Plasencia-Martínez Juana María, Carmona-Bayonas Alberto, Calvo-Temprano David, Jiménez-Fonseca Paula, Fenoy Francisco, Benegas Mariana, Sánchez Marcelo, Font Carme, Varona Diego, Martínez de la Haza David, Pueyo Jesús, Biosca Mercè, Antonio Maite, Beato Carmen, Solís Pilar, Fáez Laura, de Al Haba Irma, Hernández-Muñiz Susana, Madridano Olga, Martín Mar, Castañón Eduardo, Ramchandani Avinash, Marchena Pablo, Sánchez-Cánovas Manuel, Vicente María Ángeles, Martínez Mari José, Fernández-Plaza Ángela, Martínez-Encarnación Lourdes, Puerta Alejandro, Domínguez Ángel, Rodríguez Daniel, Marín Gema, Otero Remedios, Sánchez-Lasheras Fernando, Vicente Vicente
Radiology Department, Hospital Universitario Morales Meseguer, Av Marqués de los Vélez, s/n, 30008, Murcia, Spain.
Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Av Marqués de los Vélez, s/n, 30008, Murcia, Spain.
Eur J Radiol. 2017 Feb;87:66-75. doi: 10.1016/j.ejrad.2016.12.010. Epub 2016 Dec 13.
To analyze the prognostic value of pulmonary artery obstruction versus right-ventricle (RV) dysfunction radiologic indices in cancer-related pulmonary embolism (PE).
We enrolled 303 consecutive patients with paraneoplastic PE, evaluated by computed tomography pulmonary angiography (CTPA) between 2013 and 2014. The primary outcome measure was serious complications at 15days. Multivariate analyses were conducted by using binary logistic and robust regressions. Radiological features such as the Qanadli index (QI) and RV dysfunction signs were analyzed with Spearman's partial rank correlations.
RV diameter was the only radiological variable associated with an adverse outcome. Subjects with enlarged RV (diameter>45mm) had more 15-day complications (58% versus 40%, p=0.001). The QI correlated with the RV diameter (r=0.28, p<0.001), left ventricle diameter (r=-0.19, p<0.001), right ventricular-to-left ventricular diameter ratio (r=0.39, p<0.001), pulmonary artery diameter (r=0.22, p<0.001), and pulmonary artery/ascending aorta ratio (r=0.27, p<0.001). A QI≥50% was only associated with 15-day complications in subjects with enlarged RV, inverted intraventricular septum, or chronic cardiopulmonary diseases. The central or peripheral PE location did not affect the correlations among radiological variables and was not associated with clinical outcomes.
Right ventricular dysfunction signs in CTPA are more useful than QI in predicting cancer-related PE outcome.
分析肺动脉阻塞与右心室（RV）功能障碍的放射学指标在癌症相关肺栓塞（PE）中的预后价值。
我们纳入了2013年至2014年间通过计算机断层扫描肺动脉造影（CTPA）评估的303例连续性副肿瘤性PE患者。主要结局指标为15天时的严重并发症。采用二元逻辑回归和稳健回归进行多变量分析。使用Spearman偏秩相关分析Qanadli指数（QI）和RV功能障碍征象等放射学特征。
RV直径是唯一与不良结局相关的放射学变量。RV增大（直径>45mm）的患者15天时的并发症更多（58%对40%，p=0.001）。QI与RV直径（r=0.28，p<0.001）、左心室直径（r=-0.19，p<0.001）、右心室与左心室直径比（r=0.39，p<0.001）、肺动脉直径（r=0.22，p<0.001）以及肺动脉/升主动脉比（r=0.27，p<0.001）相关。仅在RV增大、室间隔倒置或患有慢性心肺疾病的患者中，QI≥50%与15天时的并发症相关。PE的中央或外周位置不影响放射学变量之间的相关性，且与临床结局无关。
在预测癌症相关PE结局方面，CTPA中的右心室功能障碍征象比QI更有用。
