Prediction of chronic thromboembolic pulmonary hypertension with standardised evaluation of initial computed tomography pulmonary angiography performed for suspected acute pulmonary embolism

Autor: Lucia J.M. Kroft, Lilian J. Meijboom, Anton Vonk Noordegraaf, Marion Delcroix, Albert T. A. Mairuhu, Marek Gołębiowski, Yvonne M. Ende-Verhaar, Gudula J. A. M. Boon, Johan Coolen, Cornelis J. van Rooden, Ludo F. M. Beenen, Menno V. Huisman, Frederikus A. Klok, Saskia Middeldorp, Piotr Pruszczyk
Přispěvatelé: Pulmonary medicine, Radiology and nuclear medicine, ACS - Pulmonary hypertension & thrombosis, Graduate School, Radiology and Nuclear Medicine, ACS - Microcirculation, ANS - Neurovascular Disorders, Vascular Medicine, ARD - Amsterdam Reproduction and Development
Rok vydání: 2021
Předmět:
Zdroj: European Radiology. Springer Verlag
European radiology. Springer Verlag
European Radiology, 32, 2178-2187. SPRINGER
Boon, G J A M, Ende-Verhaar, Y M, Beenen, L F M, Coolen, J, Delcroix, M, Golebiowski, M, Huisman, M V, Mairuhu, A T A, Meijboom, L J, Middeldorp, S, Pruszczyk, P, van Rooden, C J, Vonk Noordegraaf, A, Kroft, L J M & Klok, F A 2021, ' Prediction of chronic thromboembolic pulmonary hypertension with standardised evaluation of initial computed tomography pulmonary angiography performed for suspected acute pulmonary embolism ', European Radiology . https://doi.org/10.1007/s00330-021-08364-0
European Radiology, 32, 4, pp. 2178-2187
European Radiology, 32, 2178-2187
ISSN: 1432-1084
0938-7994
DOI: 10.1007/s00330-021-08364-0
Popis: Objectives Closer reading of computed tomography pulmonary angiography (CTPA) scans of patients presenting with acute pulmonary embolism (PE) may identify those at high risk of developing chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to validate the predictive value of six radiological predictors that were previously proposed. Methods Three hundred forty-one patients with acute PE were prospectively followed for development of CTEPH in six European hospitals. Index CTPAs were analysed post hoc by expert chest radiologists blinded to the final diagnosis. The accuracy of the predictors using a predefined threshold for ‘high risk’ (≥ 3 predictors) and the expert overall judgment on the presence of CTEPH were assessed. Results CTEPH was confirmed in nine patients (2.6%) during 2-year follow-up. Any sign of chronic thrombi was already present in 74/341 patients (22%) on the index CTPA, which was associated with CTEPH (OR 7.8, 95%CI 1.9–32); 37 patients (11%) had ≥ 3 of 6 radiological predictors, of whom 4 (11%) were diagnosed with CTEPH (sensitivity 44%, 95%CI 14–79; specificity 90%, 95%CI 86–93). Expert judgment raised suspicion of CTEPH in 27 patients, which was confirmed in 8 (30%; sensitivity 89%, 95%CI 52–100; specificity 94%, 95%CI 91–97). Conclusions The presence of ≥ 3 of 6 predefined radiological predictors was highly specific for a future CTEPH diagnosis, comparable to overall expert judgment, while the latter was associated with higher sensitivity. Dedicated CTPA reading for signs of CTEPH may therefore help in early detection of CTEPH after PE, although in our cohort this strategy would not have detected all cases. Key Points • Three expert chest radiologists re-assessed CTPA scans performed at the moment of acute pulmonary embolism diagnosis and observed a high prevalence of chronic thrombi and signs of pulmonary hypertension. • On these index scans, the presence of ≥ 3 of 6 predefined radiological predictors was highly specific for a future diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), comparable to overall expert judgment. • Dedicated CTPA reading for signs of CTEPH may help in early detection of CTEPH after acute pulmonary embolism.
Databáze: OpenAIRE
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