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1
Department of Radiology, University René
Descartes-Paris V, Ambroise Paré Hospital, 9
Avenue Charles De Gaulle, 92104 Boulogne, France.
2
Medical Intensive Care Unit, University René
Descartes-Paris V, Ambroise Paré Hospital,
92104 Boulogne, France.
3
Department of Cardiology, University René
Descartes-Paris V, Ambroise Paré Hospital,
92104 Boulogne, France.
4
Department of Radiology, Centre Hospitalier de
L'Université de
Montréal, 1560 Sherbrooke E., Montreal, H2L
4M1, Canada.
OBJECTIVE. This study was designed to define and evaluate a specific index to quantify arterial obstruction with helical CT in acute pulmonary embolism.
MATERIALS AND METHODS. Fifty-four patients (mean age, 56 years) with
proven pulmonary emboli among 158 consecutive patients, who had undergone both
CT and pulmonary angiography for clinically suspected pulmonary embolism, were
eligible for the study. The CT obstruction index was defined as
(n · d) (n, value of the proximal
clot site, equal to the number of segmental branches arising distally;
d, degree of obstruction scored as partial obstruction [value of 1]
or total obstruction [value of 2]). We compared the CT obstruction index with
pulmonary arterial obstruction on angiography (assessed by the Miller index),
using linear regression, and correlated it with findings on echocardiography.
Interobserver variability was determined for both CT and pulmonary angiography
indexes.
RESULTS. The CT obstruction index (29% ± 17%) and the Miller index (43% ± 25%) were well correlated (r = 0.867, p < 0.0001) with an excellent concordance between investigators for both the CT index (r = 0.944, p < 0.0001) and the Miller index (r = 0.904, p < 0.0001). A CT obstruction index greater than 40% identified more than 90% of patients with right ventricular dilatation.
CONCLUSION. The degree of arterial obstruction in pulmonary embolism may be quantified by a specific CT index that appears reproducible and highly correlated to the previously described index with pulmonary angiography. Further evaluations are needed to investigate the usefulness of the CT obstruction index for stratification of patient risk and determining therapeutic options.
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