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Doğan K, Selçuk T, Alkan A. An Enhanced Mask R-CNN Approach for Pulmonary Embolism Detection and Segmentation. Diagnostics (Basel) 2024; 14:1102. [PMID: 38893629 PMCID: PMC11171979 DOI: 10.3390/diagnostics14111102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Pulmonary embolism (PE) refers to the occlusion of pulmonary arteries by blood clots, posing a mortality risk of approximately 30%. The detection of pulmonary embolism within segmental arteries presents greater challenges compared with larger arteries and is frequently overlooked. In this study, we developed a computational method to automatically identify pulmonary embolism within segmental arteries using computed tomography (CT) images. The system architecture incorporates an enhanced Mask R-CNN deep neural network trained on PE-containing images. This network accurately localizes pulmonary embolisms in CT images and effectively delineates their boundaries. This study involved creating a local data set and evaluating the model predictions against pulmonary embolisms manually identified by expert radiologists. The sensitivity, specificity, accuracy, Dice coefficient, and Jaccard index values were obtained as 96.2%, 93.4%, 96.%, 0.95, and 0.89, respectively. The enhanced Mask R-CNN model outperformed the traditional Mask R-CNN and U-Net models. This study underscores the influence of Mask R-CNN's loss function on model performance, providing a basis for the potential improvement of Mask R-CNN models for object detection and segmentation tasks in CT images.
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Affiliation(s)
- Kâmil Doğan
- Department of Radiology, Kahramanmaras Sutcu Imam University, 46050 Onikişubat, Turkey;
| | - Turab Selçuk
- Department of Electrical and Electronics Engineering, Kahramanmaras Sutcu Imam University, 46050 Onikişubat, Turkey;
| | - Ahmet Alkan
- Department of Electrical and Electronics Engineering, Kahramanmaras Sutcu Imam University, 46050 Onikişubat, Turkey;
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Makowska A, Treumann T, Venturini S, Christ M. Pulmonary Embolism in Pregnancy: A Review for Clinical Practitioners. J Clin Med 2024; 13:2863. [PMID: 38792409 PMCID: PMC11121909 DOI: 10.3390/jcm13102863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Diagnostic and therapeutic decision-making in pregnancy with suspected pulmonary embolism (PE) is challenging. European and other international professional societies have proposed various recommendations that are ambiguous, probably due to the unavailability of randomized controlled trials. In the following sections, we discuss the supporting diagnostic steps and treatments. We suggest a standardized diagnostic work-up in pregnant patients presenting with symptoms of PE to make evidence-based diagnostic and therapeutic decisions. We strongly recommend that clinical decisions on treatment in pregnant patients with intermediate- or high-risk pulmonary embolism should include a multidisciplinary team approach involving emergency physicians, pulmonologists, angiologist, cardiologists, thoracic and/or cardiovascular surgeons, radiologists, and obstetricians to choose a tailored management option including an interventional treatment. It is important to be aware of the differences among guidelines and to assess each case individually, considering the specific views of the different specialties. This review summarizes key concepts of the diagnostics and acute management of pregnant women with suspected PE that are supportive for the clinician on duty.
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Affiliation(s)
- Agata Makowska
- Emergency Department, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland; (S.V.); (M.C.)
- Cardiology, Hospital Centre of Biel, 2501 Biel, Switzerland
| | - Thomas Treumann
- Radiology, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland;
| | - Stefan Venturini
- Emergency Department, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland; (S.V.); (M.C.)
| | - Michael Christ
- Emergency Department, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland; (S.V.); (M.C.)
