Evaluation of computed tomography obstruction index in guiding therapeutic decisions and monitoring percutanous catheter fragmentation in massive pulmonary embolism

In the present study, we evaluated computed tomography pulmonary angiography (CTPA) in guiding therapeutic decisions and monitoring patients undergoing percutaneous catheter fragmentation in acute massive pulmonary embolism. From Jan 2003 to Dec 2009, 35 patients were diagnosed with acute massive pulmonary embolism by CTPA (T0) and treated with percutaneous catheter fragmentation. The severity was assessed by CT obstruction index (Qanadli index) and compared with Miller index. CTPA, oxygen saturation (SaO(2)) and pulmonary artery pressure were performed as follow-up index. The mean percentage of Qanadli index was (55±13)% (range, 40%-75%), and Miller index was (62±15)% (range, 45%–85%). Correlations between them were statistically significant (r = 0.867, P < 0.0001). The Qanadli index showed significant reduction [T0: (55±13)%; T1: (12±10)%; P < 0.001] in 33 patients. Significant correlation was observed between the Qanadli index, SaO(2) (r = 0.934), and pulmonary artery pressure (r = 0.813). The Qanadli index provides an accurate method for distinguishing massive pulmonary embolism from sub-massive pulmonary embolism. It can be used to determine therapeutic options and monitor clinical outcomes.