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Jůza T, Válek V, Vlk D, Dostál M, Andrašina T. Roles of spectral dual-layer CT, D-dimer concentration, and COVID-19 pneumonia in diagnosis of pulmonary embolism. Eur J Radiol Open 2024; 12:100575. [PMID: 38882633 PMCID: PMC11179566 DOI: 10.1016/j.ejro.2024.100575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/22/2024] [Accepted: 05/29/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose To demonstrate advantages of spectral dual-layer computed tomography (CT) in diagnosing pulmonary embolism (PE). To compare D-dimer values in patients with PE and concomitant COVID-19 pneumonia to those in patients without PE and COVID-19 pneumonia. To compare D-dimer values in cases of minor versus extensive PE. Methods A monocentric retrospective study of 1500 CT pulmonary angiographies (CTPAs). Three groups of 500 consecutive examinations: 1) using conventional multidetector CT (CTC), 2) using spectral dual-layer CT (CTS), and 3) of COVID-19 pneumonia patients using spectral dual-layer CT (COV). Only patients with known D-dimer levels were enrolled in the study. Results Prevalence of inconclusive PE findings differed significantly between CTS and CTC (0.8 % vs. 5.4 %, p < 0.001). In all groups, D-dimer levels were significantly higher in PE positive patients than in patients without PE (CTC, 8.04 vs. 3.05 mg/L; CTS, 6.92 vs. 2.57 mg/L; COV, 10.26 vs. 2.72 mg/L, p < 0.001). There were also statistically significant differences in D-dimer values between minor and extensive PE in the groups negative for COVID-19 (CTC, 5.16 vs. 8.98 mg/L; CTS 3.52 vs. 9.27 mg/L, p < 0.001). The lowest recorded D-dimer value for proven PE in patients with COVID-19 pneumonia was 1.19 mg/L. Conclusion CTPAs using spectral dual-layer CT reduce the number of inconclusive PE findings. Plasma D-dimer concentration increases with extent of PE. Cut-off value of D-dimer with 100 % sensitivity for patients with COVID-19 pneumonia could be doubled to 1.0 mg/L. This threshold would have saved 110 (22 %) examinations in our cohort.
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Affiliation(s)
- Tomáš Jůza
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, University Hospital Brno, Masaryk University, Jihlavská 340/20, Brno 625 00, Czech Republic
- Department of Biophysics, Faculty of Medicine, Masaryk University, Kamenice 126/3, Brno 625 00, Czech Republic
| | - Vlastimil Válek
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, University Hospital Brno, Masaryk University, Jihlavská 340/20, Brno 625 00, Czech Republic
| | - Daniel Vlk
- Department of Biophysics, Faculty of Medicine, Masaryk University, Kamenice 126/3, Brno 625 00, Czech Republic
| | - Marek Dostál
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, University Hospital Brno, Masaryk University, Jihlavská 340/20, Brno 625 00, Czech Republic
- Department of Biophysics, Faculty of Medicine, Masaryk University, Kamenice 126/3, Brno 625 00, Czech Republic
| | - Tomáš Andrašina
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, University Hospital Brno, Masaryk University, Jihlavská 340/20, Brno 625 00, Czech Republic
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Valente Silva B, Jorge C, Plácido R, Nobre Menezes M, Mendonça C, Luísa Urbano M, Rigueira J, G Almeida A, Pinto FJ. Comparison of the accuracy of four diagnostic prediction rules for pulmonary embolism in patients admitted to the emergency department. Rev Port Cardiol 2024:S0870-2551(24)00106-9. [PMID: 38663529 DOI: 10.1016/j.repc.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 12/21/2023] [Accepted: 02/07/2024] [Indexed: 07/12/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Ruling out pulmonary embolism (PE) through a combination of clinical assessment and D-dimer level can potentially avoid excessive use of computed tomography pulmonary angiography (CTPA). We aimed to compare the diagnostic accuracy of the standard approach based on the Wells and Geneva scores combined with a standard D-dimer cut-off (500 ng/ml), with three alternative strategies (age-adjusted and the YEARS and PEGeD algorithms) in patients admitted to the emergency department (ED) with suspected PE. METHODS Consecutive outpatients admitted to the ED who underwent CTPA due to suspected PE were retrospectively assessed. Sensitivity, specificity, positive and negative predictive values, likelihood ratios and diagnostic odds ratios were calculated and compared between the different diagnostic prediction rules. RESULTS We included 1402 patients (mean age 69±18 years, 54% female), and PE was confirmed in 25%. Compared to the standard approach (p<0.001), an age-adjusted strategy increased specificity with a non-significant decrease in sensitivity only in patients older than 70 years. Compared to the standard and age-adjusted approaches, the YEARS and PEGeD algorithms had the highest specificity across all ages, but were associated with a significant decrease in sensitivity (p<0.001), particularly in patients aged under 60 years (sensitivity of 81% in patients aged between 51 and 60 years). CONCLUSION Compared to the standard approach, all algorithms were associated with increased specificity. The age-adjusted strategy was the only one not associated with a significant decrease in sensitivity compared to the standard approach, enabling CTPA requests to be reduced safely.
