Li Caiying MD, PhD, Abstract Co-Author: Nothing to Disclose

Cheng Ting Lin MD, Abstract Co-Author: Nothing to Disclose

Seth Jay Kligerman MD, Abstract Co-Author: Author, Reed Elsevier

Susie N Hong, Abstract Co-Author: Nothing to Disclose

Charles S. White MD, Presenter: Nothing to Disclose

To evaluate the value of CT pulmonary angiography (CTPA) test bolus curve data to predict mortality in patients with pulmonary embolism (PE) in comparison with conventional methods of right ventricular (RV) dysfunction.

The study was approved by our IRB and is HIPAA-compliant. We consecutively evaluated each CTPA study performed with a test bolus technique in a 2-year period. Time-density curve was derived from each test bolus. For comparison, left and right ventricular dimensions (area, diameter) were measured using CT data. A cardiologist blinded to the clinical and other imaging data reviewed a subset of the corresponding echocardiographic images to assess for RV dysfunction. Demographic data, mode of treatment, and patient outcome information were gathered using electronic medical records. Test bolus and anatomic data were correlated with PE-related mortality.

71 patients (34 men and 37 women, average age 54.4 years) who had a CTPA performed using a test bolus technique were diagnosed with acute pulmonary embolism. Factors that were significantly correlated with PE-related mortality were: age > 60 years, RV/LV diameter > 1.5, RV/LV area > 1, bolus curve upslope time > 6 seconds, and 50% downslope time > 6 seconds. Sensitivity/specificity for the last two parameters were 100%/69% and 80%/86%, respectively. 

 Data from the CTPA timing bolus curve provides predictive power similar to that of conventional methods of assessing right ventricular dysfunction for PE-related mortality.

To the best of our knowledge, scant attention has been paid to the characteristics of the test bolus curve and their implications in assessingthe severity of pulmonary embolism. Thus, the purpose of this study is to determine whether test bolus parameters obtained in conjunction with CTPA have predictive value equal to or greater than image-based anatomical parameters for predicting PE-relatedmortality.

Caiying, L, Lin, C, Kligerman, S, Hong, S, White, C, Enhancement Characteristics of the CTPA Test Bolus Curve: Use in Predicting Right Ventricular Dysfunction and Mortality in Patients with Acute Pulmonary Embolism.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003359.html