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Si G, Du Y, Tang P, Ma G, Jia Z, Zhou X, Mu D, Shen Y, Lu Y, Mao Y, Chen C, Li Y, Gu N. Unveiling the next generation of MRI contrast agents: current insights and perspectives on ferumoxytol-enhanced MRI. Natl Sci Rev 2024; 11:nwae057. [PMID: 38577664 PMCID: PMC10989670 DOI: 10.1093/nsr/nwae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/23/2024] [Accepted: 02/05/2024] [Indexed: 04/06/2024] Open
Abstract
Contrast-enhanced magnetic resonance imaging (CE-MRI) is a pivotal tool for global disease diagnosis and management. Since its clinical availability in 2009, the off-label use of ferumoxytol for ferumoxytol-enhanced MRI (FE-MRI) has significantly reshaped CE-MRI practices. Unlike MRI that is enhanced by gadolinium-based contrast agents, FE-MRI offers advantages such as reduced contrast agent dosage, extended imaging windows, no nephrotoxicity, higher MRI time efficiency and the capability for molecular imaging. As a leading superparamagnetic iron oxide contrast agent, ferumoxytol is heralded as the next generation of contrast agents. This review delineates the pivotal clinical applications and inherent technical superiority of FE-MRI, providing an avant-garde medical-engineering interdisciplinary lens, thus bridging the gap between clinical demands and engineering innovations. Concurrently, we spotlight the emerging imaging themes and new technical breakthroughs. Lastly, we share our own insights on the potential trajectory of FE-MRI, shedding light on its future within the medical imaging realm.
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Affiliation(s)
- Guangxiang Si
- Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210009, China
| | - Yue Du
- Key Laboratory for Bio-Electromagnetic Environment and Advanced Medical Theranostics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 210029, China
| | - Peng Tang
- Key Laboratory for Bio-Electromagnetic Environment and Advanced Medical Theranostics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 210029, China
| | - Gao Ma
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhaochen Jia
- Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210009, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai 200126, China
| | - Dan Mu
- Department of Radiology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Yan Shen
- Key Laboratory for Bio-Electromagnetic Environment and Advanced Medical Theranostics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 210029, China
| | - Yi Lu
- School of Mathematical Sciences, Capital Normal University, Beijing 100048, China
| | - Yu Mao
- Nanjing Key Laboratory for Cardiovascular Information and Health Engineering Medicine, Institute of Clinical Medicine, Nanjing Drum Tower Hospital, Medical School, Nanjing University, Nanjing 210093, China
| | - Chuan Chen
- Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210009, China
| | - Yan Li
- Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210009, China
| | - Ning Gu
- Nanjing Key Laboratory for Cardiovascular Information and Health Engineering Medicine, Institute of Clinical Medicine, Nanjing Drum Tower Hospital, Medical School, Nanjing University, Nanjing 210093, China
- Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210009, China
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Liu H, Fu Y, Zhao B, Zhang X, Li G, Liu M, Li H. EFFECTS OF TEST-BOLUS AND LOW-DOSE SCAN ON CT PULMONARY ANGIOGRAPHY IMAGE QUALITY IN PATIENTS WITH DIFFERENT BODY MASS INDEXES. RADIATION PROTECTION DOSIMETRY 2020; 192:387-395. [PMID: 33415327 DOI: 10.1093/rpd/ncaa217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/30/2020] [Accepted: 11/26/2020] [Indexed: 06/12/2023]
Abstract
This study aimed to investigate different methods of obtaining high-quality Computed Tomography pulmonary angiography (CTPA) images using low-dose scanning in patients with different body mass index (BMI) values. Sixty patients with suspected pulmonary embolism were grouped based on their BMI values (BMI < 25, designated N, and BMI ≥ 25, designated O) and were assigned to receive either test bolus (TB) or bolus tracking (BT) at conventional (C) or low (L) dose. The effective dose (ED) in the N-TB-L group was lower than in the group N-TB-C (0.56 ± 0.05 vs. 3.78 ± 1.16, p < 0.001), with similar image quality (4.90 ± 0.31 vs. 4.70 ± 0.47, p = 0.120). The ED in the O-TB-L group was lower than in the O-TB-C group (0.54 ± 0.03 vs. 5.14 ± 1.34, p < 0.001), but the group O-TB-C's image quality was higher (4.65 ± 0.59 vs. 3.95 ± 0.89, p = 0.006). Groups N-TB-L versus O-TB-L, groups N-TB-L versus N-BT-L and groups O-TB-C versus O-BT-C had similar EDs (all ps > 0.05), but the image quality was different (all ps < 0.05). In conclusion, the results showed that the image quality of low-dose CTPA scanning using TB was similar to that of the conventional-dose CTPA in patients with BMI < 25 but was lower in patients with BMI ≥ 25. TB was better than BT for all patients, regardless of BMI, when receiving the same ED.
