title: CT pulmonary angiography-based scoring system to predict the prognosis of acute pulmonary embolism.
abstract: BACKGROUND
  The purpose is to develop a comprehensive risk-scoring system based on CT findings for predicting 30-day mortality after acute pulmonary embolism (PE), and to compare it with PE Severity Index (PESI).
  
  
  METHODS
  The study included consecutive 1698 CT pulmonary angiograms (CTPA) positive for acute PE performed at a single institution (2003-2010). Two radiologists independently assessed each study regarding clinically relevant findings and then performed adjudication. These variables plus patient clinical information were included to build a LASSO logistic regression model to predict 30-day mortality. A point score for each significant variable was generated based on the final model. PESI score was calculated in 568 patients who visited the hospital after 2007.
  
  
  RESULTS
  Inter-reader agreements of interpretations were >95% except for septal bowing (92%). The final prediction model showed superior ability over PESI (AUC = 0.822 vs 0.745) for predicting all-cause 30-day mortality (12.4%). The scoring system based on the significant variables (age (years), pleural effusion (+20), pericardial effusion (+20), lung/liver/bone lesions suggesting malignancy (+60), chronic interstitial lung disease (+20), enlarged lymph node in thorax (+20), and ascites (+40)) stratified patients into 4 severity categories, with mortality rates of 0.008% in class-I (≤50 pt), 3.8% in class-II (51-100 pt), 17.6% in class-III (101-150 pt), and 40.9% in class-IV (>150 pt). The mortality rate in the CTPA-high risk category (class-IV) was higher than those in the PESI's high risk (27.4%) and very high risk (25.2%) categories.
  
  
  CONCLUSIONS
  The CTPA-based model was superior to PESI in predicting 30-day mortality. Incorporating the CTPA-based scoring system into image interpretation workflows may help physicians to select the most appropriate management approach for individual patients.
authors: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States; Department of Radiology, Juntendo Univeristy, Tokyo, Japan. Electronic address: k-kumamaru@juntendo.ac.jp.
authors: Kanako K
authors: KK
authors: Kumamaru
authors: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States; Department of Radiology, UT Southwestern Medical Center, Dallas, TX, United States.
authors: Sachin S
authors: SS
authors: Saboo
authors: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States.
authors: Ayaz
authors: A
authors: Aghayev
authors: Massachusetts Institute of Technology, Cambridge, MA, United States.
authors: Phoebe
authors: P
authors: Cai
authors: Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States.
authors: Carlos Gonzalez
authors: CG
authors: Quesada
authors: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States.
authors: Elizabeth
authors: E
authors: George
authors: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States.
authors: Zoha
authors: Z
authors: Hussain
authors: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States.
authors: Tianrun
authors: T
authors: Cai
authors: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States; Department of Radiology, The University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors: Frank J
authors: FJ
authors: Rybicki
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D015588:Observer Variation; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D012372:ROC Curve; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D057188:Workflow
keywords: Computed tomography; Mortality; Prediction; Pulmonary embolism; Risk assessment