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Affiliation(s)
- Beatriz Valente Silva
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| | - Cláudia Jorge
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Rui Plácido
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Miguel Nobre Menezes
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Carlos Mendonça
- Radiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Maria Luísa Urbano
- Radiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Joana Rigueira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana G Almeida
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Yao MM, Lin TT, Shi X, Chen MG, Wu JX, Zhao YP, Lin BS. Thrombosis density ratio can predict the occurrence of pulmonary embolism and post-thrombotic syndrome in lower-extremity deep vein thrombosis patients. Clin Hemorheol Microcirc 2024; 86:395-405. [PMID: 38073380 PMCID: PMC11091615 DOI: 10.3233/ch-231778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Deep vein thrombosis (DVT) formation of lower extremities can lead to serious complications including pulmonary embolism (PE) and chronic post-thrombotic syndrome (PTS). We aimed to explore the relationship between the ratio of thrombotic density and the occurrence of PE and PTS in patients with DVT of the lower extremities. METHODS A retrospective analysis was conducted in patients who performed computed tomography venography, dividing into DVT with PE group (54 patients) and DVT-alone group (34 patients), The clinical data were recorded. Univariate and multivariate logistic regression analysis were used to analysis variables associated with PE. The ability of thrombosis density ratio and Wells score to diagnose PE was evaluated by using the receiver operating characteristic curve (ROC) area under the curve (AUC). According to the treatment and follow-up results, subgroup analysis was performed, and the Villata score was used to determine the presence or absence of PTS and its severity. RESULTS Compare with the DVT-alone group, more patients had dyspnea and chest pain in the DVT with PE group. DVT with PE group had lower the percentage of neutrophils, white blood cell count and platelet count, while had higher blood cell count, D-dimer, wells score, thrombus and thrombus density ratio. Multivariate logistic analysis showed that percentage of neutrophils (OR(95% CIs)=1.15 (1.01,1.31), P = 0.040), platelets (OR(95% CIs)=0.96 (0.93,0.99), P = 0.011), and thrombus density ratio (OR(95% CIs)=5.99 (1.96,18.35), P = 0.002) are independent predictors of PE. The Wells score and thrombosis density ratio were consistent in the diagnostic efficacy of PE. In the subgroup analysis, there was a relevance between the ratio of thrombosis density and the Villalta score. CONCLUSION Percentage of neutrophils, platelets, and thrombus density ratio are independent predictors of PE. The thrombosis density of DVT patients may be an index to predict the risk of PE and PTS in DVT patients.
