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Moon, Seon, Baek, Lee, Yoon, and Kim: Diagnostic Usefulness of Dual-Energy Computed Tomography in Evaluation of the Severity of Acute Pulmonary Thromboembolism
Chest Radiology

Journal of the Korean Society of Radiology 2015; 72(1): 38-45.

Published online: 5 January 2015

DOI: https://doi.org/10.3348/jksr.2015.72.1.38

Diagnostic Usefulness of Dual-Energy Computed Tomography in Evaluation of the Severity of Acute Pulmonary Thromboembolism

Sung Min Moon, MD1, Hyun Ju Seon, MD2, 3, Jang Mi Baek, MD1, Seung Jin Lee, MD4, Yeon Hong Yoon, MD1, Yun-Hyeon Kim, MD1, 3

1Department of Radiology, Chonnam National University Hospital, Gwangju, Korea.

2Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea.

3Department of Radiology, Chonnam National University Medical School, Gwangju, Korea.

4Department of Radiology, Chonnam National University Bitgoeul Hospital, Gwangju, Korea.

Corresponding author: Yun-Hyeon Kim, MD. Department of Radiology, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea. Tel. 82-62-220-5746, Fax. 82-62-226-4380, yhkim001@jnu.ac.kr

Received 27 October 2014       Accepted 29 October 2014

Copyright © 2015 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the usefulness of dual-energy computed tomography (DECT) in severity assessment of patients with acute pulmonary thromboembolism (APTE).

Materials and Methods

We evaluated 61 patients diagnosed as APTE from 2011 to 2012 in a retrospective analysis of the severity assessment indices according to Criteria by European Society of Cardiology as well as pulmonary CT angiographic obstruction score (OS) and lung perfusion index (pulmonary perfusion defect score; DS) by DECT. The correlation between OS, DS and the severity of pulmonary thromboembolism was evaluated using logit analysis.

Results

Patients with high OS also showed significantly higher DS values (p < 0.001). There was a significant correlation between both the OS and DS values and the severity of the pulmonary thromboembolism using simple sequence logit analysis (p < 0.001). However, only the DS value showed a very high correlation with the severity of pulmonary thromboembolism using multiple sequence logit analysis.

Conclusion

DECT provides a more useful marker for the diagnosis and severity assessment of pulmonary thromboembolism by checking the degree of lung perfusion as well as determining the existence of APTE in patients with suspected pulmonary thromboembolism.

Keywords: Acute Pulmonary Thromboembolism, Dual-Energy Computed Tomography

Figures and Tables

Fig. 1

Correlation between pulmonary perfusion defect score and pulmonary CT angiographic obstruction score in patient based analysis.

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Fig. 2

57-year-old woman with pulmonary thromboembolism, who had high obstruction score (75/100) and low perfusion defect score (42.5/100). Pulmonary CT angiography (A, B) shows extensive thromboembolic filling defect in both main, lobar, and segmental pulmonary arteries, but lung perfusion is relatively well preserved on pulmonary perfusion image (C).

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Fig. 3

82-year-old woman with pulmonary thromboembolism, who had low obstruction score (12.5/100) but relatively high perfusion defect score (60/100). Pulmonary CT angiography (A) shows only focal thromboembolic filling defect in right lower lobar and segmental pulmonary arteries, but prominent low attenuation on lung window setting image (B) and perfusion defect areas on pulmonary perfusion image (C).

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Table 1

The Value of Each Group [Mean (Maximum-Minimum)]

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Risk Group DS OS Patient Number
High 37.26 (5-75) 58.69 (0-100) 21
Intermediate 38.75 (0-70) 39.90 (5-80) 20
Low 17.38 (0-45) 25.63 (0-45) 20

Note.-DS = pulmonary perfusion defect score, OS = pulmonary CT angiographic obstruction score

Table 2

Univariate Analyses of Predictors for Pulmonary Thromboembolism Severity Score

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Variables Odds Ratio; Exp (b) 95% Wald Confidence Limits p-Value
Pulmonary perfusion defect score (0-100) 1.049 1.025-1.073 < 0.001***
Pulmonary CTA obstruction score (0-100) 1.027 1.006-1.049 0.013*

Note.-*p < 0.5.

***p < 0.01.

CTA = computed tomography angiography

Table 3

Multivariate Analysis of Predictors for Pulmonary Thromboembolism Severity Score

jksr-72-38-i003
Variables Odds Ratio; Exp (b) 95% Wald Confidence Limits p-Value
Pulmonary perfusion defect score (0-100) 1.046 1.019-1.073 < 0.001***
Pulmonary CTA obstruction score (0-100) 1.005 0.981-1.030 0.662

Note.-***p < 0.01.

