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A Novel Approach to Quantify Acute Pulmonary Embolism Using Computed Tomography Pulmonary Angiography.

Michal Buk1,2, Jiri Weichet1, Josef Kroupa3

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A new Obstruction Index (OI) accurately quantifies thrombus burden in acute pulmonary embolism (APE) patients. This method, using direct measurements from CTPA scans, shows better correlation with right ventricular function improvement than traditional scores.

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acute pulmonary embolismcomputed tomography pulmonary angiographypulmonary embolism quantificationtotal thrombus burden assessment

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Area of Science:

  • Cardiovascular Imaging
  • Pulmonary Medicine
  • Radiology

Background:

  • Acute pulmonary embolism (APE) is a leading cause of cardiovascular death.
  • Current risk assessment relies on CTPA for right ventricular (RV) dysfunction and thrombus burden.
  • Existing scores like MMS and RMS may oversimplify vessel occlusion.

Purpose of the Study:

  • To introduce a novel Obstruction Index (OI) for improved APE quantification.
  • OI is derived from direct thrombus and vessel area measurements on CTPA.
  • To enhance accuracy in assessing thrombus burden and treatment response.

Main Methods:

  • Retrospective analysis of CTPA scans from 20 intermediate- to high-risk APE patients.
  • Assessed RV/LV ratio, Modified Miller Score (MMS), Refined Miller Score (RMS), and OI.
  • Evaluated correlations between RV/LV ratio reduction and reduction of MMS, RMS, and OI using Spearman correlation.

Main Results:

  • Significant reduction in RV/LV ratio, MMS, RMS, and OI post-treatment.
  • OI showed a stronger correlation with RV/LV ratio reduction (r=0.448, P=0.048) than MMS (r=0.279) and RMS (r=0.261).
  • OI demonstrated superior accuracy in reflecting thrombus burden reduction.

Conclusions:

  • The novel Obstruction Index (OI) is more accurate than MMS and RMS for APE quantification.
  • Direct thrombus and vessel area measurements provide precise and reproducible assessments.
  • OI is particularly valuable for evaluating treatment efficacy in APE patients.