Dual-Energy CT for Assessment of the Severity of Acute Pulmonary Embolism: Pulmonary Perfusion Defect Score Compared With CT Angiographic Obstruction Score and Right Ventricular/Left Ventricular Diameter Ratio

OBJECTIVE: The purpose of this study was to prospectively evaluate the usefulness of scoring perfusion defects on perfusion images at dual-energy CT for assessment of the severity of pulmonary embolism. SUBJECTS AND METHODS: Thirty patients (13 men, 17 women; mean age, 55 +/- 15 SD years; range, 26-81 years) with pulmonary thromboembolism underwent dual-source CT at two voltages (140 and 80 kV). The weighted average image of two acquisitions was used for CT angiograms, and a color-coded iodine image was used for perfusion images. Two thoracic radiologists with 15 and 6 years of clinical experience independently assigned perfusion defect scores to perfusion images and both a CT angiographic (CTA) obstruction score and right ventricular-to-left ventricular (RV/LV) diameter ratio to CT angiograms. The CTA obstruction score was based on the Qanadli method. The perfusion defect score was defined as Sigma (n . d) / 40 x 100, where n is the number of segments and d is the degree of perfusion from 0 to 2. Correlations between perfusion defect score, CTA obstruction score, and RV/LV diameter ratio were evaluated. Agreement between perfusion defect score and CTA score was assessed per patient and per segment. Interobserver agreement regarding perfusion defect and CTA obstruction scores was analyzed. RESULTS: Perfusion defect and CTA obstruction scores had good correlation with RV/LV diameter ratio (r = 0.69, r = 0.66; all p < 0.001). Per patient, correlation between perfusion defect score and CTA obstruction score also was good (reader 1, r = 0.87; reader 2, r = 0.85; all p < 0.001). Per segment, moderate agreement was found between perfusion defect score and CTA obstruction score (reader 1, kappa = 0.56; reader 2, kappa = 0.51; all p < 0.05). Both readers were in strong agreement on perfusion defect score and CTA obstruction score. CONCLUSION: The proposed perfusion defect score had good correlation with RV/LV diameter ratio and CTA obstruction score. Therefore, acquisition of perfusion images at dual-energy CT may be helpful for assessing the severity of acute pulmonary embolism.