Computed tomographic angiography in acute pulmonary embolism: do we need multiplanar reconstructions to evaluate the right ventricular dysfunction?
OBJECTIVE
To compare the indices of right ventricular dysfunction (RVD) obtained from axial transverse images with those derived from the reconstructed 4-chamber and short-axis views in patients with acute pulmonary embolism (PE).


METHODS
Eighty-eight patients with acute PE were retrospectively enrolled. For each patient, axial transverse images and reconstructed 4-chamber and short-axis views were reviewed. Measurements of the ratios of right ventricle to left ventricle (RV/LV) diameters and RV/LV areas were then obtained from all series. Values derived from each method were compared and correlated to arterial obstruction index.


RESULTS
In the studied cohort, RV/LV diameters and RV/LV areas obtained from axial transverse images and the reconstructed 4-chamber views were not statistically different. In contrast, a statistically significant difference was observed between the values of RV/LV areas derived from both axial transverse and 4-chamber views and those obtained from short-axis views (P < 0.0001). There was a weak to moderate correlation between both RV/LV diameters and RV/LV areas and the computed tomographic obstruction index. However, when the study cohort was divided into 3 subgroups with an arterial obstruction index of less than 15% (n = 26), 15% to 30% (n = 21), and greater than 30% (n = 41), those who had values greater than 30% revealed the highest correlation with the indices of RVD.


CONCLUSIONS
In patients with acute PE, the indices of RVD derived from axial transverse images and the reconstructed 4-chamber views yield comparative values. Given the simplicity of the former analysis, it should be taken into consideration for risk stratification in acute PE.
Department of Radiology, Cardiovascular and Metabolic Diseases Centre-CHUV, University of Lausanne, Lausanne, Switzerland. Mohamed-ehab.kamel@chuv.ch
Ehab M
EM
Kamel
Sabine
S
Schmidt
Francesco
F
Doenz
Ghazal
G
Adler-Etechami
Pierre
P
Schnyder
Salah D
SD
Qanadli
D000208:Acute Disease; D000368:Aged; D000792:Angiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging*