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Pulmonary perfusion defect volume on dual-energy CT: prognostic marker of adverse events in patients with suspected pulmonary embolism. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023:10.1007/s10554-023-02836-8. [PMID: 36939984 DOI: 10.1007/s10554-023-02836-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/11/2023] [Indexed: 03/21/2023]
Abstract
To assess whether quantification of pulmonary perfusion defects on dual-energy computed tomography (DECT) relates to adverse events beyond clinical parameters and traditional embolus detection in patients with suspected pulmonary embolism (PE). We included consecutive patients who underwent DECT to rule out acute PE in 2018-2020 and recorded incident adverse events, defined as a composite of short-term (< 30 days) in-hospital all-cause mortality or admission to intensive care unit. Relative perfusion defect volume (PDV) was measured on DECT and indexed by total lung volume. PDV was then related to adverse events using logistic regressions adjusting for clinical parameters, clinical PE pre-test probability (Wells score), and visual PE burden on pulmonary angiography (Qanadli score). Among 136 included patients (63 [46%] females; age: 70 ± 14 years), 19/136 (14%) experienced adverse events during a median hospitalization of 7.5 (4-14) days. Overall, 7/19 (37%) events occurred in those without visible emboli but with measurable perfusion defects. An increase of PDV by one standard deviation was associated with over two times higher odds of adverse events (OR = 2.24; 95%CI:1.37-3.65; p = 0.001). This association remained significant after adjusting for the Wells and Qanadli scores (OR = 2.34; 95%CI:1.20-4.60; p = 0.013). PDV significantly increased the combined discriminatory capacity of Wells and Qanadli scores (AUC 0.76 vs. 0.80; p = 0.011 for difference). DECT-derived PDV may represent a prognostic imaging marker with incremental value beyond clinical and traditional imaging findings, improving risk stratification and aiding clinical management in patients with suspected PE.
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Clinical Presentations and Multimodal Imaging Diagnosis in Chronic Thromboembolic Pulmonary Hypertension. J Clin Med 2022; 11:jcm11226678. [PMID: 36431155 PMCID: PMC9698386 DOI: 10.3390/jcm11226678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but life-threatening pulmonary vascular disease caused by the presence of a prolonged thrombus in the pulmonary artery. CTEPH is a distinct disease entity classified as group 4 pulmonary hypertension according to the World Symposium on Pulmonary Hypertension. It is the only potentially curable cause of pulmonary hypertension. However, timely diagnosis and treatment are often hampered by nonspecific symptoms and signs and a lack of physician awareness regarding the condition. Thus, it is important to be familiar with the clinical features of CTEPH and the associated diagnostic processes. Herein, we cover the diagnostic approach for CTEPH using multimodal imaging tools in a clinical setting.
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Patel N, Hyder SN, Michaud E, Moles V, Agarwal PP, Rosenfield K, Abe K, Haft J, Visovatti SH, Cascino TM, Auger WR, Mclaughlin VV, Aggarwal V. Interventional Imaging Roadmap to Successful Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100429. [PMID: 39132377 PMCID: PMC11307535 DOI: 10.1016/j.jscai.2022.100429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 08/13/2024]
Abstract
Balloon pulmonary angioplasty (BPA) is an evolving treatment modality for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are not candidates for pulmonary endarterectomy. Although several imaging modalities currently exist for evaluating CTEPH, their individual use, specifically in the clinical practice of BPA, has not been well described. In this article, we provide a preprocedural, intraprocedural, and postprocedural interventional imaging roadmap for safe and effective BPA performance in routine clinical practice. Preprocedural assessment includes transthoracic echocardiography for right ventricular assessment, ventilation/perfusion scan to identify pulmonary segments with the highest degree of hypoperfusion, cross-sectional chest imaging excluding alternative causes of mismatched defects and providing anatomic and perfusion imaging concurrently, and nonselective invasive pulmonary angiography for risk stratification of individual lesion subtypes. Intraprocedural assessment includes subselective segmental angiography (SSA) for delineating segmental and subsegmental branch anatomy, lesion identification, and vessel sizing. Intravascular ultrasound and optical coherence tomography serve as adjunctive intraprocedural tools for more accurate vessel sizing and lesion characterization when SSA alone is insufficient. Postprocedural considerations include chest radiography to monitor for immediate postprocedure complications and echocardiography for the interval assessment of the right ventricle on longer-term follow-up.