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Affiliation(s)
- Huijia Liu
- Radiology Department, Second Hospital of Tianjin Medical University, Pingjiang Road, Hexi District, 300211, Tianjin, China
| | - Yan Fu
- Radiology Department, Second Hospital of Tianjin Medical University, Pingjiang Road, Hexi District, 300211, Tianjin, China
| | - Bo Zhao
- Radiology Department, Second Hospital of Tianjin Medical University, Pingjiang Road, Hexi District, 300211, Tianjin, China
| | - Xuening Zhang
- Radiology Department, Second Hospital of Tianjin Medical University, Pingjiang Road, Hexi District, 300211, Tianjin, China
| | - Guilai Li
- Radiology Department, Second Hospital of Tianjin Medical University, Pingjiang Road, Hexi District, 300211, Tianjin, China
| | - Meizhou Liu
- Radiology Department, Second Hospital of Tianjin Medical University, Pingjiang Road, Hexi District, 300211, Tianjin, China
| | - Hewen Li
- Radiology Department, Second Hospital of Tianjin Medical University, Pingjiang Road, Hexi District, 300211, Tianjin, China
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Digumarthy SR, Singh R, Rastogi S, Otrakji A, Homayounieh F, Zhang EW, McDermott S, Kalra MK. Low contrast volume dual-energy CT of the chest: Quantitative and qualitative assessment. Clin Imaging 2020; 69:305-310. [PMID: 33045474 DOI: 10.1016/j.clinimag.2020.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/18/2020] [Accepted: 10/01/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the image quality of chest CT performed on dual-energy scanners using low contrast volume for routine chest (DECT-R) and pulmonary angiography (DECTPA) protocols. MATERIALS AND METHODS This retrospective study included dual-energy CT scans of chest performed with low contrast volume in 84 adults (34M:50F; Age 69 ± 16 years: Weight 71 ± 16kg). There were 42 patients with DECT-R and 42 patients with DECT-PA protocols. Images were reviewed by two thoracic radiologists. Qualitative assessment was done on a four-point scale, for subjective assessment of contrast enhancement and artifacts (1 = Excellent, 2 = optimal, 3 = suboptimal, and 4 = Limited) in the pulmonary arteries and thoracic aorta, on virtual monoenergetic and material decomposition iodine (MDI) images. Quantitative assessment was performed by measuring the CT (Hounsfield) units in aorta and pulmonary arteries. The estimated glomerular filtration rate (eGFR) was calculated before and after CT scans. Two tailed student's t-test was performed to assess the significance of findings, and strength of correlation between readers was determined by Cohen's kappa test. RESULTS DECT-PA and DECT-R demonstrated excellent/adequate contrast density within the pulmonary arteries (up to segmental branch), and aorta. There was no suboptimal or limited examination. There was strong interobserver agreement for arterial enhancement in pulmonary arteries (kappa = 0.62-0.89) and for thoracic aorta (kappa = 0.62-0.94). Pulmonary emboli were seen in 3/42(7%) in DECT-R and in 5/42(12%) in DECT-PA. There was no significant change in eGFR before and after IV contrast injection (p = 0.46-0.52). CONCLUSION DECT-R and DECT-PA performed with low contrast volume provide diagnostic quality opacification of the pulmonary vessels and aorta vessels.
