Prognostic significance of radiological parameters in patients with acute pulmonary embolism: a retrospective observational study

Aims: Acute pulmonary embolism (PE) is a significant global cause of mortality. This study aimed to evaluate the prognostic relationship between radiological parameters obtained from computed tomography pulmonary angiography (CTPA) in patients with acute PE. Methods: This study included 227 patients diagnosed with PE who underwent CTPA upon admission to a tertiary emergency department (ED) between January 1, 2019, and July 1, 2021. We compared 24 patients (10.6%) who died with 203 patients (89.4%) who survived. Clot burden was assessed by calculating the Qanadli score (Qscore) from CTPA images. The study evaluated several radiological parameters, including the Qanadli score (Qscore), main pulmonary artery (PA) diameter, ascending aorta (AO) diameter, AO/PA ratio, right ventricular (RV) to left ventricular (LV) diameter ratio (RV/LV ratio), and inferior vena cava (IVC) reflux. Short-term mortality within one month was tracked, and mortality rates were determined accordingly. Results: The Qscore demonstrated limited accuracy in predicting mortality, with a sensitivity of 41% and a specificity of 44% (AUC: 0.415, 95% CI 0.312–0.518, p=0.175). IVC reflux was an indicator of RV dysfunction. Compared to surviving patients, those who died exhibited a lower incidence of IVC reflux, with a statistically significant difference (p=0.047). The RV/LV and AO/PA ratios did not show significant associations with mortality. In contrast, AO and PA diameters were found to be predictors of mortality, with sensitivities of 66% and 61%, and specificities of 66% and 62%, respectively (AO: AUC 0.683, 95% CI 0.562–0.804, p=0.03; PA: AUC 0.651, 95% CI 0.514–0.788, p=0.016). Conclusion: Overall, the study concluded that the Qscore from CTPA was not a reliable prognostic indicator of mortality in PE patients admitted to the emergency department. In contrast, the diameters of the AO and PA emerged as potential predictors of mortality.