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Borgheresi A, Cesari E, Agostini A, Badaloni M, Balducci S, Tola E, Consoli V, Palucci A, Burroni L, Carotti M, Giovagnoni A. Pulmonary emphysema: the assessment of lung perfusion with Dual-Energy CT and pulmonary scintigraphy. LA RADIOLOGIA MEDICA 2024:10.1007/s11547-024-01883-y. [PMID: 39256299 DOI: 10.1007/s11547-024-01883-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 08/20/2024] [Indexed: 09/12/2024]
Abstract
AIM To assess the correlation of quantitative data of pulmonary Perfused Blood Volume (PBV) on Dual-Energy CT (DECT) datasets in patients with moderate - severe Pulmonary Emphysema (PE) with Lung Perfusion Scintigraphy (LPS) as the reference standard. The secondary endpoints are the correlation between the CT densitometric analysis and the visual assessment of parenchymal destruction with PBV. MATERIALS AND METHODS Patients with moderate - severe PE candidate to Lung Volumetric Reduction (LVR), with available a pre-procedural LS and a contrast-enhanced DECT were retrospectively included. DECT studies were performed with a 3rd generation Dual-Source CT and the PBV was obtained with a 3-material decomposition algorithm. The CT densitometric analysis was performed with a dedicated commercial software (Pulmo3D). The Goddard Score was used for visual assessment. The perfusion LS were performed after the administration of albumin macroaggregates labeled with 99mTechnetium. The image revision was performed by two radiologists or nuclear medicine physicians blinded, respectively, to LS and DECT data. The statistical analysis was performed with nonparametric tests. RESULTS Thirty-one patients (18 males, median age 69 y.o., interquartile range 62-71 y.o.) with moderate - severe PE (Median Goddard Score 14/20 and 31% of emphysematous parenchyma at quantitative CT) candidate to LVR were retrospectively included. The median enhancement on PBV was 17 HU. Significant correlation coefficients were demonstrated between lung PBV and LS, poor in apical regions (Rho = 0.1-0.2) and fair (Rho = 0.3-0.5) in middle and lower regions. No significant correlations were recorded between the CT densitometric analysis, the visual score, and the PBV. CONCLUSIONS Lung perfusion with PBV on DECT is feasible in patients with moderate - severe PE candidate to LVR, and has a poor to fair agreement with LPS.
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Affiliation(s)
- Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy
- Department of Radiological Sciences, Division of Clinical Radiology, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Via Conca 71, 60126, Ancona, AN, Italy
| | - Elisa Cesari
- School of Radiology, University Politecnica Delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy.
- Department of Radiological Sciences, Division of Clinical Radiology, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Via Conca 71, 60126, Ancona, AN, Italy.
| | - Myriam Badaloni
- Department of Radiological Sciences, Division of Clinical Radiology, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Via Conca 71, 60126, Ancona, AN, Italy
| | - Sofia Balducci
- School of Radiology, University Politecnica Delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy
| | - Elisabetta Tola
- School of Radiology, University Politecnica Delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy
| | - Valeria Consoli
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy
- Department of Radiological Sciences, Division of Clinical Radiology, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Via Conca 71, 60126, Ancona, AN, Italy
| | - Andrea Palucci
- Department of Radiological Sciences. Division of Nuclear Medicine, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Via Conca 71, 60126, Ancona, AN, Italy
| | - Luca Burroni
- Department of Radiological Sciences. Division of Nuclear Medicine, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Via Conca 71, 60126, Ancona, AN, Italy
| | - Marina Carotti
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy
- Department of Radiological Sciences, Division of Clinical Radiology, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Via Conca 71, 60126, Ancona, AN, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy
- Department of Radiological Sciences, Division of Clinical Radiology, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Via Conca 71, 60126, Ancona, AN, Italy
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Karpov AA, Vaulina DD, Smirnov SS, Moiseeva OM, Galagudza MM. Rodent models of pulmonary embolism and chronic thromboembolic pulmonary hypertension. Heliyon 2022; 8:e09014. [PMID: 35295664 PMCID: PMC8919224 DOI: 10.1016/j.heliyon.2022.e09014] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/06/2021] [Accepted: 02/21/2022] [Indexed: 11/26/2022] Open
Abstract
