Comparison of Informative Values on Different Imaging Methods in Diagnostic of Pulmonary Embolism (PE)

Ligita Zvaigzne
Departaments of Radiology and Cardiology, Paul Stradins Clinical University Hospital, Latvia

PE is a cardiovascular pathology which is one of the main causes of mortality and hospitalization in Europe, therefore it is important to diagnose it timely and to start the appropriate treatment. The diagnosis is confirmed by different imaging techniques from which most frequently is used computerized tomographic pulmonary angiography (CTPA) and/or echocardiography (ECHO).

Aim. To clarify the sensitivity of imaging techniques (CTPA and ECHO) for diagnosing PE and to compare them informatively.

Methods. The information is collected from medical archive of P.Stradins Clinical University Hospital about 190 patients treated with the diagnosis of PE from 01.01.2013.–31.10.2014.

Results.66.3%(126) were women and 33.7%(64) men. CTPA was performed in 93.7% (118) of women, with PE diagnosis confirmed in 99.2% (117), and 98.4% (63) of men, with PE confirmed in 96.8%(61). In the main pulmonary arteries filling defects were observed in 63.6% (75) of women and 55.6% (35) of men, in lobe arteries – 50.8%(60) and 31.7% (20), in segmental – 86.4%(102) and 84.1% (53). Bilateral PE was found in 82.9% (97) of and 82.0% (50), massive – 68,7%(81) and 60,4% (38), central – 78,0% (92) and 66,7% (42). Right heart dilation in CTPA was detected in 47.0%(31) and 43.3%(13).

ECHO was performed in 73.0%(93) of women and 81.0%(51) of men. Right atrial area(RAA) was above the norm – statistically significantly higher in men 21.7 (±6.7) than in women 19.4 (±5.4)cm2 (p=0.029). Right ventricular systolic pressure (RVSP) was increased in 76.3% (103) of both genders – women 42.5 (35;55), men 40.0 (33;50) mmHg. Left atrial volume index (LAVI) was also increased – 29.0 (24;35)vs. 28.5 (23;39) ml/m2. Ejection fraction (EF Simpson) in men was on the lower limit – 55,0 (45;60)% (reduced in 41,2% (21) of men) with a statistically significant difference (p=0.009) compared to women 60,0 (55;60)% (reduced only in 17,4% (16) of women). Tricuspid regurgitation(TR) occurred in 96.7% (89) and 100% (51) (mostly grade 2).

Conclusions. CTPA is the gold standard for diagnosing PE (sensitivity 98.3%), however, there are situations when it is contraindicated (hemodynamically unstable patient, severe renal failure, etc.). In those cases echocardiography can be performed (sensitivity 50,7–76,3%). Most frequently in CTPA filling defects are observed bilaterally in segmental arteries. There is a statistically significant correlation between increased RAA (determined in ECHO) and the right heart dilatation described in CTPA.