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KMID : 0385920090200010040
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Journal of the Korean Society of Emergency Medicine
2009 Volume.20 No. 1 p.40 ~ p.49
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Usefulness of Quantitative Analysis of Computed Tomography Pulmonary Angiography as a Predictor of Prognosis of Acute Pulmonary Embolism
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Song Sung-Wook
Shin Sang-Do
Kwak Young-Ho
Jae Hwan-Jun
Jung Sung-Koo
Suh Gil-Jun
Park Jin-Sik
Lee Hyun-Ju
Park Eun-Ah
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Abstract
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Purpose: We evaluated the usefulness of quantitative analysis of computed tomography (CT) pulmonary angiography as a predictor of the prognosis of acute pulmonary embolism (PTE).
Methods: We performed a retrospective analysis of 55 patients who visited our emergency department from
January 2000 to November 2007 who were confirmed with PTE by CT pulmonary angiography. Two radiologists blinded
to patient outcome measured CT parameters including the diameter of vessels and chambers, and the quantified
pulmonary artery (PA) clot load score on the basis of embolus size and location. CT parameters and other clinical predictors were analyzed to determine their ability to predict major adverse event (MAE).
Results: Of the 55 patients, 16 (29.1%) had a MAE PTE related shock, intubation, death, thrombolysis, right ventricular (RV) dysfunction within 30 days). Geneva score (odds ratio 2.5, 95% CI 1.18-5.29, p=0.02) and PA clot load score (odds ratio 1.64, 95% CI 1.18-2.27, p<0.01) were strong independent predictors of MAE. The cut-off value of Geneva and PA clot load scores were 4.5 and 19.0, respectively, and the area under the ROC curve were 0.697 (0.546~0.848) and 0.908 (0.828-0.988), respectively.
Conclusion: Geneva and PA clot load score are significant predictors of PTE related shock, intubation, death, thrombolysis, and RV dysfunction within 30 days. CT pulmonary angiography is a useful predictor for the prognosis of PTE
as well as a useful diagnostic tool.
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KEYWORD
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Pulmonary embolism, Pulmonary arteries, angiography, Prognosis
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