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Affiliation(s)
- Miao-Miao Yao
- Imaging Teaching and Research Office, School of Medicine, Quanzhou Medical College, Quanzhou, Fujian, China
| | - Ting-Ting Lin
- Training Teaching and Research Section, School of Medicine, Quanzhou Medical College, Quanzhou, Fujian, China
| | - Xu Shi
- Imaging Teaching and Research Office, School of Medicine, Quanzhou Medical College, Quanzhou, Fujian, China
| | - Mei-Gui Chen
- Department of Imaging, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Jia-Xiang Wu
- Imaging Teaching and Research Office, School of Medicine, Quanzhou Medical College, Quanzhou, Fujian, China
| | - Yan-Ping Zhao
- Imaging Teaching and Research Office, School of Medicine, Quanzhou Medical College, Quanzhou, Fujian, China
| | - Bao-Shan Lin
- Department of Child Health, Quanzhou Women’s and Children’s Hospital, Quanzhou, Fujian, China
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Diagnosis of acute heart failure in CT pulmonary angiography: feasibility and accuracy. Eur Radiol 2022; 32:5287-5296. [PMID: 35294585 PMCID: PMC8924734 DOI: 10.1007/s00330-022-08676-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the feasibility and accuracy of diagnosing acute heart failure (HF) with CT pulmonary angiography (CTPA) in emergency department patients. METHODS In this retrospective single-center study, we evaluated 150 emergency department patients (mean age 65 ± 17 years) undergoing CTPA with a fixed scan (100 kVp) and contrast media protocol (60 mL, 4 mL/s) who had no pulmonary embolism (PE). Patients were subdivided into training cohort (n = 100) and test cohort (n = 50). Three independent, blinded readers measured the attenuation in the right ventricle (RV) and left ventricle (LV) on axial images. The ratio (HUratio) and difference (HUdiff) between RV and LV attenuation were calculated. Diagnosis of acute HF was made on the basis of clinical, laboratory, and echocardiography data. Optimal thresholds, sensitivity, and specificity were calculated using the area under the curve (AUC) from receiver operating characteristics analysis. RESULTS Fifty-nine of the 150 patients (40%) were diagnosed with acute HF. Attenuation measurements showed an almost perfect interobserver agreement (intraclass correlation coefficient: 0.986, 95%CI: 0.980-0.991). NT-pro BNP exhibited moderate correlations with HUratio (r = 0.50, p < 0.001) and HUdiff (r = 0.50, p < 0.001). In the training cohort, HUratio (AUC: 0.89, 95%CI: 0.82-0.95) and HUdiff (AUC: 0.88, 95%CI: 0.81-0.95) showed a very good performance to diagnose HF. Optimal cutoff values were 1.42 for HUratio (sensitivity 93%; specificity 75%) and 113 for HUdiff (sensitivity 93%; specificity 73%). Applying these thresholds to the test cohort yielded a sensitivity of 89% and 89% and a specificity of 69% and 63% for HUratio and HUdiff, respectively. CONCLUSION In emergency department patients undergoing CTPA and showing no PE, both HUratio and HUdiff have a high sensitivity for diagnosing acute HF. KEY POINTS • Heart failure is a common differential diagnosis in patients undergoing CT pulmonary angiography. • In emergency department patients undergoing CT pulmonary angiography and showing no pulmonary embolism, attenuation differences of the left and right ventricle have a high sensitivity for diagnosing acute heart failure.
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Prentice D, Wipke-Tevis DD. Adherence to Best Practice Advice for Diagnosis of Pulmonary Embolism. CLIN NURSE SPEC 2021; 36:52-61. [PMID: 34843194 DOI: 10.1097/nur.0000000000000642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study evaluated clinician adherence to the American College of Physicians Best Practice Advice for diagnosis of pulmonary embolism. DESIGN A prospective, single-center, descriptive design was utilized. METHODS A heterogeneous sample of 111 hemodynamically stable adult inpatients with a computed tomography pulmonary angiogram ordered was consented. Electronic medical records were reviewed for demographic and clinical variables to determine adherence. The 6 individual best practice statements and the overall adherence were evaluated by taking the sum of "yes" answers divided by the sample size. RESULTS Overall adherence was 0%. Partial adherence was observed with clinician-recorded clinical decisions rules and obtaining d-dimer (3.6% [4/111] and 10.2% [9/88], respectively) of low/intermediate probability scorers. Age adjustment of d-dimer was not recorded. Computed tomography pulmonary angiogram was the first diagnostic test in 89.7% (79/88) in low/intermediate probability patients. CONCLUSION In hemodynamically stable, hospitalized adults, adherence to best practice guidelines for diagnosis of pulmonary embolism was minimal. Clinical utility of the guidelines in hospitalized adults needs further evaluation. Systems problems (eg, lack of standardized orders, age-adjusted d-dimer values, information technology support) likely contributed to poor guideline adherence.
