The value of the Ratıo of Pulmonary Artery Dıameter to Aortıc Dıameter ın the Dıagnosıs of Pulmonary Embolısm ın the Emergency Department

Keywords

Computed tomography pulmonary angiography
Diagnosis
Pulmonary artery diameter
Pulmonary artery-aortic diameter ratio
Pulmonary embolism

Categories

How to Cite

Tav Simsek , D., Simsek, C., Erdil, I., Dogan , H. ., & Ozucelik , D. N. (2022). The value of the Ratıo of Pulmonary Artery Dıameter to Aortıc Dıameter ın the Dıagnosıs of Pulmonary Embolısm ın the Emergency Department. Iranian Red Crescent Medical Journal, 24(12). https://doi.org/10.32592/ircmj.2022.24.12.890

Abstract

Background: Pulmonary embolism (PE) can be easily diagnosed with computed tomography pulmonary angiography (CTPA). However, the diagnosis of PE is difficult when contrast material cannot be used.
Objectives: The aim of this study is to investigate whether an increase in Pulmonary Artery- Diameter and an increase in PA-Diameter / Ascending Aortic-Diameter ratio can be used in the diagnosis of PE.
Methods: CTPA of patients diagnosed with PE (88 patients) and control group (89 patients) were examined retrospectively. Aortic (Ao) and pulmonary artery (PA) diameters were measured radiologically.  PA-Diameter/Ao-Diameter ratio were proportioned.
Results: Mean D-Dimer levels were found to be higher in the PE group (7.31±3.528 mcg/L) than in the control group (1.52±1.042 mcg/L), (p<0.001). PE diagnosis of right main PA, right segmental PA and right subsegmental PA was observed more than left. In PE group the mean Ao-Diameter (35,14±4,55 mm) was larger than in control group (34,97±5,28 mm), (p=0.828). In PE group the mean main PA-Diameter (30,45±4,77 mm) was larger than in control group (28,35±3,81 mm), (p=0.001). Also in PE group the mean main PA-Dimeter/Ao-Diameter ratio (0,87±0,15) were higher than in control group (0,82±0,13), (p=0.016).
Conclusion: The increase in PA-Diameter and PA-Diameter/Ao-Diameter ratio in non-contrast CT can be used in the diagnosis of PE in patients with suspected PE in whom contrast cannot be given in the ED.

https://doi.org/10.32592/ircmj.2022.24.12.890

References

Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, Hylek EM, Kakkar A, Konstantinides SV, McCumber M, Ozaki Y, Wendelboe A, Weitz JI. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol 2014;34:2363–2371.

Wendelboe AM, Raskob GE. Global burden of thrombosis: epidemiologic aspects. Circ Res 2016;118:1340–1347.

Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J, Roy PM, Fine MJ. A prediction rule to identify low-risk patients with pulmonary embolism. Arch Intern Med. 2006 Jan 23;166(2):169–75.

Minakawa M, Fukuda I, Miyata H, Motomuro N, Takamoto S, Taniguchi S, Daitoku K, Kando N, Japan Cardiovascular Surgery Database Organizaiton. Outcomes of Pulmonary Embolectomy for Acute Pulmonary Embolism. Circ J. 2018;82(8):2184-2190.

Pulmonary embolism. https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/diagnosis-treatment/drc-20354653. Acces: 13.10.2020.

McIntyre KM, Sasahara AA. The hemodynamic response to pulmonary embolism in patients without prior cardiopulmonary disease. Am J Cardiol 1971;28:288–294.

Haimovici JB, Trotman-Dickenson B, Halpern EF, Dec GW, Ginns LC, Shepard JA, McLoud TC. Relationship between pulmonary artery diameter at computed tomography and pulmonary artery pressures at right-sided heart catheterization. Massachusetts General Hospital Lung Transplantation Program. Acad Radiol.1997; 4: 327– 334.

Wittram C, Maher MM, Yoo AJ, Kalra MK, Shepard JA, McLoud TC. CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis. Radiographics: a review publication of the Radiological Society of North America, Inc. 2004;24(5):1219–38.

Edwards PD, Bull RK, Coulden R. CT measurement of main pulmonary artery diameter. Br J Radiol. 1998;71:1018–1020.

Kam JC, Pi J, Doraiswamy V, Elnahar Y, Abdul-Jawad S, A DeBari V, Klukowicz AJ, Fayez Shamoon, Miller RA. CT scanning in the evaluation of pulmonary hypertension. Lung. 2013 Aug;191(4):321-6.

Sanal S, Aronow WS, Ravipati G, Maguire GP, Belkin RN, Lehrman SG. Prediction of Moderate or Severe Pulmonary Hypertension by Main Pulmonary Artery Diameter and Main Pulmonary Artery Diameter/Ascending Aorta Diameter in Pulmonary Embolism. Cardiology in Review 14(5):213-4.

Liu YY, Li XC, Duan Z, Yuan YD. Correlation between the embolism area and pulmonary arterial systolic pressure as an indicator of pulmonary arterial hypertension in patients with acute pulmonary thromboembolism. Eur Rev Med Pharmacol Sci. 2014;18(17):2551-2555.

Goodman LR, Curtin JJ, Mewissen MW, Foley WD, Lipchik RJ, Crain MR, Sagar KB, Collier BD. Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: helical CT versus angiography. AJR 1995; 164:1369-1374.

Blum AG, Delfau F, Grignon B, Beurrier D, Chabot F, Claudon M, Danchin N, Regent D. Spiral-computed tomography versus pulmonary angiography in the diagnosis of acute massive pulmonary embolism. Am J Cardiol. 1994 Jul 1;74(1):96–98.

Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl. 2006 Apr;(100):S11–S5.

Stein PD, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, Leeper KV Jr, Popovich J Jr, Quinn DA, Sos TA, Sostman HD, Tapson VF, Wskefield TW, Weg JG, Woodard PK, PIPED II Investıgators. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med. 2006;354(22):2317–27.

Carman TL, Deitcher SR. Advances in diagnosing and excluding pulmonary embolism: spiral CT and D-dimer measurement. Cleve Clin J Med. 2002 Sep; 69(9):721-9.

Geersing GJ, Erkens PMG, Lucassen WAM, Büller HR, Cate HT, Hoes AW, Moons KGM, Prins MH, Oudega R, van Weert HCPM, Stoffers HEJH. Safe exclusion of pulmonary embolism using the Wells rule and qualitative D-dimer testing in primary care: prospective cohort study. The BMJ. 2012; 345: 6564.

Gupta, RT, Kakarla RK, Kirshenbaum KJ, Tapson VF. D-dimer and efficacy of clinical risk estimation algorithms: sensitivity in evaluation of acute pulmonary embolism. AJR Am J Roentgenol 2009; 193; 425–430.

Vyas V, Goyal A. Review. Acute Pulmonary Embolism. https://pubmed.ncbi.nlm.nih.gov/32809386/. Access: 13.10.2020

Leitman EM, McDermott S. Pulmonary arteries: imaging of pulmonary embolism and beyond. Cardiovasc Diagn Ther. 2019;9(Suppl 1):S37-S58.

Emet M, Ozucelik DN, Sahin M, Oran M, Sivri B. Computed tomography pulmonary angiography in the diagnosis of acute pulmonary embolism in the emergency department. Adv Ther. Nov-Dec 2007;24(6), 1173–1180.

Senturk A, Ozsu S, Duru S, Cakır E, Ulaslı SS, Demirdogen E, Kayhan S, GuzelA, Yakar F, Berk S. Prognostic importance of central thrombus in hemodynamically stable patients with pulmonary embolism. Cardiol J. 2017;24(5):508.

Bozlar U, Ors F, Deniz O, Uzun M. Pulmonary Artery Diameters Measured By Multidetector row computed tomography in healty adults. Acta Radiol. 2007 Dec; 48(10):1086-91.

Yoo HHB, Nunes-Nogueira V, Fortes Villas Boas PJ. Anticoagulant treatment for subsegmental pulmonary embolism. Cochrane Database of Systematic Reviews 2020, Issue 2. Art. No.: CD010222. doi: 10.1002/14651858.CD010222.pub4

Carrier M, Righini M, Wells PS, et al. Subsegmental pulmonary embolism diagnosed by computed tomography: incidence and clinical implications. A systematic review and meta-analysis of the management outcome studies. J Thromb Haemost. 2010;8:1716–1722.

Hutchinson BD, Navin P, Marom EM, Truong MT, Bruzzi JF. Overdiagnosis of Pulmonary Embolism by Pulmonary CT Angiography. AJR Am J Roentgenol. 2015 Aug;205(2):271-7.

Lee SH, Kim YJ, Lee HJ, Kim HY, Kang YA, Park MS, Kim YS, Kim SK, Chang J, Yung YJ. Comprasion of CT determined Pulmonary Artery Diameter, and their Ratio in Healty and Diverse Clinical Conditions. PLoS One. 2015; 10(5): e0126646.

Truong QA, Massaro JM, Rogers IS, Mahabadi AA, Kriegel MF, Fox CS, O’Donnell CJ, Hoffmann U. Reference values for normal pulmonary artery dimensions by noncontrast cardiac computed tomography: the Framingham Heart Study. Circ Cardiovasc Imaging. 2012;5:147–154.

Karazincir S, Balci A, Seyfeli E, Akoğlu S, Babayiğit C, Akgül F, Yalçin F, Eğilmez E. CT assessment of main pulmonary artery diameter. Diagn Interv Radiol. 2008 Jun;14(2):72-4.

Wong LF, Akram AR, McGurk S, Van Beek EJ, Reid JH, Murchison JT. Thrombus load and acute right ventricular failure in pulmonary embolism: correlation and demonstration of a "tipping point" on CT pulmonary angiography. Br J Radiol. 2012;85(1019):1471-1476.

Collomb D, Paramelle PJ, Calaque O, Bosson JL, Vanzetto G, Barnoud D, Pison C, Coulomb M, Ferretti G. Severity assesment of acute pulmonary embolism: evaluation using helical CT. Eur Radiol 2003; 13: 1508-1514.

Guo F, Zhu G, Shen J, Ma Y. Health risk stratification based on computed tomography pulmonary artery obstruction index for acute pulmonary embolism. Sci Rep. 2018;8(1):17897. Published 2018 Dec 17.

Abdelwahab HW, Arafa S, Bondok K, Batouty N, Bakeer M. Relationship between clot burden in pulmonary computed tomography angiography and different parameters of right cardiac dysfunction in acute pulmonary embolism. Cardiovasc J Afr. 2020;31(1):21-24.

Turkbey EB, Jain A, Johnson C, Redheuil A, Arai AE, Gomes AS, Carr J, Hundley WG, Teixido-Tura G, Eng J, Lima JAC, Bluemke DA. Determinants and normal values of ascending aortic diameter by age, gender, and race/ethnicity in the Multi-Ethnic Study of Atherosclerosis (MESA). J Magn Reson Imaging. 2014 Feb;39(2):360-8. doi: 10.1002/jmri.24183. Epub 2013 May 16.