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CC BY 4.0 · TH Open 2021; 05(01): e66-e72
DOI: 10.1055/s-0041-1723782
Original Article

Computed Tomography Pulmonary Perfusion for Prediction of Short-Term Clinical Outcome in Acute Pulmonary Embolism

Lisette F. van Dam 
1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
,
Lucia J. M. Kroft
2   Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
,
Menno V. Huisman
1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
,
Maarten K. Ninaber
3   Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
,
Frederikus A. Klok 
1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
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Abstract

Background Computed tomography pulmonary angiography (CTPA) is the imaging modality of choice for the diagnosis of acute pulmonary embolism (PE). With computed tomography pulmonary perfusion (CTPP) additional information on lung perfusion can be assessed, but its value in PE risk stratification is unknown. We aimed to evaluate the correlation between CTPP-assessed perfusion defect score (PDS) and clinical presentation and its predictive value for adverse short-term outcome of acute PE.

Patients and Methods This was an exploratory, observational study in 100 hemodynamically stable patients with CTPA-confirmed acute PE in whom CTPP was performed as part of routine clinical practice. We calculated the difference between the mean PDS in patients with versus without chest pain, dyspnea, and hemoptysis and 7-day adverse outcome. Multivariable logistic regression analysis and likelihood-ratio test were used to assess the added predictive value of PDS to CTPA parameters of right ventricle dysfunction and total thrombus load, for intensive care unit admission, reperfusion therapy and PE-related death.

Results We found no correlation between PDS and clinical symptoms. PDS was correlated to reperfusion therapy (n = 4 with 16% higher PDS, 95% confidence interval [CI]: 3.5–28%) and PE-related mortality (n = 2 with 22% higher PDS, 95% CI: 4.9–38). Moreover, PDS had an added predictive value to CTPA assessment for PE-related mortality (from Chi-square 14 to 19, p = 0.02).

Conclusion CTPP-assessed PDS was not correlated to clinical presentation of acute PE. However, PDS was correlated to reperfusion therapy and PE-related mortality and had an added predictive value to CTPA-reading for PE-related mortality; this added value needs to be demonstrated in larger studies.

Keywords

pulmonary embolism - diagnosis - diagnostic imaging - perfusion - prognosis

Authors' Contributions

L.F.V.D. and F.A.K. had full access to all data in the study and take the responsibility for the integrity of the data and the accuracy of the data analysis. L.F.V.D., L.J.M.K., and F.A.K. performed analysis and interpretation of the data. L.F.V.D. and F.A.K. drafted the manuscript. L.F.V.D., L.J.M.K., M.V.H., M.K.N., and F.A.K. acquired the data, carried out critical revision of the manuscript, and approved the manuscript.




Publication History

Received: 10 November 2020

Accepted: 18 December 2020

Article published online:
10 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
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