Automated Computed Tomography Volume Analysis for the Prediction of Hemodynamic Significant Pericardial Effusion

Purpose: Pericardial effusion is a frequent finding in CT pulmonary angiography (CTPA) since it may present as pleuritic chest pain and dyspnea. It is caused by the accumulation of pericardial fluid in the pericardial space which may compress all cardiac chambers, especially the lower pressure right sided chambers. The hemodynamic significance of pericardial effusion is usually determined by echocardiography. We hypothesize that CTPA-based analysis of the cardiac chambers’ volumes can be used to predict the hemodynamic significance of the pericardial effusion (HsPE).

Materials and Methods: Consecutive patients who underwent CTPA between January 2009 and November 2017, that ruled-out acute pulmonary embolism and had pericardial effusion and echocardiography were included. Differences in cardiac chamber volumes were investigated in correlation to evidence of HsPE on the echocardiography.

Results: The final cohort included 208 patients, of whom 22 (11%) were diagnosed with HsPE. HsPE patients had much smaller cardiac chamber volumes. A decision tree for the prediction of HsPE showed multiple cutoff values. Right Atrium volume (RA) had the best accuracy (AUC 0.851, 95% CI 0.776-0.925, P<0.001) for predicting the presence of HsPE.
Accordingly, RA volume ≤86ml allows a sensitivity of 95.5%, specificity of 64% with a negative predictive value of 99.2% for the existence of HsPE.

Conclusion: CTPA-based volumetric information with focus on the RA volume may help predicting the existence of HsPE.