The role of computed tomography pulmonary angiography in assessing severity in patients with acute pulmonary embolism

Abstract

Objective: To describe the imaging characteristics of PE on CTPA and assess the relationship between CTPA imaging characteristics and the ability to predict severity in PE patients.

Subjects and methods: 112 cases of PE were divided into two groups: high-risk PE (HRPE) and non-high-risk PE (NHRPE), comparing the PESI score and CTPA imaging variables.

Results: The HRPE group had a significantly higher PESI score (175.78±39.94), Qanadli score (60.56±21.25), and RVD/LVD ratio (2.39±0.80) compared to the NHRPE group with PESI score (76.60±25.27), Qanadli score (31.75±20.51), and RVD/LVD ratio (1.01±0.29), (P < 0.05). Variables such as RVD, LVD, and interventricular septal abnormalities also showed differences between the two groups (P < 0.05). PAD, AD, PAD/AD ratio, and contrast reflux into the inferior vena cava showed no differences between the two groups (P ≥ 0.05). The RVD/LVD ratio strongly correlated with Qanadli score (r = 0.520) and PESI score (r = 0.510), while Qanadli score weakly correlated with PESI score (r = 0.265). The highest area under the curve for PESI score, reaching 0.998 (95% CI: 0.992-1.000), with a cutoff point of 122.5; RVD/LVD ratio reached 0.981 (95% CI: 0.953-1.000), with a cut-off point of 1.339; Qanadli score reached 0.851 (95% CI: 0.6881.000), with a cut-off point of 51.339. The RVD/LVD ratio was a predictor of HRPE (P < 0.05).

Conclusion: CTPA imaging is valuable in stratifying the risk of PE, along with the PESI score.