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Affiliation(s)
- Subba R Digumarthy
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
| | - Ramandeep Singh
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Shivam Rastogi
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Alexi Otrakji
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Fatemeh Homayounieh
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Eric W Zhang
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Shaunagh McDermott
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Mannudeep K Kalra
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
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Cantarinha A, Dillenseger JP, Bellin MF. Development and Evaluation of a CT Pulmonary Angiography Protocol Dedicated to Pregnant and Postpartum Women. J Med Imaging Radiat Sci 2020; 51:480-488. [PMID: 32741741 DOI: 10.1016/j.jmir.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION This study presents and evaluates a CT pulmonary angiography protocol dedicated to pregnant women. The specific feature of this protocol is to place the region of interest (ROI) (bolus detection) in the superior vena cava. The objective is to evaluate the performances of this method. MATERIALS AND METHODS The protocol uses a iodine-based contrast agent at 300mgI/mL and an injection rate of 5 to 6 mL/sec for an injection volume of 50 mL of iodine contrast agent followed by 40 mL of NaCl. The ROI is positioned on the superior vena cava, with a 100 Hounsfield units (HU) threshold, and the acquisition is performed at 100 kVp. This protocol was evaluated retrospectively on a large population (n = 105: group 1) and compared with a control group that did not benefit from this protocol (n = 55: group 2). Both groups were studied on the same device in the same center. Each examination was evaluated and classified into 3 groups: optimal, suboptimal, and noncontributory. Dose length products (DLP) values were also recorded. Statistical tests were applied to the data collected. RESULTS The rate of noncontributory examinations increased from 43.1% for the control group to 4.8% for the new protocol group. The reference enhancement level in the pulmonary trunk is 250 UH. The mean enhancement in the pulmonary trunk of the new protocol group (332 HU (±71 HU (±71 HU)) is significantly greater than the reference value of 250 HU (P < .0001), which is not the case for control group (P = .3485 > .05), which has a mean enhancement of 239 HU (±87 HU). The control group had a mean DLP of 225 mGy.cm (±81 mGy.cm), and the new-protocol group had a mean DLP of 189 mGy.cm (±75 mGy.cm). DISCUSSION Our noncontributory examination rate is the lowest rate described in the literature. Our protocol contradicts standard practices of placing an ROI in the pulmonary trunk for bolus detection of iodinated contrast media. CONCLUSION The results of this study showed that this protocol reduces the number of noncontributory examinations while reducing the dose delivered to patients. This robust protocol is applicable to other devices and meets perfectly radiation-safety requirements and injected contrast media volume limitation.
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Affiliation(s)
- Alfredo Cantarinha
- Pôle d'imagerie médicale, CHU du Kremlin Bicêtre, Paris, France; Collège scientifique de l'Association française du personnel paramédical d'électroradiologie médicale (AFPPE), Paris, France.
| | - Jean-Philippe Dillenseger
- Collège scientifique de l'Association française du personnel paramédical d'électroradiologie médicale (AFPPE), Paris, France; Section Imagerie Médicale et Radiologie Thérapeutique, Académie de Strasbourg, Strasbourg, France; ICube - UMR 7357, CNRS, Université de Strasbourg, Strasbourg, France
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Patel C, Akhtar H, Gupta S, Harky A. Pregnancy and cardiac interventions: What are the optimal management options? J Card Surg 2020; 35:1589-1596. [PMID: 32484993 DOI: 10.1111/jocs.14637] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiac disease is the leading cause of maternal mortality in the United Kingdom. Major causes of cardiac death in pregnant women include cardiomyopathies, myocardial infarction, ischemic heart disease, and aortic dissection. Uncorrected congenital heart disease and women who have had corrective or palliative surgery may have complicated pregnancies as well. Some women with significant cardiac disease are unable to meet the increased physiological demands of pregnancy. Of these, those who do not respond to medical treatment may require surgical correction such as coronary artery bypass grafting. The risk of cardiac operations for pregnant women is similar to that for nonpregnant women but the fetal mortality rate remains high. Contributing factors to high fetal mortality rates include timing, urgency of operation, and the fetal/fetoplacental response to cardiopulmonary bypass. The aim of this review is to summarize current evidence in utilizing the different management approaches of cardiac issues during pregnancy.