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Affiliation(s)
- Donna Prentice
- Author Affiliations: Research Scientist, Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, Missouri (Dr Prentice); and Associate Professor, Interim Assistant Dean of Research, and PhD Program Director, Sinclair School of Nursing at the University of Missouri, Columbia (Dr Wipke-Tevis)
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Fu Z, Zhuang X, He Y, Huang H, Guo W. The diagnostic value of D-dimer with simplified Geneva score (SGS) pre-test in the diagnosis of pulmonary embolism (PE). J Cardiothorac Surg 2020; 15:176. [PMID: 32690039 PMCID: PMC7372827 DOI: 10.1186/s13019-020-01222-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background Pulmonary embolism (PE) is the third most common cardiovascular syndrome with an average annual incidence rate of 77 per 100,000 population in the worldwide. The diagnose algorithms for suspected PE are generally include clinical scoring assessment and plasma D-dimer evaluation, patients with high risk of PE require computed tomographic pulmonary angiogram (CTPA) detection for confirmation. Methods In this retrospective analysis, 1035 patients with suspected PE were recruited. All the patients were clinically received simplified Geneva score (SGS) pre-test, determination of plasma D-dimer level, and CTPA detection. All enrolled patients were grouped according to the CTPA results: PE patients and non-PE patients. Then, receiver operating characteristic (ROC) curve were constructed to determine the optimal D-dimer cutoff point value which is based on Yonden’s index (YI). Results 294 (28.4%) patients were confirmed with PE and 741(71.6%) individuals were regarded as non-PE cases by CTPA detection. Using the SGS pre-test, 829 (80.1%) patients were classified PE-unlikely (SGS ≤ 2) and 206 (19.9%) patients were PE-likely (SGS ≥ 3). Patients with D-dimer levels above 1.96 mg/L had a significant risk to suffer from PE (area under curve (AUC), 0.707; 95% CI, 0.678–0.735; p < 0.05). Meanwhile, in patients with SGS ≥ 3, the D-dimer cutoff point value moved to 2.2 mg/L (AUC, 0.644; 95% CI, 0.574–0.709; p < 0.05). Conclusion D-dimer test in combination with SGS pre-test could improve the accuracy of PE diagnosis. Patients with D-dimer levels over 1.96 mg/L (4 times of the normal level) have a significant risk for PE. In patients with SGS ≥ 3, the D-dimer cutoff point concentration for PE risk moves to the levels of 2.2 mg/L.
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Affiliation(s)
- Zhihui Fu
- Department of Respiratory, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 248-252 Dongjie Street, Quanzhou, 362000, Fujian Province, China.
| | - Xibin Zhuang
- Department of Respiratory, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 248-252 Dongjie Street, Quanzhou, 362000, Fujian Province, China
| | - Yueming He
- Department of Respiratory, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 248-252 Dongjie Street, Quanzhou, 362000, Fujian Province, China
| | - Hong Huang
- Department of Respiratory, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 248-252 Dongjie Street, Quanzhou, 362000, Fujian Province, China
| | - Weifeng Guo
- Department of Respiratory, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 248-252 Dongjie Street, Quanzhou, 362000, Fujian Province, China
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Hsiao CC, Chen PC, Kuo PC, Ho CH, Jao JC. Assessment of image quality and dose in contrast-enhanced head and neck CT angiography of New Zealand rabbit. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:739-750. [PMID: 32597826 DOI: 10.3233/xst-200669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Although computed tomography (CT) is a powerful diagnostic imaging modality for diagnosing vascular diseases, it is some what risky to human health due to the high radiation dosage. Thus, CT vendors have developed low dose computed tomography (LDCT) aiming to solve this problem. Nowadays, LDCT has gradually become a main stream of CT examination. OBJECTIVE This study aimed to assess the feasibility of LDCTAin an animal model and compare the imaging features and doses in two clinical scanners. METHODS Twenty-two New Zealand rabbit head and neck CTA images pre- and post-contrast agent injection were performed using256-sliceand 64-slice CT scanners. The tube voltages used in the 256-slice and the 64-slice CTA were 70 kVp and 80 kVp, respectively. Quantitative images indices and radiation doses obtained from CTA in these two scanners were compared. RESULTS More neck arterial vessels could be visualized in multi-planar reconstruction (MPR) CTA on the 256-slice CT scanner than on the 64-slice CT scanner. After contrast agent injection, all observed neck arterial vessels had higher CT numbers in 256-slice CTA than in 64-slice CTA. There was no significant difference in contrast-to-noise (CNR) of CTA images between these two scanners. CT dose index (CTDI) and dose length product (DLP) for the 256-slice CTA were lower than those for the 64-slice CTA. CONCLUSIONS Low dose CTA of rabbits with 70 or 80 kVp is feasible in a 256-slice or a 64-slice CT scanner. The radiation dose from the 256-slice CTA was much lower than that from the 64-slice CTA with comparable SNR and CNR. The technique can be further applied in longitudinal monitoring of an animal stroke model in the future.
