Predictive Value of Computed Tomography in Acute Pulmonary Embolism: Systematic Review and Meta-analysis

Am J Med. 2015 Jul;128(7):747-59.e2. doi: 10.1016/j.amjmed.2015.01.023. Epub 2015 Feb 11.


Background: Many computed tomography (CT) parameters have been proposed as potential predictors of outcome in acute pulmonary embolism. We sought to summarize available evidence on the predictive value of CT severity parameters for short-term clinical outcome in pulmonary embolism.

Methods: We searched PubMed and EMBASE through February 2014 for studies that reported on the association between CT parameters of acute pulmonary embolism severity and short-term (≤6 months) clinical outcome. Risk estimates for quantitative parameters of right ventricular (RV) dysfunction (abnormally increased RV/left ventricular [LV] diameter ratio on transverse sections and 4-chamber views), qualitative parameters of RV dysfunction (abnormal septal morphology and contrast reflux), thrombus load, and central thrombus location were derived using random effect regression analysis. Meta-regression analysis was performed to quantify and explain study heterogeneity.

Results: A total of 49 studies with 13,162 patients with acute pulmonary embolism (median age of 61 years, 55.1% were women) who underwent diagnostic CT imaging were included in the analysis. An abnormally increased RV/LV diameter ratio measured on transverse sections was associated with an approximately 2.5-fold risk for all-cause mortality (pooled odds ratio [OR], 2.5; 95% confidence interval [CI], 1.8-3.5) and adverse outcome (OR, 2.3; 95% CI, 1.6-3.4) and a 5-fold risk for pulmonary embolism-related mortality (OR, 5.0; 95% CI, 2.7-9.2). Thrombus load (OR, 1.6, 95% CI, 0.7-3.9; P = .2896) and central location (OR, 1.7; 95% CI, 0.7-4.2; P = .2609) were not predictive for all-cause mortality, although both were associated with adverse clinical outcome.

Conclusions: Across all end points, the RV/LV diameter ratio on transverse CT sections has the strongest predictive value and most robust evidence base for adverse clinical outcomes in patients with acute pulmonary embolism.

Keywords: Computed tomography; Mortality; Prognosis; Pulmonary embolism.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Acute Disease
  • Adult
  • Age Distribution
  • Aged
  • Cause of Death*
  • Confidence Intervals
  • Evidence-Based Medicine
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Multidetector Computed Tomography / methods
  • Odds Ratio
  • Predictive Value of Tests
  • Prognosis
  • Pulmonary Embolism / diagnostic imaging*
  • Pulmonary Embolism / epidemiology*
  • Pulmonary Embolism / physiopathology
  • Risk Assessment
  • Severity of Illness Index
  • Sex Distribution
  • Survival Analysis
  • Tomography, X-Ray Computed / methods*
  • Ventricular Dysfunction, Left / diagnosis
  • Ventricular Dysfunction, Left / epidemiology
  • Ventricular Dysfunction, Right / diagnosis
  • Ventricular Dysfunction, Right / epidemiology