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Does Adding the Pulmonary Infarction and Right Ventricle to Left Ventricle Diameter Ratio to the Qanadli Index (A Combined Qanadli Index) More Accurately, Predict Short-Term Mortality in Patients with Pulmonary Embolism?Funding None.
Background The Qanadli index can be used to assess the severity of pulmonary arterial involvement in patients with acute pulmonary embolism. However, it seems that considering pulmonary infarction and right ventricle/left ventricle (RV/LV) ratio along with this index (called the combined Qanadli index) can provide a more accurate view of changes in cardiovascular parameters in these patients and help predict mortality in a better manner. In this regard, we evaluated the ability of the combined Qanadli index versus the Qanadli index in predicting short-term mortality in patients with pulmonary embolism.
Methods This retrospective study enrolled 234 patients with acute pulmonary embolism. Patients were divided into two groups: those who expired in 30 days and who survived. Then they were evaluated by computed tomography angiography of pulmonary arteries. The RV/LV diameter ratio and also pulmonary artery obstruction index (PAOI) were calculated. The patient's computed tomography scans were reviewed for pulmonary infarction. By adding the RV/LV ratio and pulmonary infarction to PAOI, a new index called the modified Qanadli score was made. Univariable and multivariable logistic regression was done for finding predictors of mortality.
Results Nine cases (40%) of patients in the mortality group and 42 (20%) of survivors had ischemic heart disease and the difference was significantly meaningful. The mean Qanadli index in the mortality group was 16.8 ± 8.45 and in survivors was 8.3 ± 4.2. By adding the pulmonary infarction score and PAOI score to RV/LV ratio score, the odds ratio (OR) for predicting mortality increased significantly to 13 and 16, respectively, which were significantly meaningful. Based on our findings, the highest OR for predicting short-term mortality was obtained through a combined Qanadli index (PAOI score + pulmonary infarction score + RV/LV score) that was 17 in univariable and 18 in multivariable logistic regression analysis (p-value = 0.015).
Conclusion The new combined Qanadli index has more ability than the Qanadli index and RV/LV ratio for predicting changes in cardiovascular parameters and short-term mortality in patients with pulmonary embolism.
Article published online:
16 June 2023
© 2023. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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- 1 Espinosa LA, Kelly AM, Hawley C. et al. Clinical utility of multiplanar reformation in pulmonary CT angiography. Am J Roentgenol 2010; 194 (01) 70-75
- 2 Akhoundi N, Langroudi TF, Rajebi H. et al. Computed tomography pulmonary angiography for acute pulmonary embolism: prediction of adverse outcomes and 90-day mortality in a single test. Pol J Radiol 2019; 84: e436-e446
- 3 Akhoundi N, Faghihi Langroudi T, Rezazadeh E. et al. Role of clinical and echocardiographic findings in patients with acute pulmonary embolism: prediction of adverse outcomes and mortality in 180 days. Tanaffos 2021; 20 (02) 99-108
- 4 Abdellatif W, Ebada MA, Alkanj S. et al. Diagnostic accuracy of dual-energy CT in detection of acute pulmonary embolism: a systematic review and meta-analysis. Can Assoc Radiol J 2021; 72 (02) 285-292
- 5 Cozzi D, Moroni C, Cavigli E. et al. Prognostic value of CT pulmonary angiography parameters in acute pulmonary embolism. Radiol Med (Torino) 2021; 126 (08) 1030-1036
- 6 Rotzinger DC, Knebel JF, Jouannic AM, Adler G, Qanadli SD. CT pulmonary angiography for risk stratification of patients with nonmassive acute pulmonary embolism. Radiol Cardiothorac Imaging 2020; 2 (04) e190188 DOI: 10.1148/ryct.2020190188.
- 7 Shen C, Yu N, Wen L. et al. Risk stratification of acute pulmonary embolism based on the clot volume and right ventricular dysfunction on CT pulmonary angiography. Clin Respir J 2019; 13 (11) 674-682
- 8 Chen Z, Deblois S, Toporowicz K. et al. Yield of CT pulmonary angiography in the diagnosis of acute pulmonary embolism: short report. BMC Res Notes 2019; 12 (01) 41
- 9 Wang RC, Miglioretti DL, Marlow EC. et al. Trends in imaging for suspected pulmonary embolism across US health care systems, 2004 to 2016. JAMA Netw Open 2020; 3 (11) e2026930 DOI: 10.1001/jamanetworkopen.2020.26930.