Pulmonary embolism (PE) is the third most prevalent cardiovascular disease. It is associated with high in-hospital mortality and the development of acute and chronic complications. New approaches aimed at improving the prognosis of patients with PE are largely dependent on reliable animal models. Mice, rats, hamsters, and rabbits, are currently most commonly used for PE modeling because of their ethical acceptability and economic feasibility. This article provides an overview of the main approaches to PE modeling, and the advantages and disadvantages of each method. Special attention is paid to experimental endpoints, including morphological, functional, and molecular endpoints. All approaches to PE modeling can be broadly divided into three main groups: 1) induction of thromboembolism, either by thrombus formation in vivo or by injection of in vitro prepared blood clots; 2) introduction of particles of non-thrombotic origin; and 3) surgical procedures. The choice of a specific model and animal species is determined based on the objectives of the study. Rodent models of chronic thromboembolic pulmonary hypertension (CTEPH), which is the most devastating complication of PE, are also described. CTEPH models are especially challenging because of insufficient knowledge about the pathogenesis and high fibrinolytic activity of rodent plasma. The CTEPH model should demonstrate a persistent increase in pulmonary artery pressure and stable reduction of the vascular bed due to recurrent embolism. Based on the analysis of available evidence, one might conclude that currently, there is no single optimal method for modeling PE and CTEPH.
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Andersen A, van der Feen DE, Andersen S, Schultz JG, Hansmann G, Bogaard HJ. Animal models of right heart failure. Cardiovasc Diagn Ther 2020; 10:1561-1579. [PMID: 33224774 PMCID: PMC7666958 DOI: 10.21037/cdt-20-400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022]
Abstract
Right heart failure may be the ultimate cause of death in patients with acute or chronic pulmonary hypertension (PH). As PH is often secondary to other cardiovascular diseases, the treatment goal is to target the underlying disease. We do however know, that right heart failure is an independent risk factor, and therefore, treatments that improve right heart function may improve morbidity and mortality in patients with PH. There are no therapies that directly target and support the failing right heart and translation from therapies that improve left heart failure have been unsuccessful, with the exception of mineralocorticoid receptor antagonists. To understand the underlying pathophysiology of right heart failure and to aid in the development of new treatments we need solid animal models that mimic the pathophysiology of human disease. There are several available animal models of acute and chronic PH. They range from flow induced to pressure overload induced right heart failure and have been introduced in both small and large animals. When initiating new pre-clinical or basic research studies it is key to choose the right animal model to ensure successful translation to the clinical setting. Selecting the right animal model for the right study is hence important, but may be difficult due to the plethora of different models and local availability. In this review we provide an overview of the available animal models of acute and chronic right heart failure and discuss the strengths and limitations of the different models.
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Affiliation(s)
- Asger Andersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Diederik E. van der Feen
- Center for Congenital Heart Diseases, University Medical Center Groningen, Groningen, The Netherlands
| | - Stine Andersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
| | - Harm Jan Bogaard
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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Detection of Pulmonary Embolism with Gallium-68 Macroaggregated Albumin Perfusion PET/CT: An Experimental Study in Rabbits. CONTRAST MEDIA & MOLECULAR IMAGING 2020; 2020:5607951. [PMID: 32694958 PMCID: PMC7345963 DOI: 10.1155/2020/5607951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/02/2020] [Accepted: 06/09/2020] [Indexed: 01/30/2023]
Abstract
This study was designed to evaluate the accuracy of detecting pulmonary embolism (PE) using the Technegas SPECT/CT combined with 68Ga PET/CT in a rabbit model. One hour after artificial PE (n = 6) and sham (n = 6) models were created, Technegas SPECT/CT ventilation and 68Ga-MAA PET/CT perfusion scan (V/Q scan) were performed. Ventilation imaging was performed first on all cases. Technegas SPECT/CT and 68Ga-MAA PET/CT images were evaluated by a nuclear medicine physician who recorded the presence, number, and location of PE on a per-lobe basis. The sensitivity, specificity, and accuracy of Technegas SPECT/CT and 68Ga-MAA PET/CT for detecting PE were calculated using a histopathological evaluation as a reference standard. A total of 60 lung lobes were evaluated in 12 rabbits, and PE was detected in 20 lobes in V/Q scans and histopathological analysis. The overall sensitivity, specificity, and accuracy were 100%, 100%, and 100%, respectively, for both the Technegas SPECT/CT and 68Ga-MAA PET/CT V/Q scans. Technegas/68Ga-MAA V/Q scans have good sensitivity, specificity, and accuracy in the detection of PE in this animal model study.
