Prognostic value of computed tomography pulmonary angiography indices in patients with cancer-related pulmonary embolism: Data from a multicenter cohort study
Juana María Plasencia-Martínez 1 , Alberto Carmona-Bayonas 2 , David Calvo-Temprano 3 , Paula Jiménez-Fonseca 4 , Francisco Fenoy 5 , Mariana Benegas 6 , Marcelo Sánchez 6 , Carme Font 7 , Diego Varona 8 , David Martínez de la Haza 9 , Jesús Pueyo 10 , Mercè Biosca 11 , Maite Antonio 12 , Carmen Beato 13 , Pilar Solís 4 , Laura Fáez 4 , Irma de Al Haba 14 , Susana Hernández-Muñiz 15 , Olga Madridano 16 , Mar Martín 16 , Eduardo Castañón 17 , Avinash Ramchandani 18 , Pablo Marchena 19 , Manuel Sánchez-Cánovas 2 , María Ángeles Vicente 2 , Mari José Martínez 20 , Ángela Fernández-Plaza 21 , Lourdes Martínez-Encarnación 21 , Alejandro Puerta 22 , Ángel Domínguez 23 , Daniel Rodríguez 24 , Gema Marín 25 , Remedios Otero 26 , Fernando Sánchez-Lasheras 27 , Vicente Vicente 2
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.
CITA DEL ARTÍCULO Eur J Radiol. 2017 Feb;87:66-75. doi: 10.1016/j.ejrad.2016.12.010. Epub 2016 Dec 13.