New CT Index to Quantify Arterial Obstruction in Pulmonary Embolism
Comparison with Angiographic Index and Echocardiography
Salah D. Qanadli1,
Mostafa El Hajjam1,
Antoine Vieillard-Baron2,
Thierry Joseph3,
Benoit Mesurolle1,
Vincent L. Oliva4,
Olivier Barré1,
Frédéric Bruckert1,
Olivier Dubourg3 and
Pascal Lacombe1
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.
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Fig. 1A. —57-year-old man with acute chest pain. Supraselective
angiogram of left inferior lobar pulmonary artery shows isolated bisegmental
pulmonary emboli in laterobasal (arrow) and anterobasal
(arrowhead) segmental arteries. First investigator scored obstruction
as 2 and perfusion as 1, resulting in Miller index of 8.8%. Second
investigator scored obstruction as 1 and perfusion as 1, resulting in Miller
index of 5.8%.
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Fig. 1B. —57-year-old man with acute chest pain. Axial transverse CT
scan shows totally occlusive clot in left laterobasal segmental artery
(thin arrow) scored by two investigators as 1 with weighting factor
of 2 and partially occlusive clot in left anterobasal segmental artery
(thick arrow) scored by two investigators as 1 with weighting factor
of 1. CT obstruction index for both investigators was 7.5%.
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Fig. 2A. —66-year-old woman with dyspnea. Selective pulmonary
angiograms of right (A) and left (B) pulmonary arteries show
multiple emboli. First investigator scored arterial obstruction as 16 and
perfusion as 7; Miller index was 67%. Second investigator scored obstruction
and perfusion as 16 and 13, respectively; Miller index was 85%. Note that both
investigators had scored obstruction component as 16.
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Fig. 2B. —66-year-old woman with dyspnea. Selective pulmonary
angiograms of right (A) and left (B) pulmonary arteries show
multiple emboli. First investigator scored arterial obstruction as 16 and
perfusion as 7; Miller index was 67%. Second investigator scored obstruction
and perfusion as 16 and 13, respectively; Miller index was 85%. Note that both
investigators had scored obstruction component as 16.
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Fig. 2C. —66-year-old woman with dyspnea. Axial transverse CT scan
shows proximal nonocclusive clot in right and left pulmonary arteries
(arrowheads). Both investigators calculated CT index for obstruction
as 50%.
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Fig. 3A. —47-year-old man with acute right chest pain and dyspnea.
Selective pulmonary angiogram of right pulmonary artery shows proximal clot in
right pulmonary artery (arrows). No residual perfusion in right upper
lobe was seen. Miller index was 65% for first investigator and 55% for second
investigator.
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Fig. 3B. —47-year-old man with acute right chest pain and dyspnea.
Axial transverse CT scans show proximal clot (arrows) completely
occluding upper part of right pulmonary artery (B) and right upper lobe
artery (C). CT index was scored as 40% and 20% for first and second
investigators, respectively.
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Fig. 3C. —47-year-old man with acute right chest pain and dyspnea.
Axial transverse CT scans show proximal clot (arrows) completely
occluding upper part of right pulmonary artery (B) and right upper lobe
artery (C). CT index was scored as 40% and 20% for first and second
investigators, respectively.
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Fig. 3D. —47-year-old man with acute right chest pain and dyspnea.
Axial transverse CT scan (parenchymal setting) at level of right upper lobe
shows subsequent right upper lobe infarction.
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Fig. 4. —Diagram shows relationship between CT obstruction index (red
triangle), Miller index (green triangle), and right ventricle dilatation at
echocardiography. Patients are divided into two subgroups based on presence or
absence of right ventricle dilatation. A ratio of right ventricle area to left
ventricle area (RV/LV) greater than 0.6 is considered indicative of right
ventricle dilatation. Note that all patients except one with CT obstruction
index greater than 40% had right ventricle dilatation and all patients except
one with right ventricle dilatation had Miller index greater than 50%.
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Copyright © 2001 by the American Roentgen Ray Society.