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Takx RAP, Henzler T, Schoepf UJ, Germann T, Schoenberg SO, Shirinova A, Bauer RW, Frellesen C, Zhang LJ, Nance JW, Fink C, Apfaltrer P. Predictive value of perfusion defects on dual energy CTA in the absence of thromboembolic clots. J Cardiovasc Comput Tomogr 2017; 11:183-187. [PMID: 28431860 DOI: 10.1016/j.jcct.2017.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/05/2017] [Accepted: 04/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND To determine the predictive value of volumetrically measured lung perfusion defects (PDvol) and right ventricular dysfunction on dual-energy computed tomography angiography (DE-CTA) for predicting all cause mortality in patients suspected of pulmonary embolism (PE) but without evident thromboembolic clot on CTA. METHODS 448 patients underwent DE-CTA on a 64-channel DSCT system between January 2007 and December 2012 for suspected PE, of which 115 were without detectable thromboembolic clot on CTA. Diagnostic performance for identifying patients at risk of dying was evaluated using ROC analysis. All-cause mortality was assessed via the hospital electronic medical records and/or consultation of the patient or the patient's primary care physician via phone call interviews. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and area under the curve (AUC) were determined for PDvol (volume of perfusion defects/total lung volume), transverse right ventricular to left ventricular diameter ratios (RV/LV) and for the combination of both tests. RESULTS Mortality was 38% within the investigated time period of 6 months. Patients who died had significantly higher PDvol (PDvol 28 ± 13% vs. 19 ± 12%, p < 0.001) and a non-significant difference in transverse RV/LV ratio (1.14 ± 0.37 vs. 1.06 ± 0.22, p = 0.159). The AUC was 0.71 for PDvol, 0.53 for RV/LV ratio, and 0.67 for the combination of PDvol and RV/LV ratio. PDvol remained a significant predictor after correcting for age. CONCLUSIONS In the absence of thromboembolic clots, PDvol at DE-CTA appears to be predictive for all cause mortality.
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Affiliation(s)
- Richard A P Takx
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas Henzler
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States.
| | - Thomas Germann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Aysel Shirinova
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ralf W Bauer
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt, Germany; Clinic of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland
| | - Claudia Frellesen
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt, Germany
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - John W Nance
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Christian Fink
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Radiology, General Hospital Celle, Celle, Germany
| | - Paul Apfaltrer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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Getting the Most From Your Dual-Energy Scanner: Recognizing, Reducing, and Eliminating Artifacts. AJR Am J Roentgenol 2016; 206:119-28. [PMID: 26700343 DOI: 10.2214/ajr.14.13901] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Dual-energy CT (DECT) is an innovative imaging modality that allows superior detection of pulmonary embolism, enhanced detection of urate in gout, and improved assessment of metal prostheses when compared with conventional CT. CONCLUSION The primary aim of this review is to describe these DECT protocols and compare each to its respective diagnostic reference standards. Moreover, this review will describe how to recognize, reduce, and eliminate DECT artifacts, thereby maximizing its diagnostic capabilities.
