Pulmonary Artery-to-Vein Volume Difference: A New Imaging Biomarker for Risk Stratification in Acute Pulmonary...

To propose a new imaging biomarker, the pulmonary artery-to-vein volume difference (PAVVD), and evaluate its efficacy in risk stratification of acute pulmonary embolism (APE) compared with traditional computed tomography pulmonary angiography (CTPA) parameters, as well as the impact of chronic pulmonary disease (CPD).

This retrospective study included 134 patients with APE (high/intermediate-high risk, n = 46; intermediate-low/low risk, n = 88) from April 2023 to March 2024. A commercial artificial intelligence software was used to automatically quantify PAVVD and traditional CTPA parameters. The performances of different CTPA parameters for APE risk stratification were compared using the area under the curve (AUC), diagnostic metrics (e.g., sensitivity, specificity, negative predictive value [NPV], negative likelihood ratio [NLR]), and decision curve analysis (DCA). Multivariate linear regression was conducted to identify factors influencing PAVVD.

PAVVD exhibited the highest AUC (0.89, 95% CI: 0.83-0.95) for identifying high/intermediate-high risk APE, with the lowest missed diagnosis risk (NPV = 0.94, NLR = 0.13). DCA demonstrated that PAVVD yielded the highest net benefit within the low-to-moderate threshold probability range. A crossover effect was observed between PAVVD and clot volume: PAVVD performed better when the Qanadli score was <50%, while clot volume was superior when the Qanadli score was ≥50%. CPD (β = 35.74, 95% CI: 15.25-56.23; P = 0.001) and log(1+clot volume) (β = 13.34, 95% CI: 8.44-18.25; P < 0.001) were independently correlated with PAVVD.

PAVVD is a promising and competitive metric for APE risk stratification. It serves as an important complement to traditional CTPA parameters and has the potential to provide valuable support for emergency triage.