• Juana María Plasencia-Martínez, Alberto Carmona-Bayonas, David Calvo-Temprano, Paula Jiménez-Fonseca, Francisco Fenoy, Mariana Benegas, Marcelo Sánchez, Carme Font, Diego Varona, David Martínez de la Haza, Jesús Pueyo, Mercè Biosca, Maite Antonio, Carmen Beato, Pilar Solís, Laura Fáez, Irma de Al Haba, Susana Hernández-Muñiz, Olga Madridano, Mar Martín, Eduardo Castañón, Avinash Ramchandani, Pablo Marchena, Manuel Sánchez-Cánovas, María Ángeles Vicente, Mari José Martínez, Ángela Fernández-Plaza, Lourdes Martínez-Encarnación, Alejandro Puerta, Ángel Domínguez, Daniel Rodríguez, Gema Marín, Remedios Otero, Fernando Sánchez-Lasheras, and Vicente Vicente.
• Radiology Department, Hospital Universitario Morales Meseguer, Av Marqués de los Vélez, s/n, 30008, Murcia, Spain. Electronic address: plasen79@gmail.com.
• Eur J Radiol. 2017 Feb 1; 87: 66-75.

ObjectiveTo analyze the prognostic value of pulmonary artery obstruction versus right-ventricle (RV) dysfunction radiologic indices in cancer-related pulmonary embolism (PE).MethodsWe enrolled 303 consecutive patients with paraneoplastic PE, evaluated by computed tomography pulmonary angiography (CTPA) between 2013 and 2014. The primary outcome measure was serious complications at 15days. Multivariate analyses were conducted by using binary logistic and robust regressions. Radiological features such as the Qanadli index (QI) and RV dysfunction signs were analyzed with Spearman's partial rank correlations.ResultsRV diameter was the only radiological variable associated with an adverse outcome. Subjects with enlarged RV (diameter>45mm) had more 15-day complications (58% versus 40%, p=0.001). The QI correlated with the RV diameter (r=0.28, p<0.001), left ventricle diameter (r=-0.19, p<0.001), right ventricular-to-left ventricular diameter ratio (r=0.39, p<0.001), pulmonary artery diameter (r=0.22, p<0.001), and pulmonary artery/ascending aorta ratio (r=0.27, p<0.001). A QI≥50% was only associated with 15-day complications in subjects with enlarged RV, inverted intraventricular septum, or chronic cardiopulmonary diseases. The central or peripheral PE location did not affect the correlations among radiological variables and was not associated with clinical outcomes.ConclusionsRight ventricular dysfunction signs in CTPA are more useful than QI in predicting cancer-related PE outcome.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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