Contrast Circulation Time to Assess Right Ventricular Dysfunction in Pulmonary Embolism: A Retrospective Pilot StudyReport as inadecuate




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Objective

To optimize enhancement of pulmonary arteries and facilitate diagnosis of pulmonary embolism PE, modern computed tomography angiography CTA contains a contrast bolus tracking system. We explored the diagnostic accuracy of the time-intensity curves given by this automated system to identify right ventricular dysfunction RVD in acute PE.

Methods

114 CTAs with a diagnosis of PE were reviewed. RVD was defined as right-to-left ventricular diameter ratio of 1 or greater. Four parameters on time-intensity curves were identified. Parameters between CTAs with and those without RVD were compared with the Wilcoxon rank-sum test. The ability of the four parameters to discriminate patients with RVD was explored by compiling the area under the operating curves AUC.

Results

The time needed by the contrast media to reach the pulmonary artery 8 seconds IQR: 7–9 versus 7 seconds IQR: 6–8, p<0.01, the time needed to reach 40 Hounsfield units HU 11 seconds IQR: 8.5–14 versus 9.5 seconds IQR: 8–10.5, p<0.01, and the contrast intensity reached after 10 seconds 19 HU IQR: 4–67 versus 53 HU IQR: 32–80, p<0.05 were all statistically different between CTA with and CTA without RVD. Those three parameters changed gradually across severity categories of RVD p<0.05 for trend. Their AUC to identify RVD ranged from 0.63 to 0.66. The slope of contrast intensity over time was not informative: 31 HU-s IQR: 20–57 in CTA with, compared to 36 HU-s IQR: 22.5–53 in CTA without RVD, p = 0.60.

Conclusion

Several parameters of the time-intensity curve obtained by the bolus tracking system are associated with RVD assessed on CTA images. Of those, the time needed to reach a predefined threshold seems to be the easiest to obtain in any CTA without additional processing time or contrast injection. However, the performance of those parameters is globally low.



Author: Gregor John , Alexandra Platon, Pierre-Alexandre Poletti, Arnaud Perrier, Karim Bendjelid

Source: http://plos.srce.hr/



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