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Right Ventricular Function in Patients with Acute Pulmonary Embolism: Analysis with Electrocardiography-synchronized Multi–Detector Row CT¹

Halil Doan, MD, Lucia J. M. Kroft, MD, Menno V. Huisman, MD, Rob J. van der Geest, MSc and Albert de Roos, MD

¹ From the Departments of Radiology (H.D., L.J.M.K., R.J.v.d.G., A.d.R.) and Vascular Medicine, Department of General Internal Medicine and Endocrinology (M.V.H.), Leiden University Medical Center, Albinusdreef 2, C2-S, 2333 ZA Leiden, the Netherlands. Received December 21, 2005; revision requested February 16, 2006; revision received March 17; accepted April 11; final version accepted July 10. Address correspondence to A.d.R. (e-mail: A.de_Roos{at}lumc.nl).

Purpose: To prospectively assess electrocardiography (ECG)-synchronized multi–detector row computed tomography (CT) for the evaluation of right ventricular (RV) function in patients suspected of having pulmonary embolism (PE).

Materials and Methods: All patients gave informed consent after the study details, including radiation exposure, were explained; institutional ethical committee approval was obtained. Nonsynchronized multi–detector row CT of the chest was performed in 66 consecutive patients (29 men, 37 women; mean age, 58 years ± 15 [standard deviation]) who were suspected of having PE. ECG-synchronized cardiac multi–detector row CT was performed to assess cardiac function. Dimension ratios for the RV and left ventricle (LV) were measured on nonsynchronized transverse and angulated four-chamber views. Furthermore, the RV end-diastolic and end-systolic volumes were measured on ECG-synchronized multi–detector row CT scans. An independent samples t test was performed to compare the mean value of different groups. An analysis of variance post hoc test was performed to investigate whether the values of the variables varied between groups.

Results: PE was detected in 29 of 66 patients. The location of PE was categorized as central (n = 17) or peripheral (n = 12). The RV/LV dimension ratio was larger on the four-chamber view (P = .002), and RV end-systolic volume was larger (P = .01) and ejection fraction was lower (P = .01) in patients with PE. The RV end-systolic volumes and RV/LV volume ratios, as assessed by using ECG-synchronized multi–detector row CT, showed significant differences (P < .005) between patients with central PE and those with peripheral PE. However, the RV/LV dimensions on nonsynchronized images revealed no significant differences.

Conclusion: Retrospective ECG-synchronized multi–detector row CT facilitates detection of RV dysfunction, depending on pulmonary embolus location.

© RSNA, 2006