CTA = computed tomography angiography

Notes

This study was supported by a grant (CRI 11010-1) Chon-nam National University Hospital Biomedical Research Institute.

References

1. Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J. 2008; 29:2276–2315.
2. Anderson FA Jr, Wheeler HB, Goldberg RJ, Hosmer DW, Patwardhan NA, Jovanovic B, et al. The Worcester DVT Study. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. Arch Intern Med. 1991; 151:933–938.
3. Kasper W, Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser KD, et al. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol. 1997; 30:1165–1171.
4. Wildberger JE, Schoepf UJ, Mahnken AH, Herzog P, Ditt H, Niethammer MU, et al. Approaches to CT perfusion imaging in pulmonary embolism. Semin Roentgenol. 2005; 40:64–73.
5. Chung MJ, Goo JM, Im JG, Lee KS, Kim KG, Park JH. CT perfusion image of the lung: value in the detection of pulmonary embolism in a porcine model. Invest Radiol. 2004; 39:633–640.
6. Hoey ET, Mirsadraee S, Pepke-Zaba J, Jenkins DP, Gopalan D, Screaton NJ. Dual-energy CT angiography for assessment of regional pulmonary perfusion in patients with chronic thromboembolic pulmonary hypertension: initial experience. AJR Am J Roentgenol. 2011; 196:524–532.
7. Chae EJ, Seo JB, Jang YM, Krauss B, Lee CW, Lee HJ, et al. Dual-energy CT for assessment of the severity of acute pulmonary embolism: pulmonary perfusion defect score compared with CT angiographic obstruction score and right ventricular/left ventricular diameter ratio. AJR Am J Roentgenol. 2010; 194:604–610.
8. Thieme SF, Johnson TR, Lee C, McWilliams J, Becker CR, Reiser MF, et al. Dual-energy CT for the assessment of contrast material distribution in the pulmonary parenchyma. AJR Am J Roentgenol. 2009; 193:144–149.
9. Flohr TG, McCollough CH, Bruder H, Petersilka M, Gruber K, Süss C, et al. First performance evaluation of a dual-source CT (DSCT) system. Eur Radiol. 2006; 16:256–268.
10. Johnson TR, Krauss B, Sedlmair M, Grasruck M, Bruder H, Morhard D, et al. Material differentiation by dual energy CT: initial experience. Eur Radiol. 2007; 17:1510–1517.
11. Dogan H, Kroft LJ, Huisman MV, van der Geest R, Li OY, Lamb HJ, et al. Assessment of right ventricular function in acute pulmonary embolism using ECG-synchronized MDCT. AJR Am J Roentgenol. 2010; 195:909–915.
12. Seon HJ, Kim KH, Lee WS, Choi S, Yoon HJ, Ahn Y, et al. Usefulness of computed tomographic pulmonary angiography in the risk stratification of acute pulmonary thromboembolism. Comparison with cardiac biomarkers. Circ J. 2011; 75:428–436.
13. Qanadli SD, El Hajjam M, Vieillard-Baron A, Joseph T, Mesurolle B, Oliva VL, et al. New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. AJR Am J Roentgenol. 2001; 176:1415–1420.
14. Petersson J, Sánchez-Crespo A, Larsson SA, Mure M. Physiological imaging of the lung: single-photon-emission computed tomography (SPECT). J Appl Physiol (1985). 2007; 102:468–476.
15. Ryan KL, Fedullo PF, Davis GB, Vasquez TE, Moser KM. Perfusion scan findings understate the severity of angiographic and hemodynamic compromise in chronic thromboembolic pulmonary hypertension. Chest. 1988; 93:1180–1185.
16. Kreitner KF, Kunz RP, Ley S, Oberholzer K, Neeb D, Gast KK, et al. Chronic thromboembolic pulmonary hypertension-assessment by magnetic resonance imaging. Eur Radiol. 2007; 17:11–21.
17. Ley S, Kreitner KF, Fink C, Heussel CP, Borst MM, Kauczor HU. Assessment of pulmonary hypertension by CT and MR imaging. Eur Radiol. 2004; 14:359–368.
18. Nikolaou K, Schoenberg SO, Attenberger U, Scheidler J, Dietrich O, Kuehn B, et al. Pulmonary arterial hypertension: diagnosis with fast perfusion MR imaging and high-spatial-resolution MR angiography--preliminary experience. Radiology. 2005; 236:694–703.
19. Fink C, Thieme S, Ley S, Clevert D, Reiser MF, Kauczor HU, et al. [MRI of pulmonary embolism]. Radiologe. 2007; 47:708–715.
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