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Affiliation(s)
- Nimai Patel
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Syed N. Hyder
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Erinleigh Michaud
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Victor Moles
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Prachi P. Agarwal
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Kenneth Rosenfield
- Division of Cardiology, Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jonathan Haft
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Scott H. Visovatti
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Thomas M. Cascino
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - William R. Auger
- Division of Pulmonary Medicine, Department of Internal Medicine, University of California San Diego, San Diego, California
| | - Vallerie V. Mclaughlin
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Vikas Aggarwal
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Section of Cardiology, Department of Internal Medicine, Veterans Affairs Medical Center, Ann Arbor, Michigan
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Wang P, Tang Z, Xiao Z, Hong R, Wang R, Wang Y, Zhan Y. Dual-energy CT in differentiating benign sinonasal lesions from malignant ones: comparison with simulated single-energy CT, conventional MRI, and DWI. Eur Radiol 2021; 32:1095-1105. [PMID: 34427744 DOI: 10.1007/s00330-021-08159-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To explore the value of dual-energy CT (DECT) for differentiating benign sinonasal lesions from malignant ones, and to compare this finding with simulated single-energy CT (SECT), conventional MRI (cMRI), and diffusion-weighted imaging (DWI). METHODS Patients with sinonasal lesions (38 benign and 34 malignant) who were confirmed by histopathology underwent DECT, cMRI, and DWI. DECT-derived parameters (iodine concentration (IC), effective atomic number (Eff-Z), 40-180 keV (20-keV interval), virtual non-enhancement (VNC), slope (k), and linear-mixed 0.3 (Mix-0.3)), DECT morphological features, cMRI characteristics, and ADC value of benign and malignant tumors were compared using t test or chi-square test. Receiver operating characteristic (ROC) curve was performed to evaluate the diagnostic performance, and the area under the ROC curve (AUC) was compared using the Z test to select the optimal diagnostic approach. RESULTS Significantly higher DECT-derived single parameters (IC, Eff-Z, 40 keV, 60 keV, 80 keV, slope (k), Mix-0.3) were found in malignant lesions than those of benign sinonasal lesions (all p < 0.004, Bonferroni correction). Combined quantitative parameters (IC, Eff-Z, 40 keV, 60 keV, 80 keV, slope (k)) can improve the diagnostic efficiency for discriminating these two entities. Combination of DECT quantitative parameters and morphological features can further improve the overall diagnostic performance, with AUC, sensitivity, specificity, and accuracy of 0.935, 96.67%, 90.00%, and 93.52%. Moreover, the AUC of DECT was higher than those of Mix-0.3 (simulated SECT), cMRI, DWI, and cMRI+DWI. CONCLUSIONS Compared with simulated SECT, cMRI, and DWI, DECT appears to be a more accurate imaging technique for differentiating benign from malignant sinonasal lesions. KEY POINTS • DE can differentiate benign sinonasal lesions from malignant ones based on DECT-derived qualitative parameters. • DECT appears to be more accurate in the diagnosis of sinonasal lesions when compared with simulated SECT, cMRI, and DWI.
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Affiliation(s)
- Peng Wang
- Department of Radiology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Department of Radiology, The Affiliated Renmin Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212002, People's Republic of China
| | - Zuohua Tang
- Department of Radiology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.