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Affiliation(s)
- Chandni Patel
- Department of Medicine, St George's University of London, London, UK
| | - Hubba Akhtar
- Department of Medicine, St George's University of London, London, UK
| | - Shubhi Gupta
- Department of Medicine, University of Liverpool, Liverpool, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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Allen BD, Schiebler ML, François CJ. Pulmonary Vascular Disease Evaluation with Magnetic Resonance Angiography. Radiol Clin North Am 2020; 58:707-719. [PMID: 32471539 DOI: 10.1016/j.rcl.2020.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pulmonary vascular assessment commonly relies on computed tomography angiography (CTA), but continued advances in magnetic resonance angiography have allowed pulmonary magnetic resonance angiography (pMRA) to become a reasonable alternative to CTA without exposing patients to ionizing radiation. pMRA allows the evaluation of pulmonary vascular anatomy, hemodynamic physiology, lung parenchymal perfusion, and (optionally) right and left ventricular function with a single examination. This article discusses pMRA techniques and artifacts; performance in commonly encountered pulmonary vascular diseases, specifically pulmonary embolism and pulmonary hypertension; and recent advances in both contrast-enhanced and noncontrast pMRA.
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Affiliation(s)
- Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 North Michigan Avenue, Suite 1600, Chicago, IL 60611, USA.
| | - Mark L Schiebler
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, USA
| | - Christopher J François
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, USA
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Dymbe B, Mæland EV, Styve JR, Rusandu A. Individualization of computed tomography protocols for suspected pulmonary embolism: a national investigation of routines. J Int Med Res 2020; 48:300060520918427. [PMID: 32290743 PMCID: PMC7157970 DOI: 10.1177/0300060520918427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective Given the extensive use of computed tomography (CT) in radiation-sensitive patients such as pregnant and pediatric patients, and considering the importance of tailoring CT protocols to patient characteristics for both the radiation dose and image quality, this study was performed to investigate the extent to which individualization of CT protocols is practiced across Norway. Methods This cross-sectional study involved collection of CT protocols and administration of a mini-questionnaire to obtain additional information about how CT examinations are individualized. All public hospitals performing CT to detect pulmonary embolism were invited, and 41% participated. Results Tailoring a standard protocol to different patient groups was more common than using dedicated protocols. Most of the available radiation dose-reduction approaches were used. However, implementation of these strategies was not systematic. Children and pregnant patients were examined without using dedicated CT protocols or by using protocol adjustments focusing on radiation dose reduction in 30% and 39% of the hospitals, respectively. Conclusion Practice optimization is needed, especially the development of dedicated CT protocols or guidelines that tailor the existing protocol to pediatric and pregnant patients. Practice might benefit from a more systematic approach to individualization of CT examinations, such as inserting tailoring instructions into CT protocols.
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Affiliation(s)
- Berit Dymbe
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Elisabeth Vespestad Mæland
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jorunn Rønhovde Styve
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Albertina Rusandu
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Abdellatif W, Ebada MA, Alkanj S, Negida A, Murray N, Khosa F, Nicolaou S. Diagnostic Accuracy of Dual-Energy CT in Detection of Acute Pulmonary Embolism: A Systematic Review and Meta-Analysis. Can Assoc Radiol J 2020; 72:285-292. [PMID: 32103682 DOI: 10.1177/0846537120902062] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE In this systematic review and meta-analysis, we aimed to investigate the accuracy of dual-energy computed tomography (DECT) in the detection of acute pulmonary embolism (PE). METHODS We searched Medline (via PubMed), EBSCO, Web of Science, Scopus, and the Cochrane Library for relevant published studies. We selected studies assessing the accuracy of DECT in the detection of PE. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies-2 tool. Meta-analysis was performed to calculate mean estimates of sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR). The summary receiver operating characteristic (sROC) curve was drawn to get the Cochran Q-index and the area under the curve (AUC). RESULTS Seven studies were included in our systematic review. Of the 182 patients included, 108 patients had PEs. The pooled analysis showed an overall sensitivity and specificity of 88.9% (95% confidence interval [CI]: 81.4%-94.1%) and 94.6% (95% CI: 86.7%-98.5%), respectively. The pooled PLR was 8.186 (95% CI: 3.726-17.986), while the pooled NLR was 0.159 (95% CI: 0.093-0.270). Cochran-Q was 0.8712, and AUC was 0.935 in the sROC curve. CONCLUSION Dual-energy computed tomography shows high sensitivity, specificity, and diagnostic accuracy in the detection of acute PE. The high PLR highlights the high clinical importance of DECT as a prevalence-independent, rule-in test. Studies with a larger sample size with standardized reference tests are still needed to increase the statistical power of the study and support these findings.
