfunction. Uni- and multivariate analyses were used to test association between CT pulmonary angiographic findings and short-term mortality.
RESULTS
A total of 635 CT pulmonary angiographic studies from 635 patients (304 men, 331 women; mean age, 59 years) were included; 39 (6%) patients died within 30 days. Clot volume was strongly correlated with Qanadli score (ρ=0.841, P<.01) and Mastora score (ρ=0.863, P<.01) and moderately correlated (ρ=0.378, P<.01) with the ratio of right ventricle diameter to left ventricle diameter (RV/LV ratio). Among the pulmonary angiographic signs, only increase in RV/LV ratio (cut-off value, 1.0) was independently associated with short-term mortality in multivariate analysis.
CONCLUSION
Clot volume strongly correlated with semiquantitative CT scores of clot burden, and greater clot volume was associated with higher incidence of right heart dilatation. Increase in RV/LV ratio was associated with short-term mortality; however, measures of clot burden were not.
目的
评估急性肺栓塞（PE）患者 CT 肺动脉造影（CTPA）中血栓体积测量、半定量血栓负荷指数与右心功能障碍征象之间的相关性，并确定血栓负荷和右心功能障碍征象是否与短期死亡率相关。
材料与方法
本回顾性研究获得机构审查委员会批准和 HIPAA 合规性。检索 2007 年 1 月至 2007 年 12 月 CTPA 检查结果阳性的 PE 患者的 CTPA 研究。两位读者在 CTPA 上评估右心功能障碍征象，使用专用软件程序测量血栓体积，并使用半定量评分（Qanadli 和 Mastora）评估血栓负荷。采用 Spearman 秩相关系数评估血栓负荷测量值与右心功能障碍征象之间的相关性。采用单变量和多变量分析测试 CTPA 检查结果与短期死亡率之间的关联。
结果
共纳入 635 例患者（304 例男性，331 例女性；平均年龄 59 岁）的 635 例 CTPA 研究；39 例（6%）患者在 30 天内死亡。血栓体积与 Qanadli 评分（ρ=0.841，P<.01）和 Mastora 评分（ρ=0.863，P<.01）呈高度相关，与右心室直径与左心室直径比（RV/LV 比）呈中度相关（ρ=0.378，P<.01）。在肺动脉造影征象中，只有 RV/LV 比增加（截断值为 1.0）在多变量分析中与短期死亡率独立相关。
结论
血栓体积与血栓负荷的半定量 CT 评分高度相关，较大的血栓体积与更高的右心扩张发生率相关。RV/LV 比增加与短期死亡率相关；然而，血栓负荷的测量值与短期死亡率无关。
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