CT spots cardiac signs in pulmonary embolism

Radiologists interpreting scans of patients with suspected pulmonary embolism should check for signs of right heart dysfunction. This could save a life, according to a study presented at the meeting of the American Roentgen Ray Society in May.

Patients with PE often die due to acute right heart failure, said lead author Dr. Benjamin Zalta. Patients with PE and right valve dilation have increased mortality rates.

"CT can be diagnostic of pulmonary embolism and also has prognostic implications," Zalta said.

Zalta and colleagues at Albert Einstein College of Medicine and the Montefiore Medical Center in New York City retrospectively examined 74 consecutive adults who had been diagnosed with PE on either a four- or 16-slice CT scanner. Thirty-four subjects had received echocardiography as well.

The researchers diagnosed right heart dysfunction in patients with dilated right ventricles or an interventricular septum that flattened or bowed into the left ventricle. They also determined clot burden.

Sixty-six percent of patients had CT findings of right heart dysfunction, while nearly 50% had clot burdens greater than or equal to 30% pulmonary vascular obstruction.

CT showed a significant difference between the mean clot burden in patients with right heart dysfunction (49) and those without (25). Echocardiography showed no such significant difference.

Sensitivity and specificity for CT were 81% and 47%, respectively, compared with echocardiography's 56% and 42%. Four echo studies did not provide adequate images.