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Affiliation(s)
- Chia-Chi Hsiao
- Department of Radiology, Kaohsiung Veterans General Hospital, Taiwan, R.O.C
| | - Po-Chou Chen
- Department of Biomedical Engineering, I-Shou University, Taiwan, R.O.C
| | - Pei-Chi Kuo
- Department of Biomedical Engineering, I-Shou University, Taiwan, R.O.C
| | - Chih-Hao Ho
- Department of Medical Imaging, Taipei City Hospital (Yangming Branch), Taiwan, R.O.C
| | - Jo-Chi Jao
- Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Taiwan, R.O.C
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Jeong MJ, Kwon H, Noh M, Ko GY, Gwon DI, Lee JS, Kim MJ, Choi JY, Han Y, Kwon TW, Cho YP. Relationship of Lower-extremity Deep Venous Thrombosis Density at CT Venography to Acute Pulmonary Embolism and the Risk of Postthrombotic Syndrome. Radiology 2019; 293:687-694. [PMID: 31592733 DOI: 10.1148/radiol.2019190358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Acute deep venous thrombi (DVT) have higher Hounsfield unit values than chronic (bland) thrombi at CT venography. Purpose To determine the relationship between DVT thrombus density found on CT venography images to the presence of acute pulmonary embolism (PE) and the future risk of postthrombotic syndrome (PTS) in patients with DVT. Materials and Methods In this retrospective study, patients were divided into two groups: PE with DVT group and DVT-only group. Wells scores were recorded. Thrombus density ratios were calculated (DVT thrombus Hounsfield units/surrounding vein Hounsfield units). The presence or absence of PTS was determined from the results of the Venous Insufficiency Epidemiologic and Economic Study on Quality of Life (VEINES-QOL) questionnaires given to the patients with DVT. Statistical analyses used receiver operating characteristic curves and Spearman correlation analyses. Results Eighty-six patients were included; the mean age was 60 years ± 17 (51 men; PE with DVT group, 54 patients [63%]; DVT-only group, 32 patients [37%]). The mean thrombus density ratio was significantly higher in the PE with DVT group than in the DVT-only group (53.6% ± 12.4 [standard deviation] vs 42.8% ± 11.9, respectively; P < .001). At multivariable analysis, Wells score greater than 4 (odds ratio, 12.0; 95% confidence interval [CI]: 3.0, 47; P < .001) and higher thrombus density ratio (odds ratio, 1.1; 95% CI: 1.0, 1.2; P = .001) were independent predictors of PE. The diagnostic performance for the thrombus density ratio (area under the receiver operating characteristic curve, 0.74; 95% CI: 0.63, 0.85; P < .001) may be more discriminative than that of the Wells score (area under the receiver operating characteristic curve, 0.70; 95% CI: 0.59, 0.81; P = .002) for the presence of PE. In subgroup analysis, the thrombus density ratio and VEINES-QOL score were correlated (r = 0.61; 95% CI: 0.30, 0.80; P < .001). Conclusion Deep venous thrombosis (DVT) density ratio at CT venography was associated with acute pulmonary embolism in patients with lower-extremity DVT. © RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- Min-Jae Jeong
- From the Departments of Surgery (M.J.J., H.K., M.N., J.Y.C., Y.H., T.W.K., Y.P.C.), Radiology (G.Y.K., D.I.G.), Pulmonology (J.S.L.), and Clinical Epidemiology and Biostatistics (M.J.K.), University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Hyunwook Kwon
- From the Departments of Surgery (M.J.J., H.K., M.N., J.Y.C., Y.H., T.W.K., Y.P.C.), Radiology (G.Y.K., D.I.G.), Pulmonology (J.S.L.), and Clinical Epidemiology and Biostatistics (M.J.K.), University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Minsu Noh
- From the Departments of Surgery (M.J.J., H.K., M.N., J.Y.C., Y.H., T.W.K., Y.P.C.), Radiology (G.Y.K., D.I.G.), Pulmonology (J.S.L.), and Clinical Epidemiology and Biostatistics (M.J.K.), University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Gi-Young Ko
- From the Departments of Surgery (M.J.J., H.K., M.N., J.Y.C., Y.H., T.W.K., Y.P.C.), Radiology (G.Y.K., D.I.G.), Pulmonology (J.S.L.), and Clinical Epidemiology and Biostatistics (M.J.K.), University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Dong Il Gwon
- From the Departments of Surgery (M.J.J., H.K., M.N., J.Y.C., Y.H., T.W.K., Y.P.C.), Radiology (G.Y.K., D.I.G.), Pulmonology (J.S.L.), and Clinical Epidemiology and Biostatistics (M.J.K.), University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Jae Seung Lee