| | - Zebin Xiao
- Department of Radiology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Department of Biomedical Sciences, University of Pennsylvania, Philadelphia, 19104, USA
| | - Rujian Hong
- Department of Radiology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
| | - Rong Wang
- The Shanghai Institution of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Yuzhe Wang
- Department of Radiology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
| | - Yang Zhan
- The Shanghai Institution of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
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Wang P, Tang Z, Xiao Z, Wu L, Hong R, Wang J. Dual-energy CT for differentiating early glottic squamous cell carcinoma from chronic inflammation and leucoplakia of vocal cord: comparison with simulated conventional 120 kVp CT. Clin Radiol 2020; 76:238.e17-238.e24. [PMID: 33375985 DOI: 10.1016/j.crad.2020.11.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 11/25/2020] [Indexed: 11/18/2022]
Abstract
AIM To evaluate the value of dual-energy (DE) computed tomography (CT) in discriminating early glottic squamous cell carcinoma (eGSCC) from chronic inflammation and leucoplakia of the vocal cord, and to compare the diagnostic efficiency of DECT with that of simulated conventional 120 kVp CT. MATERIALS AND METHODS Seventy patients with glottic lesions confirmed by histopathology (38 cases with eGSCC, 11 cases with chronic inflammation, 21 cases with leucoplakia) were enrolled in this prospective study. The DECT-derived parameters were measured and compared using independent sample t-test. Receiver operating characteristic (ROC) curve was performed to evaluate the diagnostic performance, and comparison of the area under the ROC curve (AUC) was made using the Z test to further select the best diagnostic parameters. RESULTS Significantly higher iodine concentration (IC), normalised IC (NIC), effective atomic number (Zeff), 40-100 keV (20 keV-interval), slope(k), and Mix-0.3 values were found in eGSCC than those in chronic inflammation, leucoplakia, and inflammation + leucoplakia (all p<0.05). Compared with attenuation measurement of simulated conventional 120 kVp CT, the NIC, 60 keV values derived from DECT showed significantly higher AUC in discriminating these glottic lesions (p<0.05). CONCLUSIONS DECT is more accurate for differentiating eGSCC from chronic inflammation and leucoplakia when compared with simulated conventional 120 kVp CT.
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Affiliation(s)
- P Wang
- Department of Radiology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, Shanghai, 200031, PR China; Department of Radiology, The Affiliated Renmin Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212002, PR China
| | - Z Tang
- Department of Radiology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, Shanghai, 200031, PR China.
| | - Z Xiao
- Department of Radiology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, Shanghai, 200031, PR China
| | - L Wu
- Department of Otolaryngology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, Shanghai, PR China
| | - R Hong
- Department of Radiology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, Shanghai, 200031, PR China
| | - J Wang
- Department of Otolaryngology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, Shanghai, PR China
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Abstract
Lung emphysema represents a major public health burden and still accounts for five percent of all deaths worldwide. Hence, it is essential to further understand this disease in order to develop effective diagnostic and therapeutic strategies. Lung emphysema is an irreversible enlargement of the airways distal to the terminal bronchi (i.e., the alveoli) due to the destruction of the alveolar walls. The two most important causes of emphysema are (I) smoking and (II) α1-antitrypsin-deficiency. In the former lung emphysema is predominant in the upper lung parts, the latter is characterized by a predominance in the basal areas of the lungs. Since quantification and evaluation of the distribution of lung emphysema is crucial in treatment planning, imaging plays a central role. Imaging modalities in lung emphysema are manifold: computed tomography (CT) imaging is nowadays the gold standard. However, emerging imaging techniques like dynamic or functional magnetic resonance imaging (MRI), scintigraphy and lately also the implementation of radiomics and artificial intelligence are more and more diffused in the evaluation, diagnosis and quantification of lung emphysema. The aim of this review is to shortly present the different subtypes of lung emphysema, to give an overview on prediction and risk assessment in emphysematous disease and to discuss not only the traditional, but also the new imaging techniques for diagnosis, quantification and evaluation of lung emphysema.
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Affiliation(s)
- Katharina Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. One of the main findings is pulmonary emphysema in association with chronic bronchitis. Clinical signs, pulmonary function tests and imaging are the current used methods to diagnose and stage emphysema. Lung volume reduction (LVR) and endoscopic lung volume reduction (ELVR) are the current therapeutic options beside lung transplantation in cases of severe emphysema. Nowadays imaging is one of the key factors for the success of these therapies. Especially quantitative computed tomography (CT) with its increasing possibilities has become a viable tool, providing detailed information about distribution and heterogeneity of emphysema. Other imaging techniques like dual-energy CT (DECT) and functional magnetic resonance (MR) have shown to add functional information. These structural and functional information support thoracic surgeons and interventional pulmonologists in selecting patients and optimizing LVR procedures but also enables the development of new endobronchial therapies. Imaging will further improve the individual outcome by supporting the choice of optimal therapy.
