Risk stratification of acute pulmonary embolism based on the clot volume and right ventricular dysfunction on CT pulmonary angiography

Objective To test the feasibility of the clot volume and right ventricular dysfunction for risk stratification of acute pulmonary embolism (APE) patients. Methods CT pulmonary angiography (CTPA) images of 158 APE patients were collected. After excluding 38 (24.1%) patients due to unsatisfactory quality, 120 APE patients (61 males and 59 females) were divided into high-risk (n = 37) and non-high-risk (n = 83) groups. Clot burden was measured by an automated programme (clot volume) and by two semi-quantitative systems (Qanadli and Mastora scores). The ratios of the right ventricular diameter to left ventricular diameter (RVd/LVd) and area (RVa/LVa) were obtained. The correlations amongst the above parameters were analysed. Receiver operating characteristic (ROC) curves were calculated to determine the efficacy of high-risk APE. Multivariate analyses were used to identify the independent predictors. Results Strong positive correlations were found between the clot volume and both Qanadli score (r(2) = 0.696, P < 0.001) and Mastora score (r(2) = 0.728, P < 0.001), and moderate correlations were found between the clot volume and both RVd/LVd (r(2) = 0.392, P < 0.001) and RVa/LVa (r(2) = 0.389, P < 0.001). The clot volume contributed the highest efficacy (AUC = 0.992) for the identification of high-risk cases, followed by Mastora score (0.968), Qanadli score (0.952), RVa/LVa (0.900) and RVd/LVd (0.892). The clot volume and RVd/LVd were two independent factors of high-risk APE. Conclusions The clot volume is correlated with semi-quantitative clot burden scores and CT measured cardiac parameters. The clot volume and RVd/LVd were two independent factors of high-risk APE patients.