- From the Departments of Surgery (M.J.J., H.K., M.N., J.Y.C., Y.H., T.W.K., Y.P.C.), Radiology (G.Y.K., D.I.G.), Pulmonology (J.S.L.), and Clinical Epidemiology and Biostatistics (M.J.K.), University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Min-Ju Kim
- From the Departments of Surgery (M.J.J., H.K., M.N., J.Y.C., Y.H., T.W.K., Y.P.C.), Radiology (G.Y.K., D.I.G.), Pulmonology (J.S.L.), and Clinical Epidemiology and Biostatistics (M.J.K.), University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Ji Yoon Choi
- From the Departments of Surgery (M.J.J., H.K., M.N., J.Y.C., Y.H., T.W.K., Y.P.C.), Radiology (G.Y.K., D.I.G.), Pulmonology (J.S.L.), and Clinical Epidemiology and Biostatistics (M.J.K.), University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Youngjin Han
- From the Departments of Surgery (M.J.J., H.K., M.N., J.Y.C., Y.H., T.W.K., Y.P.C.), Radiology (G.Y.K., D.I.G.), Pulmonology (J.S.L.), and Clinical Epidemiology and Biostatistics (M.J.K.), University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Tae-Won Kwon
- From the Departments of Surgery (M.J.J., H.K., M.N., J.Y.C., Y.H., T.W.K., Y.P.C.), Radiology (G.Y.K., D.I.G.), Pulmonology (J.S.L.), and Clinical Epidemiology and Biostatistics (M.J.K.), University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Yong-Pil Cho
- From the Departments of Surgery (M.J.J., H.K., M.N., J.Y.C., Y.H., T.W.K., Y.P.C.), Radiology (G.Y.K., D.I.G.), Pulmonology (J.S.L.), and Clinical Epidemiology and Biostatistics (M.J.K.), University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
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Tak T, Karturi S, Sharma U, Eckstein L, Poterucha JT, Sandoval Y. Acute Pulmonary Embolism: Contemporary Approach to Diagnosis, Risk-Stratification, and Management. Int J Angiol 2019; 28:100-111. [PMID: 31384107 PMCID: PMC6679967 DOI: 10.1055/s-0039-1692636] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Pulmonary embolism (PE) affects over 300,000 individuals each year in the United States and is associated with substantial morbidity and mortality. Improvements in the diagnostic performance and availability of computed tomographic pulmonary angiography and D-dimer testing have facilitated the evaluation of patients with suspected PE. High clinical suspicion is required in those with risk factors and/or those that manifest signs or symptoms of venous thromboembolic disease, with validated clinical risk scores such as the Wells and modified Wells score or the PE rule-out criteria helpful in estimating the likelihood for PE. For those with confirmed PE, patients should be categorized and triaged according to the presence or absence of shock or hypotension. Normotensive patients can be further risk-stratified using validated prognostic risk scores, as well as by using imaging and cardiac biomarkers, with those having either signs of right ventricular dysfunction on imaging studies and/or abnormal cardiac biomarkers categorized as being at intermediate-risk and requiring close monitoring and hospital admission. Early discharge and/or home therapy are possible in those that do not manifest any high-risk features. The initial treatment for most patients that are stable consists of anticoagulation, with advanced therapies such as thrombolysis, catheter-based therapies, or surgical embolectomy deferred for those at high risk. Given the heterogeneous presentations of PE and various management strategies available, the development of multidisciplinary PE response teams has emerged to help facilitate decision-making in these patients.
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Affiliation(s)
- Tahir Tak
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Swetha Karturi
- Department of Hospital Medicine, Mayo Clinic Health System, La Crosse, Wisconsin
| | - Umesh Sharma
- Department of Hospital Medicine, Mayo Clinic Health System, La Crosse, Wisconsin
| | - Lee Eckstein
- Department of Imaging Services, Mayo Clinic Health System, La Crosse, Wisconsin
| | - Joseph T. Poterucha
- Division of Critical Care Medicine, Mayo Clinic Health System, La Crosse, Wisconsin
| | - Yader Sandoval
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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