Journal List > J Korean Soc Radiol > v.72(1) > 1087529

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

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.

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

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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.

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