计算机断层扫描肺动脉造影试验团注曲线的增强特征及其在预测急性肺栓塞患者右心室功能障碍和死亡率中的应用。

Enhancement Characteristics of the Computed Tomography Pulmonary Angiography Test Bolus Curve and Its Use in Predicting Right Ventricular Dysfunction and Mortality in Patients With Acute Pulmonary Embolism.

作者信息

Li Caiying, Lin Cheng Ting, Kligerman Seth J, Hong Susie N, White Charles S

机构信息

*Department of Diagnostic Radiology and Nuclear Medicine §Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine ‡Department of Radiology, Johns Hopkins University, Baltimore, MD †Department of Medical Imaging, Second Hospital of Hebei Medical University, Hebei Province, China.

出版信息

J Thorac Imaging. 2015 Jul;30(4):274-81. doi: 10.1097/RTI.0000000000000141.

DOI:10.1097/RTI.0000000000000141

PMID:25635705

Abstract

PURPOSE

The purpose of the study was to evaluate the relationship between computed tomography pulmonary angiography (CTPA) test bolus curve data and mortality in patients with pulmonary embolism (PE) in comparison with conventional methods of right ventricular (RV) dysfunction.

MATERIALS AND METHODS

The study was approved by our institutional review board and is HIPAA-compliant. We retrospectively evaluated consecutive CTPA studies performed with a test bolus technique in a 2-year period. A time-density curve was derived from each test bolus. For comparison, left ventricular (LV) and RV dimensions (area, diameter) and PE load score (Qanadli method) were measured using CT data. A cardiologist blinded to the clinical and other imaging data reviewed a subset of the corresponding echocardiographic images to assess for RV dysfunction. Demographic data, mode of treatment, and patient outcome information were gathered using electronic medical records. Test bolus and anatomic data were correlated with PE-related mortality.

RESULTS

A total of 71 patients (34 men and 37 women, average age 54.4 y) who had a CTPA performed using a test bolus technique were diagnosed with acute PE. Factors that significantly correlated with PE-related mortality on univariate analysis were: age above 60 years (odds ratio 19.1, P = 0.05), RV/LV diameter >1.5 (odds ratio 48.8, P < 0.001), RV/LV area >1 (odds ratio 8.6, P = 0.06), bolus curve upslope time >6 seconds (odds ratio 23.3, P = 0.04), 50% downslope time >6 seconds (odds ratio 20, P = 0.01), and embolus load score >15 (odds ratio 25, P = 0.03). The predictive value of upslope time (Exp(B) 1.65, P = 0.05), RV/LV diameter (Exp(B) 43.8, P = 0.01), and RV/LV area (Exp(B) 16.7, P = 0.01) were confirmed to be statistically significant in multivariate analyses.

CONCLUSIONS

Data from the CTPA timing bolus curve provide prognostic value similar to the best conventional methods for predicting PE-related mortality.

摘要

目的

本研究旨在评估计算机断层扫描肺动脉造影（CTPA）团注试验曲线数据与肺栓塞（PE）患者死亡率之间的关系，并与评估右心室（RV）功能障碍的传统方法进行比较。

材料与方法

本研究经机构审查委员会批准，符合健康保险流通与责任法案（HIPAA）规定。我们回顾性评估了在两年期间采用团注试验技术进行的连续CTPA研究。从每个团注试验中得出时间-密度曲线。为作比较，利用CT数据测量左心室（LV）和右心室尺寸（面积、直径）以及PE负荷评分（卡纳德利法）。一位对临床和其他影像数据不知情的心脏病专家审查了部分相应的超声心动图图像，以评估右心室功能障碍情况。利用电子病历收集人口统计学数据、治疗方式和患者预后信息。团注试验数据和解剖学数据与PE相关死亡率进行关联分析。

结果

共有71例患者（34例男性和37例女性，平均年龄54.4岁）采用团注试验技术进行了CTPA检查，并被诊断为急性PE。单因素分析中与PE相关死亡率显著相关的因素包括：年龄大于60岁（比值比19.1，P = 0.05）、右心室/左心室直径>1.5（比值比48.8，P < 0.001）、右心室/左心室面积>1（比值比8.6，P = 0.06）、团注曲线上升时间>6秒（比值比23.3，P = 0.04）、50%下降时间>6秒（比值比20，P = 0.01）以及栓子负荷评分>15（比值比25，P = 0.03）。在多因素分析中，上升时间（Exp(B) 1.65，P = 0.05）、右心室/左心室直径（Exp(B) 43.8，P = 0.01）和右心室/左心室面积（Exp(B) 16.7，P = 0.01）的预测价值经证实具有统计学意义。