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    J Korean Soc Radiol. 2010 Feb;62(2):139-144. Korean.
    Published online Feb 28, 2010.
    https://doi.org/10.3348/jksr.2010.62.2.139
    Copyright © 2010 The Korean Society of Radiology
    Original Article

    CT Findings of Acute Pulmonary Thromboembolism as a Predictor of the Response to Anticoagulant Therapy

    Myeong Im Ahn, M.D., Jae Jeong Choi, M.D., Hyo Lim Kim, M.D.,2 Hyun Jin Park, M.D.,3 Sun Wha Song, M.D.,4 Ki Jun Kim, M.D.,5 Hyun Sook Kim, M.D.,6 Seog Hee Park, M.D. and Jung Im Jung, M.D.
      • 1Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea.
      • 2Department of Radiology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea.
      • 3Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Korea.
      • 4Department of Radiology, Eijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea.
      • 5Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea.
      • 6Department of Radiology, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Korea.
    • Address reprint requests to: Jung Im Jung, M.D., Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea. Tel. 82-2-2258-1435, Fax. 82-2-599-6771, Email: jijung@catholic.ac.kr
    Received July 30, 2009; Accepted October 07, 2009.

    Abstract

    Purpose

    To determine the CT findings of an acute pulmonary thromboembolism for the prediction of response to anticoagulant therapy.

    Materials and Methods

    Forty-eight patients diagnosed with a pulmonary embolism underwent anticoagulant therapy, and underwent pre- and post-treatment CT scans, were selected to be part of the study. Pre-treatment CT scans were retrospectively reviewed for the number and degree of emboli, right ventricular to left ventricular (RV/LV) diameter ratio, pulmonary arterial to aorta (PA/aorta) diameter ratio, ventricular septal bowing, consolidation, mosaic perfusion, and pleural effusion. The response to anticoagulant therapy was assessed by a change in embolic burden on pre-and post-treatment CT scans. The 48 patients were divided into two groups: good responder and poor responder. The pre-treatment CT findings were compared by group to determine if there were any differences in the CT findings.

    Results

    Thirty patients were categorized as good responders (62.5%) and eighteen patients as poor responders (37.5%). A pleura-based wedge-shaped consolidation was observed in 9 of 18 cases (50%) from the poor responder group and one of 30 (3%) cases from the good responder group. The comparison of the finding by group was found to be significantly different (p<0.001). No other CT findings were significantly different between the good and poor responders.

    Conclusion

    The pre-treatment CT scans of patients with acute pulmonary embolism indicate that pleura-based wedge-shaped consolidations can predict a poor response to anticoagulant therapy.

    Keywords
    Pulmonary Embolism; Tomography, X-Ray Computed; Anticoagulants

    Figures

    Fig. 1
    CT findings of a poor responder.
    A. Initial CT scan in a 76-year-old woman shows pulmonary arterial embolus completely obstructing the right middle lobar branch of the interlobar artery (arrow), and another small embolus partially obstructing the anterior basal segmental branch (open arrow). Pleura-based wedge-shaped consolidation is noted in the right middle lobe (arrowheads).

    B. Follow-up CT scan after anticoagulant therapy (4 weeks later from initial CT scan) demonstrates little interval change of the emboli (arrows) as well as the consolidation (arrowheads).

    Fig. 2
    CT findings of a good responder.
    A. Initial CT scan in a 68-year-old woman shows a large embolus in the left interlobar artery (arrow). No parenchymal lesion is seen except for a linear atelectasis in both lower lobes. Note small amount of bilateral pleural effusion.

    B. Follow-up CT scan after anticoagulant therapy (7 weeks later from initial CT scan) reveals complete resolution of the embolus (arrow). Decreased amount of pleural effusion and cleared lower lobar atelectasis are also noted.

    Tables

    Table 1
    Pulmonary Embolism (PE) Indexes Before and After Anticoagulation Therapy

    Table 2
    Comparison of Mean Values of CT Variables Between Good and Poor Responders of Anticoagulation Therapy

    Table 3
    Comparison of Frequency of CT Findings Between Good and Poor Responders of Anticoagulation Therapy

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    MeSH Terms
    Anticoagulants
    Aorta
    Humans
    Perfusion
    Pleural Effusion
    Pulmonary Embolism
    Retrospective Studies
    Tomography, X-Ray Computed
    Metrics
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