title: Prognostic value of computed tomography pulmonary angiography indices in patients with cancer-related pulmonary embolism: Data from a multicenter cohort study.
abstract: OBJECTIVE
  To analyze the prognostic value of pulmonary artery obstruction versus right-ventricle (RV) dysfunction radiologic indices in cancer-related pulmonary embolism (PE).
  
  
  METHODS
  We enrolled 303 consecutive patients with paraneoplastic PE, evaluated by computed tomography pulmonary angiography (CTPA) between 2013 and 2014. The primary outcome measure was serious complications at 15days. Multivariate analyses were conducted by using binary logistic and robust regressions. Radiological features such as the Qanadli index (QI) and RV dysfunction signs were analyzed with Spearman's partial rank correlations.
  
  
  RESULTS
  RV diameter was the only radiological variable associated with an adverse outcome. Subjects with enlarged RV (diameter>45mm) had more 15-day complications (58% versus 40%, p=0.001). The QI correlated with the RV diameter (r=0.28, p<0.001), left ventricle diameter (r=-0.19, p<0.001), right ventricular-to-left ventricular diameter ratio (r=0.39, p<0.001), pulmonary artery diameter (r=0.22, p<0.001), and pulmonary artery/ascending aorta ratio (r=0.27, p<0.001). A QI≥50% was only associated with 15-day complications in subjects with enlarged RV, inverted intraventricular septum, or chronic cardiopulmonary diseases. The central or peripheral PE location did not affect the correlations among radiological variables and was not associated with clinical outcomes.
  
  
  CONCLUSIONS
  Right ventricular dysfunction signs in CTPA are more useful than QI in predicting cancer-related PE outcome.
authors.affiliation: Radiology Department, Hospital Universitario Morales Meseguer, Av Marqués de los Vélez, s/n, 30008, Murcia, Spain. Electronic address: plasen79@gmail.com.
authors.forename: Juana María
authors.initials: JM
authors.lastname: Plasencia-Martínez
authors.affiliation: Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Av Marqués de los Vélez, s/n, 30008, Murcia, Spain.
authors.forename: Alberto
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authors.affiliation: Radiology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Spain.
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authors.affiliation: Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Spain.
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authors.affiliation: Department of Physiology, Faculty of Medicine, Campus Universitario de Espinardo, University of Murcia, s/n, 30100 Espinardo, Murcia, Spain.
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authors.affiliation: Radiology Department, Hospital Clínic de Barcelona (HCB), Villarroel, 170, 08036, Barcelona, Spain.
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authors.affiliation: Radiology Department, Hospital Clínic de Barcelona (HCB), Villarroel, 170, 08036, Barcelona, Spain.
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authors.affiliation: Medical Oncology Department, Hospital Clínic de Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain.
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authors.affiliation: Radiology Department, Clínica Universitaria de Navarra (CUN), Avda. Pío XII, 36. 31008, Pamplona, Spain.
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authors.forename: Irma
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authors.lastname: de Al Haba
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authors.affiliation: Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Av Marqués de los Vélez, s/n, 30008, Murcia, Spain.
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authors.forename: Remedios
authors.initials: R
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authors.forename: Fernando
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authors.lastname: Sánchez-Lasheras
authors.affiliation: Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Av Marqués de los Vélez, s/n, 30008, Murcia, Spain.
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mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D011379:Prognosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000150:complications* / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: Multidetector computed tomography; Prognosis; Pulmonary embolism; Right ventricular dysfunction; Tumor