- 10 Gao Y, Chen L, Jia D. A predictive tool for the assessment of right ventricular dysfunction in non-high-risk patients with acute pulmonary embolism. BMC Pulm Med 2021; 21 (01) 42
- 11 Anjum O, Bleeker H, Ohle R. Computed tomography for suspected pulmonary embolism results in a large number of non-significant incidental findings and follow-up investigations. Emerg Radiol 2019; 26 (01) 29-35
- 12 Dhakal P, Iftikhar MH, Wang L. et al. Overutilisation of imaging studies for diagnosis of pulmonary embolism: are we following the guidelines?. Postgrad Med J 2019; 95 (1126): 420-424
- 13 Liu W, Liu M, Guo X. et al. Evaluation of acute pulmonary embolism and clot burden on CTPA with deep learning. Eur Radiol 2020; 30 (06) 3567-3575
- 14 Howard L. Acute pulmonary embolism. Clin Med (Lond) 2019; 19 (03) 243-247
- 15 Lerche M, Bailis N, Akritidou M, Meyer HJ, Surov A. Pulmonary vessel obstruction does not correlate with severity of pulmonary embolism. J Clin Med 2019; 8 (05) 584
- 16 Soffer S, Klang E, Shimon O. et al. Deep learning for pulmonary embolism detection on computed tomography pulmonary angiogram: a systematic review and meta-analysis. Sci Rep 2021; 11 (01) 15814 DOI: 10.1038/s41598-021-95249-3.
- 17 Lin Y, Su J, Wang X. et al. Automated pulmonary embolism detection from CTPA images using an end-to-end convolutional neural network. In Medical Image Computing and Computer Assisted Intervention -MICCAI 2019: 22nd International Conference, Shenzhen, China, October 13–17, 2019, Proceedings, Part IV 2019 Oct 10 (pp. 280–288). Cham: Springer International Publishing;
- 18 Cano-Espinosa C, Cazorla M, González G. Computer aided detection of pulmonary embolism using multi-slice multi-axial segmentation. Applied Sci 2020; 10 (08) 2945
- 19 Schoepf UJ, Costello P. CT angiography for diagnosis of pulmonary embolism: state of the art. Radiology 2004; 230 (02) 329-337
- 20 Qanadli SD, El Hajjam M, Vieillard-Baron A. et al. New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. AJR Am J Roentgenol 2001; 176 (06) 1415-1420
- 21 El-Menyar A, Nabir S, Ahmed N, Asim M, Jabbour G, Al-Thani H. Diagnostic implications of computed tomography pulmonary angiography in patients with pulmonary embolism. Ann Thorac Med 2016; 11 (04) 269-276
- 22 Apfaltrer P, Henzler T, Meyer M. et al. Correlation of CT angiographic pulmonary artery obstruction scores with right ventricular dysfunction and clinical outcome in patients with acute pulmonary embolism. Eur J Radiol 2012; 81 (10) 2867-2871
- 23 Duffett L, Castellucci LA, Forgie MA. Pulmonary embolism: update on management and controversies. BMJ 2020; 370: m2177 DOI: 10.1136/bmj.m2177.
- 24 Kaminetzky M, Moore W, Fansiwala K. et al. Pulmonary embolism at CT pulmonary angiography in patients with COVID-19. Radiol Cardiothorac Imaging 2020; 2 (04) e200308 DOI: 10.1148/ryct.2020200308.
- 25 Weikert T, Winkel DJ, Bremerich J. et al. Automated detection of pulmonary embolism in CT pulmonary angiograms using an AI-powered algorithm. Eur Radiol 2020; 30 (12) 6545-6553
- 26 Aldosari S, Jansen S, Sun Z. Optimization of computed tomography pulmonary angiography protocols using 3D printed model with simulation of pulmonary embolism. Quant Imaging Med Surg 2019; 9 (01) 53-62
- 27 Bozorgmehr R, Pishgahi M, Mohaghegh P, Bayat M, Khodadadi P, Ghafori A. Relationship between thrombosis risk factors, clinical symptoms, and laboratory findings with pulmonary embolism diagnosis; a cross-sectional study. Arch Acad Emerg Med 2019; 7 (01) 41
- 28 Patel P, Patel P, Bhatt M. et al. Systematic review and meta-analysis of test accuracy for the diagnosis of suspected pulmonary embolism. Blood Adv 2020; 4 (18) 4296-4311
- 29 Lyhne MD, Schultz JG, MacMahon PJ. et al. Septal bowing and pulmonary artery diameter on computed tomography pulmonary angiography are associated with short-term outcomes in patients with acute pulmonary embolism. Emerg Radiol 2019; 26 (06) 623-630
- 30 Furlan A, Aghayev A, Chang CC. et al. Short-term mortality in acute pulmonary embolism: clot burden and signs of right heart dysfunction at CT pulmonary angiography. Radiology 2012; 265 (01) 283-293
- 31 Çildag MB, Gok M, Karaman CZ. Pulmonary artery obstruction index and right ventricular dysfunction signs in initial and follow up pulmonary computed tomography angiography in acute pulmonary embolism. J Clin Diagn Res 2017; 11 (07) TC21-TC25
- 32 Zhou Y, Shi H, Wang Y, Kumar AR, Chi B, Han P. Assessment of correlation between CT angiographic clot load score, pulmonary perfusion defect score and global right ventricular function with dual-source CT for acute pulmonary embolism. Br J Radiol 2012; 85 (1015): 972-979
- 33 van der Meer RW, Pattynama PM, van Strijen MJ. et al. Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism. Radiology 2005; 235 (03) 798-803
- 34 Chaosuwannakit N, Soontrapa W, Makarawate P, Sawanyawisuth K. Importance of computed tomography pulmonary angiography for predict 30-day mortality in acute pulmonary embolism patients. Eur J Radiol Open 2021; 25 (08) 100340-100340