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Chronic thromboembolic pulmonary hypertension: Comparison of dual-energy computed tomography and single photon emission computed tomography in canines. Eur J Radiol 2015; 85:498-506. [PMID: 26781157 DOI: 10.1016/j.ejrad.2015.11.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/24/2015] [Accepted: 11/26/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare diagnostic accuracy between dual-energy CT lung perfused blood volume (Lung PBV) imaging and single photon emission computed tomography (SPECT) in detecting chronic thromboembolic pulmonary hypertension (CTEPH) with histopathological results as reference standard in a canine model. MATERIALS AND METHODS Eighteen CTEPH canines were included into this experimental study. All procedures including paracentesis, embolization, scanning, pressure measurement and feeding medicine were repeated each two weeks, until systolic/diastolic pressure in canines was ≥ 30/15 mm Hg or mean pulmonary artery pressure ≥ 20 mm Hg, and then sacrificed for histopathology examination. Two radiologists (readers 1 and 2) and two nuclear radiologists (readers 3 and 4) analyzed images of conventional CT pulmonary angiography in dual-energy CT mode, Lung PBV imaging and SPECT, respectively. The presence, numbers, and locations of pulmonary emboli (PE) were recorded on a per-lobe basis. Pathological examination was served as reference standard. Sensitivity, specificity and accuracy of Lung PBV and SPECT were calculated. Kappa statistics were used to quantify inter-reader agreement. RESULTS With histopathological results as reference standard, the sensitivities of 72.2%, 78.8%, 81.2%, specificities of 75.9%, 87.5%, 84.8%, accuracies of 73.8%, 83.1%, 83.1%, for readers 1, 2 and both with Lung PBV, respectively. Readers 3, 4 and both had sensitivities of 14.3%, 25.7%, 33.3%, specificities of 90.0%, 86.7%, 93.3%, accuracies of 49.2%, 53.8%, 60.0% with SPECT for detecting CTEPH. Inter-reader agreements were good for dual-energy CT (kappa=0.662) and SPECT (k=0.706) for detecting CTEPH. CONCLUSION Dual-energy CT had a higher accuracy to detect CTEPH than SPECT in this canine model study.
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Meysman M, Everaert H, Buls N, Nieboer K, de Mey J. Comparison of ventilation-perfusion single-photon emission computed tomography (V/Q SPECT) versus dual-energy CT perfusion and angiography (DECT) after 6 months of pulmonary embolism (PE) treatment. Eur J Radiol 2015; 84:1816-9. [DOI: 10.1016/j.ejrad.2015.05.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/11/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
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Therapeutic effectiveness of bone marrow-derived mesenchymal stem cell administration against acute pulmonary thromboembolism in a mouse model. Thromb Res 2015; 135:990-9. [DOI: 10.1016/j.thromres.2015.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 01/31/2015] [Accepted: 02/08/2015] [Indexed: 02/04/2023]
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Abstract
OBJECTIVE Recent technologic advances in MDCT have led to the introduction of dual-energy CT (DECT). The basic principle of DECT is to acquire images at two different energy levels simultaneously and to use the attenuation differences at these different energy levels for deriving additional information, such as virtual monochromatic images, artifact suppression, and material composition of various tissues. CONCLUSION A variety of image reconstruction and postprocessing techniques are available for better demonstration and characterization of pathologic abnormalities. DECT can provide both anatomic and functional information of different organ systems. This article focuses on the main applications of DECT in emergency radiology.
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Ohana M, Jeung MY, Labani A, El Ghannudi S, Roy C. Thoracic dual energy CT: acquisition protocols, current applications and future developments. Diagn Interv Imaging 2014; 95:1017-26. [PMID: 24780370 DOI: 10.1016/j.diii.2014.01.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Thanks to a simultaneous acquisition at high and low kilovoltage, dual energy computed tomography (DECT) can achieve material-based decomposition (iodine, water, calcium, etc.) and reconstruct images at different energy levels (40 to 140keV). Post-processing uses this potential to maximise iodine detection, which elicits demonstrated added value for chest imaging in acute and chronic embolic diseases (increases the quality of the examination and identifies perfusion defects), follow-up of aortic endografts and detection of contrast uptake in oncology. In CT angiography, these unique features are taken advantage of to reduce the iodine load by more than half. This review article aims to set out the physical basis for the technology, the acquisition and post-processing protocols used, its proven advantages in chest pathologies, and to present future developments.
