From imaging to functional outcome in pulmonary embolism

Alys R. Clark; Kelly S. Burrowes; David G. Milne; Margaret L. Wilsher; Merryn H. Tawhai

doi:10.1117/12.2007054

29 March 2013 From imaging to functional outcome in pulmonary embolism

Alys R. Clark, Kelly S. Burrowes, David G. Milne, Margaret L. Wilsher, Merryn H. Tawhai

Proceedings Volume 8672, Medical Imaging 2013: Biomedical Applications in Molecular, Structural, and Functional Imaging; 867212 (2013) https://doi.org/10.1117/12.2007054
Event: SPIE Medical Imaging, 2013, Lake Buena Vista (Orlando Area), Florida, United States

Abstract

The interaction between mechanical obstruction and outcome in pulmonary embolism (PE) is not well quantified. Therefore a simple prognostic tool that can be used quickly in the clinical setting remains elusive. Several scoring systems have been proposed to address this problem. However, they are unable to adequately capture the functional outcomes in PE so have not been adopted widely clinically. Here we present an image-based computational model that correlates very well with measures of RV dysfunction. The model extracts the geometric features of the lung, airways, blood vessels and emboli from CTPA (computed tomography pulmonary angiogram) imaging and simulates function (perfusion, ventilation and gas exchange) within these geometries. This results in subject-specific predictions of function in 9 patients with acute PE. There is a high correlation between model results and indicators of right heart dysfunction (p=0.001 in the case of the ratio between right and left ventricular volumes and p<0.03 in the case of systolic pulmonary artery pressure estimated from echocardiography). An existing scoring system that accounts only for the mechanical obstruction of capillary bed performs less well than the model (p=0.04 in the case of the ratio between right and left ventricular volumes and p=0.23 in the case of systolic pulmonary artery pressure estimated from echocardiography). This suggests that the functional impact of occlusion must be accounted to construct useful PE scoring systems.

Citation Download Citation

Alys R. Clark, Kelly S. Burrowes, David G. Milne, Margaret L. Wilsher, and Merryn H. Tawhai "From imaging to functional outcome in pulmonary embolism", Proc. SPIE 8672, Medical Imaging 2013: Biomedical Applications in Molecular, Structural, and Functional Imaging, 867212 (29 March 2013); https://doi.org/10.1117/12.2007054

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KEYWORDS

Lung

Arteries

Blood vessels

Systems modeling

Blood

Capillaries

Echocardiography

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