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Subjective assessment of right ventricle enlargement from computed tomography pulmonary angiography images

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Abstract

To retrospectively evaluate prognostic accuracy of subjective assessment of right ventricle (RV) enlargement on CT pulmonary angiography (CTPA) images in comparison with objective measures of RV enlargement in patients with acute pulmonary embolism (PE). For 200 consecutive patients with acute PE, two readers blinded to patient outcomes subjectively determined whether the maximum RV diameter was greater than that of the left ventricle (LV) using axial CTPA images. For the objective measurements, RV/LV diameter ratios were calculated using axial images and 4-chamber reformatted images. For all assessments, sensitivities and specificities for predicting PE-related death within 30-days and a composite outcome including PE-related death or the need for intensive therapies were compared. The agreement between two readers was 91.5% (kappa = 0.83) and all other assessments had pair-wise agreement over 75% (kappa = 0.53–0.72). There was no significant difference in sensitivity between the subjective and objective methods for predicting both outcomes. The specificity for subjective RV enlargement (55.4–67.7%) was significantly higher than objective measures (45.8–53.1%), except for the 4-chamber views where, for one reader, the specificity of the subjective evaluation was higher but did not reach statistical significance. Complex measurements of RV/LV diameter ratios may not be needed to maximize the prognostic value from CTPA. The radiologist who interprets the CTPA images should report RV enlargement when the RV diameter subjectively appears larger than the LV.

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Author notes

  1. Michael T. Lu

    Present address: Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA

Authors and Affiliations

  1. Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women’s Hospital & Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Kanako K. Kumamaru, Andetta R. Hunsaker, Arash Bedayat, Shigeyoshi Soga, Jason Signorelli, Kimberly Adams, Nicole Wake, Michael T. Lu & Frank J. Rybicki

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  1. Kanako K. Kumamaru
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  2. Andetta R. Hunsaker
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  3. Arash Bedayat
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  4. Shigeyoshi Soga
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  7. Nicole Wake
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  9. Frank J. Rybicki
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Correspondence to Frank J. Rybicki.

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Kumamaru, K.K., Hunsaker, A.R., Bedayat, A. et al. Subjective assessment of right ventricle enlargement from computed tomography pulmonary angiography images. Int J Cardiovasc Imaging 28, 965–973 (2012). https://doi.org/10.1007/s10554-011-9903-5

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