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Affiliation(s)
- Katharina Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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9
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Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the potentially curable causes of pulmonary hypertension and is definitively treated with pulmonary thromboendartectomy. CTEPH can be overlooked, as its symptoms are nonspecific and can be mimicked by a wide range of diseases that can cause pulmonary hypertension. Early diagnosis of CTEPH and prompt evaluation for surgical candidacy are paramount factors in determining future outcomes. Imaging plays a central role in the diagnosis of CTEPH and patient selection for pulmonary thromboendartectomy and balloon pulmonary angioplasty. Currently, various imaging tools are used in concert, with techniques such as computed tomography (CT) and conventional pulmonary angiography providing detailed structural information, tests such as ventilation-perfusion (V/Q) scanning providing functional data, and magnetic resonance imaging providing a combination of morphologic and functional information. Emerging techniques such as dual-energy CT and single photon emission computed tomography-CT V/Q scanning promise to provide both anatomic and functional information in a single test and may change the way we image these patients in the near future. In this review, we discuss the roles of various imaging techniques and discuss their merits, limitations, and relative strengths in depicting the structural and functional changes of CTEPH. We also explore newer imaging techniques and the potential value they may offer.
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Karia S, Screaton N. Pulmonary embolism. IMAGING 2016. [DOI: 10.1183/2312508x.10002615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kindvall SS, Diaz S, Svensson J, Wollmer P, Slusarczyk D, Olsson LE. Influence of age and sex on the longitudinal relaxation time, T1, of the lung in healthy never-smokers. J Magn Reson Imaging 2015; 43:1250-7. [DOI: 10.1002/jmri.25085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/15/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Simon S.I. Kindvall
- Medical Radiation Physics, Translational Medicine; Lund University; Malmö Sweden
| | - Sandra Diaz
- Medical Radiology, Translational Medicine; Lund University; Malmö Sweden
| | - Jonas Svensson
- Medical imaging and physiology; Skane University Hospital; Lund Sweden
| | - Per Wollmer
- Clinical Physiology, Translational Medicine; Lund University; Malmö Sweden
| | - Dariusz Slusarczyk
- Medical Radiology, Translational Medicine; Lund University; Malmö Sweden
| | - Lars E. Olsson
- Medical Radiation Physics, Translational Medicine; Lund University; Malmö Sweden
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Analysis of decrease in lung perfusion blood volume with occlusive and non-occlusive pulmonary embolisms. Eur J Radiol 2014; 83:2260-2267. [DOI: 10.1016/j.ejrad.2014.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/15/2014] [Accepted: 08/22/2014] [Indexed: 11/22/2022]
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Quantification of lung perfusion blood volume with dual-energy CT: assessment of the severity of acute pulmonary thromboembolism. AJR Am J Roentgenol 2014; 203:287-91. [PMID: 25055261 DOI: 10.2214/ajr.13.11586] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the usefulness of quantification of lung perfused blood volume (PBV) with dual-energy CT (DECT) for assessment of the severity of acute pulmonary thromboembolism (PTE). MATERIALS AND METHODS We retrospectively analyzed the records of 72 patients with PTE and 168 without PTE who underwent DECT. The PTE patients were divided into high-, intermediate-, and low-risk groups based on clinical symptoms and right ventricular dysfunction. Correlations between quantification of whole-lung PBV and clinical severity were evaluated. Also evaluated was the relation between quantification of whole-lung PBV and right-to-left ventricular diameter ratio on CT images, which was used as an indicator of right ventricular dysfunction. RESULTS In the PTE and control groups, the whole-lung PBVs were 27.6 ± 7.9 and 29.9 ± 6.8 HU with a significant difference between them (p < 0.0281). In the high-, intermediate-, and low-risk PTE groups, the whole-lung PBVs were 16.0 ± 2.9, 21.0 ± 4.2, and 31.4 ± 5.8 HU with a significant difference between them (p < 0.05). There was no significant difference in whole-lung PBV between the control group and the low-risk PTE group, but there was a significant difference between the control group and the other two PTE groups. In PTE patients, whole-lung PBV had negative correlation with right-to-left ventricular diameter ratio (R = -0.567, p < 0.001). CONCLUSION Quantification of lung PBV with DECT is useful for assessment of the clinical severity of PTE and can be used as an indicator of right ventricular dysfunction.
