Galit Aviram MD, Presenter: Nothing to Disclose

Ori rr Rogowski MD, Abstract Co-Author: Nothing to Disclose

Anna Bendler, Abstract Co-Author: Nothing to Disclose

Arie Steinvil, Abstract Co-Author: Nothing to Disclose

Moshe Graif MD, Abstract Co-Author: Nothing to Disclose

Shlomo Berliner MD,PhD, Abstract Co-Author: Nothing to Disclose

To investigate whether fast grading of reflux of contrast to the inferior vena cava (IVC) on computerized tomographic pulmonary angiography (CTPA) is a potential biomarker for real time risk stratification in patients with acute pulmonary embolism (PE).

We retrospectively identified 343 patients investigated for possible pulmonary embolism (PE) by CTPA at our medical center between 9/2004 3/2006. A total of 145 consecutive patients with PE (age 67±19 years) and 168 consecutive ones with negative CTPAs (age 64±20 years) fulfilled entry criteria. CTPAs were evaluated for retrograde reflux of contrast to the IVC by fast visual grading from 1 to 6 using the original axial images. Pulmonary obstruction index, the diameters of right and left ventricles and pulmonary artery, and patient survival data were recorded as well.

Twenty nine (20.0%) patients with positive CTs and in 23 (13.7%) patients with negative CTs had substantial degrees of reflux of contrast to the IVC (≥4) (p=0.14). The Kaplan-Meier 30 day survival curves demonstrated significant reduction in survival in individuals with grade ≥4 reflux of contrast to the IVC compared to lower grades (p=0.008), but not in patients with grade ≥4 and no PE on CTPA (p=0.26). The other cardiovascular parameters showed no significant correlation with survival in patients with and without PE.

Substantial grades of reflux of contrast to the IVC during CTPA could predict early mortality in patients with acute PE. Rapid grading of reflux of contrast from the original axial CTPA images can be used for real time risk stratification in patients with acute PE.  

Since significant grades of reflux of contrast on CTPA are related to increased mortality of patients with PE, reflux assessment has the potential to permit a real time risk stratification  

Aviram, G, Rogowski, O, Bendler, A, Steinvil, A, Graif, M, Berliner, S, Real Time Risk Stratification of Patients with Acute Pulmonary Embolism by Grading the Reflux of Contrast into the Inferior Vena Cava on Computerized Tomographic Pulmonary Angiography.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6008652.html