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Affiliation(s)
- M Ohana
- Department of Radiology, Nouvel Hôpital Civil, University Hospitals of Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France.
| | - M Y Jeung
- Department of Radiology, Nouvel Hôpital Civil, University Hospitals of Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - A Labani
- Department of Radiology, Nouvel Hôpital Civil, University Hospitals of Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - S El Ghannudi
- Department of Radiology, Nouvel Hôpital Civil, University Hospitals of Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - C Roy
- Department of Radiology, Nouvel Hôpital Civil, University Hospitals of Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
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Hansmann J, Fink C, Jost G, Pietsch H, Meyer M, Nance JW, Schoepf UJ, Attenberger UI, Schoenberg SO, Henzler T. Impact of iodine delivery rate with varying flow rates on image quality in dual-energy CT of patients with suspected pulmonary embolism. Acad Radiol 2013; 20:962-71. [PMID: 23746688 DOI: 10.1016/j.acra.2013.02.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 02/15/2013] [Accepted: 02/17/2013] [Indexed: 01/31/2023]
Abstract
RATIONALE AND OBJECTIVES To prospectively compare four contrast material injection protocols for dual-energy computed tomography (CT) pulmonary angiography (DE-CTPA) in patients with suspected pulmonary embolism (PE). MATERIALS AND METHODS One hundred twenty consecutive patients were randomized to contrast material injection protocols defined by different iodine concentrations and iodine delivery rates (IDRs): (A) 80 mL iopromide 370/4 mL/sec = IDR 1.4 gI/sec; (B) 80 mL iopromide 370 at 3 mL/sec = IDR 1.1 gI/sec; (C) 98 mL iopromide 300 at 4.9 mL/sec = IDR 1.4 gI/sec; and (D) 98 mL iopromide 300 at 3.7 mL/sec = IDR 1.1 gI/sec. Attenuation values were measured in the inflow tract (subclavian vein-superior vena cava-right atrium), target tract (right ventricle-pulmonary trunk-pulmonary arteries), and outflow tract (left atrium-left ventricle-ascending aorta). Two readers assessed subjective image quality of CTPA images and iodine perfusion maps. The number of artifacts due to hyperdense contrast material on iodine perfusion maps was recorded. RESULTS Target tract attenuation was highest for protocol A with 374 ± 98 Hounsfield units (HU) (highly concentrated contrast material/high IDR). This was significant compared to protocols B and D (P = .0118, P = .0427) but not compared to protocol C (P = .3395). No significant difference in target tract attenuation was found between protocols B (309 ± 80 HU), protocol C (352 ± 119 HU), and D (325 ± 74 HU). CTPA and iodine perfusion map image quality for protocol A was rated significantly higher compared to all other protocols (median score = 5/4; P < .0001 for both) with moderate interreader agreement (κ = 0.58/0.47). Protocols A and B displayed increased artifacts on iodine perfusion maps compared to protocols C and D (3 versus 2). CONCLUSION Despite increased artifacts on iodine perfusion maps, highly concentrated iodinated contrast material combined with high flow rates provides improved diagnostic image quality and has the highest target-tract attenuation for DE-CTPA protocols.
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Zhang LJ, Zhou CS, Schoepf UJ, Sheng HX, Wu SY, Krazinski AW, Silverman JR, Meinel FG, Zhao YE, Zhang ZJ, Lu GM. Dual-energy CT lung ventilation/perfusion imaging for diagnosing pulmonary embolism. Eur Radiol 2013; 23:2666-75. [DOI: 10.1007/s00330-013-2907-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 04/24/2013] [Accepted: 04/25/2013] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE The introduction of dual-energy CT (DECT) has ushered in the ability of material differentiation and tissue characterization beyond the traditional CT attenuation scale. This quality has been exploited for visualizing and quantifying the specific tissue content using radiographic contrast agents, such as iodine-based contrast media or inhaled xenon gas. Applications of this paradigm in the thorax include characterization of the pulmonary blood pool in the setting of acute or chronic pulmonary embolism (PE) and characterization of diseases of the lung parenchyma. Selective xenon detection is being explored for imaging of lung ventilation. In addition, the usefulness of DECT-based selective iodine uptake measurements has been described for the diagnosis and surveillance of thoracic malignancies. This article reviews the current applications of DECT-based imaging techniques in the chest with an emphasis on the diagnosis and characterization of pulmonary thromboembolic disorders. CONCLUSION DECT can provide both anatomic and functional information about the lungs in a variety of pulmonary disease states based on a single contrast-enhanced CT examination. This quality has been shown to improve the diagnosis of acute and chronic PEs, other vascular disorders, lung malignancies, and parenchymal diseases. Further developments in DECT techniques and CT scanner technology will further foster and enhance the utility of this application and open new avenues in lung imaging.
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