Association between pre-treatment computed tomography findings and post-treatment persistent decrease in lung perfusion blood volume

TL;DR

This study finds that patients with blood clots in central lung arteries are more likely to have lasting blood flow issues after treatment for pulmonary embolism.

Contribution

Identifies pre-treatment CT features linked to persistent lung perfusion deficits after PE treatment.

Findings

Proximal thrombi correlate with higher residual hypoperfusion (33/125 vs. 9/87 segments).

Patients with proximal clots had more residual hypoperfusion (16/42 vs. 3/25 patients).

Vascular patency had no significant effect on residual hypoperfusion.

Abstract

The purpose of this study was to evaluate pre-treatment CT findings in patients with acute pulmonary embolism (PE) and determine the imaging findings associated with residual hypoperfused segments in post-treatment lung perfused blood volume (LPBV). We evaluated 91 patients with acute PE who underwent dual-energy CT before and after treatment. The location of thrombi (proximal or distal) and patency of the pulmonary artery (occlusive or non-occlusive) were recorded using pre-treatment computed tomography pulmonary angiography (CTPA). Residual hypoperfusion was defined as a perfusion-decreased area seen in both the pre- and post-treatment LPBVs. The association of the location of the thrombus and vascular patency of pre-treatment CTPA with residual hypoperfusion on a segmental and patient basis was examined. In the segment-based analysis, the proportion of residual hypoperfusion in the proximal group was significantly higher than that in the peripheral group (33/125 [26.4%] vs. 9/87 [10.3%], P = 0.004). Patient-based analysis also showed that the proportion of residual hypoperfusion in patients with pre-treatment proximal thrombus was significantly higher than those without (16/42 [38.1%] vs. 3/25 (12.0%); P = 0.022). Pre-treatment vascular patency was not significantly associated with residual hypoperfusion (P > 0.05). Therefore, careful follow-up is necessary, especially in patients with proximal thrombi.

Figures