Quantitative assessment of risk stratification of acute pulmonary embolism based on three-dimensional computed...

Accurate assessment and severity grading of acute pulmonary embolism (APE) currently relies on the Simplified Pulmonary Embolism Severity Index (sPESI) combined with biomarkers or right ventricular function indicators in clinical practice, which increases implementation complexity. Computed tomography pulmonary angiography (CTPA) remains the preferred imaging modality for confirming APE, while the commonly used Qanadli semi-quantitative scoring system has limited accuracy. This study aimed to explore the feasibility of quantitatively assessing risk stratification in patients with APE using three-dimensional computed tomography bronchography and angiography (3D-CTBA).

Sixty-one patients with APE who underwent CTPA at the First Affiliated Hospital of Hebei North University were retrospectively enrolled. Clinical data were collected, and 3D-CTBA was performed using Mimics software to reconstruct pulmonary artery and embolism models. The thrombus volume-to-pulmonary artery volume ratio was calculated. Spearman correlation analysis was used to evaluate associations between this ratio, the computed tomography pulmonary artery obstruction index (Qanadli score), and related parameters, including the right ventricle-to-left ventricle (RV/LV) ratio and laboratory biomarkers. Receiver operating characteristic (ROC) curves were constructed, and the area under the curve (AUC) was calculated to assess the predictive efficacy of the thrombus volume-to-pulmonary artery volume ratio for risk stratification.

A strong correlation was observed between the thrombus volume-to-pulmonary artery volume ratio and the Qanadli score (r=0.732, P<0.001). The ratio showed moderate correlations with RV/LV (r=0.448, P<0.001), B-type natriuretic peptide (BNP; r=0.566, P<0.001), and creatinine kinase-myocardial band (CK-MB; r=0.495, P<0.001), and a weak correlation with D-dimer (r=0.371, P=0.003). In contrast, the Qanadli score correlated weakly with RV/LV (r=0.381, P=0.002) and moderately with BNP (r=0.439, P<0.001) and CK-MB (r=0.467, P<0.001), but showed no correlation with D-dimer (r=0.136, P=0.30). In ROC curve analysis, the AUC for the thrombus volume-to-pulmonary artery volume ratio was 0.847, compared with 0.811 for the Qanadli score (Z=0.629, P=0.53).

The thrombus volume-to-pulmonary artery volume ratio derived from 3D-CTBA provides a reliable quantitative method for risk stratification in patients with APE. This approach may serve as a complementary or alternative tool to the Qanadli score in clinical practice.