Ralf W. Bauer MD, Presenter: Research Consultant, Siemens AG Speakers Bureau, Siemens AG

Claudia Frellesen, Abstract Co-Author: Nothing to Disclose

Matthias Renker BSc, Abstract Co-Author: Nothing to Disclose

Boris Schell MD, Abstract Co-Author: Nothing to Disclose

Thomas Lehnert MD, Abstract Co-Author: Nothing to Disclose

Hanns Ackermann, Abstract Co-Author: Nothing to Disclose

Volkmar Jacobi MD, Abstract Co-Author: Nothing to Disclose

U. Joseph Schoepf MD, Abstract Co-Author: Speakers Bureau, Bayer AG Speakers Bureau, Siemens AG Medical Advisory Board, Bayer AG Research grant, Bayer AG Research grant, Bracco Group Research grant, General Electric Company Research grant, Siemens AG

Thomas Josef Vogl MD, PhD, Abstract Co-Author: Nothing to Disclose

Josef Matthias Kerl MD, Abstract Co-Author: Research Consultant, Siemens AG Speakers Bureau, Siemens AG

To investigate the role of perfusion defect (PD) size on dual energy CT pulmonary blood volume assessment as predictor of right heart strain and patient outcome and its correlation with d-dimer levels in acute pulmonary embolism (PE).

53 patients with acute PE who underwent DECT pulmonary angiography were retrospectively analyzed. Pulmonary PD size caused by PE was measured on DE iodine maps and quantified absolutely (VolPD) and relatively to the total lung volume (RelPD). Signs of right heart strain (RHS) on CT were determined. Information on d-dimer levels and readmission for recurrent onset of PE and death was collected. Results were compared to data of 53 patients who underwent DECT pulmonary angiography and that did not show PE or PE-related PD.

Patients without PE had significantly lower d-dimer levels than patients with PE. D-dimer level was mildly (r = 0.43-0.47) correlated with PD size. Patients with RHS had significantly higher VolPD (215 vs. 73 ml) and RelPD (9.9 vs. 2.9%) than patients without RHS (p < 0.003). There were 2 deaths and 1 readmission due of PE in 18 patients with >5% RelPD, while no such events were found for patients with <5% RelPD. While no difference in survival was seen for patients with vs. without RHS, median survival was significantly (p < 0.04) lower in patients with >5% RelPD compared to patients with <5% RelPD and without PE. Cox analysis revealed RelPD to be the strongest predictor of survival, even over RHS, in this study.

Pulmonary blood volume on DECT in acute PE correlates with RHS and appears to be a predictor of patient outcome in this pilot study. Confirmatory prospective studies are mandatory to clarify our initial observations.

PD size on DECT pulmonary angiography may serve as a novel outcome predictor and hence for risk stratification in acute PE.

Bauer, R, Frellesen, C, Renker, M, Schell, B, Lehnert, T, Ackermann, H, Jacobi, V, Schoepf, U, Vogl, T, Kerl, J, Dual-Energy CT Pulmonary Blood Volume Assessment in Acute Pulmonary Embolism: Correlation with D-Dimer Level, Right Heart Strain, and Clinical Outcome.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11005576.html