Diagnostic and Prognostic Criteria for Pulmonary Embolism: The Role of CT Angiography


Right Ventricular Disorder (RVD) patients can be categorized into one of four risk-groups (high, intermediate-high, intermediate-low, and low) based on clinical symptoms as well as imaging and biomarkers. Currently, clinical shock is the key symptom for high-risk patients, while CT angiography is required for adequate classification of intermediate patients. Clinical shock was determined when patients presented at least one of the following: altered mental status, oliguria (or anuria), peripheral coldness and an elevated lactate level. CT angiographies are used to define right ventricular failure. In a retrospective study, all CT angiography files of 68 Pulmonary Embolism (PE) patients at a Hospital in the Netherlands were reanalyzed. The observational group consisted of 34 patients in whom RVD was indicated in the CT angiography reports and a control group of 34 patients with no specific remarks on RVD. Upon reanalysis of the CT angiographies, RVD measurements were a 100% accurate in the observational group (indicating RVD) while in the control 44% of patients appeared to have RVD while they should not have. There were 4 patients with clinical signs of shock who were not treated according to their risk status. CT angiography is very accurate to determine RVD which is important in categorizing patients. Clinical signs of shock still remains the overriding indicator for initiation of optimal treatment of PE patients.


Original Research



Publication date

October 2017


132 - 139