Radiology 2004; 230:831-835.
Wu AS, Pezzullo JA, Cronan JJ, Hou DD, Mayo-Smith WW.
PURPOSE: To determine whether quantification of pulmonary embolus (PE) with computed tomographic (CT) pulmonary angiography by using a standardized index is a predictor of patient outcome.
MATERIALS AND METHODS: Multi-detector row CT was performed in 59 hospitalized patients (mean age, 61 years; age range, 22-89 years), PE was identified retrospectively by two radiologists who were blinded to patient outcome. A pulmonary arterial obstruction index was derived for each set of images on the basis of embolus size and location. By using logistic regression, PE indexes were compared with patient outcome—survival or death—to determine if there was a correlation between PE volume and survival.
RESULTS: The PE index is a significant predictor of patient outcome (P = ,002). One of 53 patients (1.9%) with an index of less than 60% died. Cause of death was end-stage malignancy. Five of six patients (83%) with an index of 60% and higher died. AH five deaths were related to the presence of PE. The one survivor with a PE index higher than 60% received thrombolytic therapy. By using a cutoff of 60%, the PE index was used to identify 52 of 53 (98%) patients who survived and five of six (83%) patients who died.
CONCLUSION: Preliminary evidence suggests that quantification of clot with CT pulmonary angiography is an important predictor of patient death in the setting of PE.