Time efficiency and reliability of established computed tomographic obstruction scores in patients with acute pulmonary embolism

Abstract

Objective Acute pulmonary embolism (PE) is a life-threatening disease with a high mortality. Computed tomographic pulmonary angiography (CTPA) is used in clinical routine for diagnosis of PE. Many pulmonary obstruction scores were proposed to aid in stratifying clinical course of PE. The purpose of the present study was to compare common pulmonary obstruction scores in PE in regard of time efficiency and interreader agreement based upon a representative patient sample. Methods Overall, 50 patients with acute PE were included in this single center, retrospective analysis. Two readers scored the CT images blinded to each other and assessed the scores proposed by Mastora et al., Qanadli et al., Ghanima et al. and Kirchner et al. The required time was assessed of each reading for scoring. Results For reader 1, Mastora score took the longest time duration, followed by Kirchner score, Qanadli score and finally Ghanima score (every test, p<0.0001). The interreader variability was excellent for all scores with no significant differences between them. In the Spearman’s correlation analysis strong correlations were identified between the scores of Mastora, Qanadli and Kirchner, whereas Ghanima score was only moderately correlated with the other scores. There was a weak correlation between time duration and Mastora score (r = 0.35, p = 0.014). For the Ghanima score, a significant inverse correlation was found (r = -0.67, p<0.0001). Conclusion For the investigated obstruction scores, there are significant differences in regard of time consumption with no relevant differences in regard of interreader variability in patients with acute pulmonary embolism. Mastora score requires the most time effort, whereas the score by Ghanima the least time.