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ulmonary embolism remains an important cause of death and imminent diagnosis as well as risk stratification is needed to try to prevent poor outcome for those patients.
CT remains the most important modality that can diagnose PE, however recent studies demonstrated that it not only helps in the diagnosis but can also be used for risk stratification of the patients.
MRI, is a promising tool in diagnosing the PE especially in major vessels, however it remains the gold standard in assessing the function of the heart, and hence the consequences of PE on the heart and great vessels.
MPA diameter, ratio between left and right ventricles diameters, septal deviation, contrast reflux and embolic burden was correlated to ICU admission and 30 days mortality demonstrating the ability of CT and MRI in diagnosis of PE and assessing its severity.
This study was conducted on 20 subjects who were diagnosed as PE patients by clinical signs, laboratory results and radiological studies. All subjects underwent CT angiography, among which we opted to perform further MRI examination on 10 patients. The results obtained were collected, calculated, and submitted for statistical analysis.
from our study we concluded that
Measurements acquired from CT and MRI along with RV/LV ratio and septal deviation were found to be significantly correlated to ICU admission as well as 30 day mortality as a predictor for severity of PE.
CT contrast reflux was found to be correlated to ICU admission with p value 0.028, however it wasn’t significantly correlated to 30 day mortality with p value 0.07. We speculate that this correlation can be deemed significant when increasing the sample number.
Calculating embolic burden score (Qanadli scoring system) is an important predictor of PE severity (p <0.001) and the need of ICU admission (p<0.001).
MRI appeared to be a superior tool in PE severity assessment, being the gold standard for cardiac function assessment, accurately measuring the PA, RV, and LV diameters, having better detection of the IV septum deviation, with great abilities in localizing thrombus in main and lobar arteries. Giving its great ability of non-contrast enhanced tissue and flow characterization, transaxial white blood cine images were more sensitive and specific to allocate the thrombi even in segmental branches. Coronal white blood cine images added to localizing and better assessment of the thrombus extent especially when in doubt regarding any flow artifacts.
Our findings aimed to identify patients with Sub-massive PE, who do not present with systemic arterial hypotension despite having anatomically large embolism, through detecting the presence of right heart strain, which confirms the diagnosis. The identification of right heart strain by CT or MRI allows risk stratification for possible treatment escalation beyond anticoagulation in normotensive patients with PE.