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Nagayama H, Sueyoshi E, Hayashida T, Ashizawa K, Sakamoto I, Uetani M. Quantification of lung perfusion blood volume (lung PBV) by dual-energy CT in pulmonary embolism before and after treatment: preliminary results. Clin Imaging 2013; 37:493-7. [DOI: 10.1016/j.clinimag.2012.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 07/08/2012] [Accepted: 08/23/2012] [Indexed: 10/27/2022]
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Wijesuriya S, Chandratreya L, Medford AR. Chronic pulmonary emboli and radiologic mimics on CT pulmonary angiography: a diagnostic challenge. Chest 2013; 143:1460-1471. [PMID: 23648910 DOI: 10.1378/chest.12-1384] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Chronic pulmonary thromboembolism (CPE) is a challenging diagnosis for clinicians. It is an often-forgotten diagnosis and can be difficult to detect and easily misdiagnosed. The radiologic features on CT pulmonary angiography are subtle and can be further compounded by pathologic mimics and unusual findings observed with disease progression. Diagnosis is important because CPE can lead to progressive pulmonary hypertension, morbidity, and mortality. Moreover, chronic thromboembolic pulmonary hypertension is the only category of pulmonary hypertension with an effective curative treatment in the form of pulmonary endarterectomy. Therefore, CPE must be considered and recognized early. The features of chronic pulmonary emboli on CT scans can be categorized into vascular or parenchymal findings. Endoluminal signs include totally or partially occlusive thrombi and webs and bands. Parenchymal features such as mosaic attenuation and pulmonary infarction are also noted, in addition to features of pulmonary artery hypertension. Additional findings have been noted, including cavitation of infarcts, microbial colonization of cavities, and bronchopleural fistulae. As CPE can be diagnosed at different stages of its disease pathway, such findings may not necessarily arouse suspicion toward a causative diagnosis of chronic embolism. To aid diagnosis for clinicians, this article describes the characteristic vascular and parenchymal CT scan features of chronic emboli, as well as important ancillary findings. We also provide an illustrative case series focusing on CT pulmonary angiography specifically as an imaging modality to highlight the progressive nature of CPE and its sequelae, as well as important radiologic mimics to consider in the differential diagnosis.
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Affiliation(s)
| | | | - Andrew R Medford
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, England.
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Ascenti G, Mileto A, Gaeta M, Blandino A, Mazziotti S, Scribano E. Single-phase dual-energy CT urography in the evaluation of haematuria. Clin Radiol 2012; 68:e87-94. [PMID: 23219453 DOI: 10.1016/j.crad.2012.11.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/31/2012] [Accepted: 11/09/2012] [Indexed: 11/26/2022]
Abstract
AIM To assess the value of a single-phase dual-energy computed tomography (DECT) urography protocol with synchronous nephrographic-excretory phase enhancement and to calculate the potential dose reduction by omitting the unenhanced scan. MATERIALS AND METHODS Eighty-four patients referred for haematuria underwent CT urography using a protocol that included single-energy unenhanced and dual-energy contrast-enhanced with synchronous nephrographic-excretory phase scans. DECT-based images [virtual unenhanced (VUE), weighted average, and colour-coded iodine overlay] were reconstructed. Opacification degree by contrast media of the upper urinary tract, and image quality of virtual unenhanced images were independently evaluated using a four-point scale. The diagnostic accuracy in detecting urothelial tumours on DECT-based images was determined. The dose of a theoretical dual-phase single-energy protocol was obtained by multiplying the effective dose of the unenhanced single-energy acquisition by two. Radiation dose saving by omitting the unenhanced scan was calculated. RESULTS The degree of opacification was scored as optimal or good in 86.9% of cases (k = 0.72); VUE image quality was excellent or good in 83.3% of cases (k = 0.82). Sensitivity, specificity, positive predictive value, and negative predictive value for urothelial tumours detection were 85.7, 98.6, 92.3, and 97.1%. Omission of the unenhanced scan led to a mean dose reduction of 42.7 ± 5%. CONCLUSION Single-phase DECT urography with synchronous nephrographic-excretory phase enhancement represents an accurate "all-in-one'' approach with a radiation dose saving up to 45% compared with a standard dual-phase protocol.
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Affiliation(s)
- G Ascenti
- Department of Radiological Sciences, Policlinico G. Martino, University of Messina, Messina, Italy
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