Role of MDCT in detection of ventricular dysfunction and pulmonary obstruction index in patients with acute pulmonary embolism

To retrospectively quantity right ventricular dysfunction [RVD] and the pulmonary artery obstruction index in MDCT on the basis of various criteria proposed in the literature and to assess the predictive value of these CT parameters for mortality it has been compared to the echocardiographic assessments. In a retrospective study we reviewed 80 patients where there primary clinical and laboratory diagosis are suggestive of Pulmonary embolism [in Erfan and Baghdo hospital], 20 patient were negative on CT Study while 60 patient were positive [25 men, 35 women; mean age +/- standard deviation 50 years +/- 16] with proved PE, by dectection of the extent of RVD by quantifying the ratio of the right ventricle to left ventricle short-axis diameters [RV/LV] and tile pulmonary artery to ascending aorta diameters, the shape of the interventricular septum, and the extent of obstruction to the pulmonary artery circulation on MDCT. Regression analysts was used to correlate these parameters with the echocardiography and patient outcome. CT signs of RVD [RV/LV ratio, >1.0] were seen in 35 patients [58.3%] in the follow-up, 5 patients died of PE. Both the obstruction index and RV/LV ratio were shown to be significant risk factors for mortality [p=.01 and .03, respectively]. No relationship was found for the ratio of the pulmonary artery to ascending aorta diameters [p= .99] or for the shape of the interventricular septum [p= .30]. The positive predictive value for PE-related mortality with an RV/LV ratio greater than 1.0 was 10.1%. The negative predictive value for an uneventful outcome with an RV/LV ratio of 1.0 or less was 100%. There was a 14 -fold increased risk of dying of PE for patients with an obstruction index of 40% or higher. The Measurement of RVD and pulmonary vascular obstruction index evaluated with MDCT CT at baseline, help predict the prognosis during follow-up