The Application Of MSCTPA In Pulmonary Embolism And Right Heart Function Evaluation

Part 1 Reproducibility of CT Signs of Right Ventricular Dysfunction in Acute Pulmonary EmbolismObjective: The purpose of our study was to evaluate the reproducibility of CT-related right ventricular parameters quantitative measurement in patient with pulmonary embolism of different interobserver and the same observer at different times.Methods: A retrospective study including 50 cases with PE MSCTPA data,from January 2013 to November 2014. To make quantitative evaluation for the CT-related right ventricular parameters of pulmonary embolism, including : bowing of the interventricular septum, inferior vena cava(IVC) contrast medium reflux, RV diameter(RVD)/left ventricular diameter(LVD) ratio on axial sections and four-chamber(4-CH) views, and right and left ventricular area ratio(RVA/LVA)on four-chamber section. Statistic analysis used kappa statistics, Pearson coefficient of rank correlation.Result: There were showed good consistency in septal position(κ=0.754) and the vena cava reflux(κ=0.865) with the same observer. The RVD-ax/LVD-ax, RVD-4ch/LVD-4ch, and RVA/LVA at different time for Pearson analysis were 0.959, 0.932 and 0.987, respectively(P=0.000).The septal position(κ= 0.308) and the vena cava reflux(κ= 0.503) consistency is acceptable with different observers. The correlation coefficients of RVD-ax/LVD-ax, RVD-4ch/LVD-4ch and RVA/LVA were 0.556,0.652,0.793(P = 0.000) for Pearson analysis.Conclusion: There was good agreement in the same observor for acute pulmonary embolism with CT-related right ventricular parameters. However, there was a significant difference between different observers.The RVA/LVA ratio is objective indicators to evaluate right ventricular function of pulmonary embolism. Part 2 The correlation research of pulmonary embolism and right heart function with MSCTPAObjective: To evaluate the correlation between acute pulmonary embolism(PE) and right cardiac function by multi-slice CT pulmonary angiography(MSCTPA),and assess the severity of patients with acute pulmonary embolism.Methods: A retrospective study including 107 cases MSCTPA data, of which 57 cases with PE(5 central PE with death, 22 central PE survivor and 30 peripheral PE cases), 50 cases without pulmonary embolism(20 male, 30 female, with mean age of 47.72±15.36), from January 2012 to November 2013. Using CT postprocessing software measured thoracic aorta and main pulmonary artery inner diameter ratio(PA/AO), right ventricular correlation parameter, including right ventricle diameter to left ventricle diameter ratio(RVD/LVD) and right ventricle area to left ventricle area ratio(RVA/LVA) on axial four-chamber(4-CH) sections and the largest of maximum minor axis diameters on axial sections(RV/LV-LD). To compare the difference of CT related right heart parameter between the groups of central PE with death,central PE survivor, peripheral PE and the control group.Results: There were significantly different between PE group and the control group with CT-related right ventricular parameters RVD/LVD, RV/LV-LD, RVA/LAV in PE group(P<0.05)(excepting PA/AO). Statistically significant differences were found in these measurements(RVD/LVD, RV/LV-LD, RVA/LAV)comparing patients with central PE with death and central PE survivors and those with peripheral PE and control group(P=0.000). There were significantly different between central PE survivor and peripheral PE with CT-related right ventricular parameters RVD/LVD, RVA/LAV;but there were no statistically significant differences between peripheral PE patients and the control group in all RV parameters. Analyze the cor dextrum measuring index ROC curve of central PE with death group, RVA/LVA is the best indicator of predicting early death(AUC = 0.873), with a sensitivity of 100%, specificity 71.2%.Conclusion: MSCTPA not only is able to accurately diagnose acute pulmonary embolism, but also is an objective evaluation of all relevant parameters of the right ventricle. Which plays an important role in assessing the severity degree of acute pulmonary embolism.Part 3 The correlation study between acute pulmonary embolism and age with MSCTPAObjective: To evaluate the correlation between acute pulmonary embolism(PE) and age by multi-slice CT pulmonary angiography(MSCTPA).Methods: A retrospective study including 107 cases MSCTPA data, of which 57 cases with PE(29 male, 28 female, with mean age of 55.63±16.01), 50 cases without pulmonary embolism(20 male, 30 female, with mean age of 47.72±15.36), from January 2012 to November 2013. Using CT postprocessing software measured right ventricular correlation parameter, including right ventricle diameter to left ventricle diameter ratio(RVD/LVD) and right ventricle area to left ventricle area ratio(RVA/LVA) on axial four-chamber(4-CH) sections and the largest of maximum minor axis diameters on axial sections(RV/LV-LD). To compare the difference of CT related right heart parameter between PE group and control group with different age.Result: There were significantly different between age <45 years old and age ≥45 years old with CT-related right ventricular parameters RVD/LVD, RV/LV-LD, RVA/LAV in PE group(P<0.05); However there were no significantly different in control group between age<45 years old and age≥45 years old(P>0.05). The RVD/LVD, RVA/LAV and RV/LV-LD have no statistically significant differences between pulmonary embolism group and the control group in age<45 years old(P>0.05); but there showed significantly different between the two groups in age≥45 years old(P<0.05).Conclusion: MSCTPA palys an important role in objective diagnosis of acute PE, The study showed acute PE severity related with age, Which has very important clinical significance.