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Affiliation(s)
- Waleed Abdellatif
- Department of Radiology, 8167Vancouver General Hospital/University of British Colombia, Vancouver, Canada
| | | | - Souad Alkanj
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Negida
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nicolas Murray
- Department of Radiology, 8167Vancouver General Hospital/University of British Colombia, Vancouver, Canada
| | - Faisal Khosa
- Department of Radiology, 8167Vancouver General Hospital/University of British Colombia, Vancouver, Canada
| | - Savvas Nicolaou
- Department of Radiology, 8167Vancouver General Hospital/University of British Colombia, Vancouver, Canada
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Tsuchiya N, Benson DG, Longhurst C, François CJ, Reeder SB, Repplinger MD, Schiebler ML. Interobserver agreement for the direct and indirect signs of pulmonary embolism evaluated using contrast enhanced magnetic angiography. Eur J Radiol Open 2020; 7:100256. [PMID: 32984448 PMCID: PMC7494795 DOI: 10.1016/j.ejro.2020.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022] Open
Abstract
Direct findings of pulmonary embolism on MRA chest exms had the highest interobserver agreement for vessel cutoff (k-.52, p value- ,.0001). Indirect findings for pulmonary embolism on MRA chest had the highest interobserver agreement for pleural effusions (k-.56, p value = .0001). There was high interobserver agreement for meaurement of the pulmonary artery and the right ventricle/left ventricle ratio.
Background Accurate diagnosis of pulmonary embolism (PE) using contrast enhanced MRA (CE-MRA) requires awareness of both the direct and indirect findings of PE. Purpose To evaluate reader agreement of the direct and indirect findings of PE on CE-MRA. Methods We evaluated pulmonary artery diameter, right ventricle/left ventricle ratio, and clot/vessel lumen signal intensity ratio. Also, eight direct and eight indirect findings of PE were interpreted twice by two radiologists with different experience levels. The prevalence, and intra- and inter-reader agreement for the direct and indirect findings of PE were recorded. Statistical analysis of the measurements was assessed using intraclass correlation while Cohen’s kappa test determined inter- and intra-reader agreement. Results We reviewed 66 positive CE-MRA exams, 10 of which cases were used for training. The largest PE for each of the remaining 56 cases (40 woman) were included in this analysis (38.9 ± 19.7 (mean age (years) ± S.D.)). The highest interobserver agreement for the direct findings were vessel cutoff (κ = 0.52, 95 % CI = (0.30, 0.74), p < .0001) and bright clot (κ = 0.51, 95 % CI = (0.26, 0.78), p = .0001). The highest interobserver agreement for the indirect findings were for atelectasis (κ = 0.67, 95 % CI = (0.49, 0.87), p < .0001), pleural effusions (κ = 0.56, 95 % CI = (0.32, 0.79), p = 0001) and blank slate sing (κ = 0.56, 95 % CI = (0.18, 0.94), p < .0001). Conclusion The indirect findings of atelectasis and pleural effusion had better interobserver reproducibility than the direct findings of vessel cutoff and bright clot. The intraobserver reproducibility of the direct and indirect findings is dependent on experience level. Summary statement Using contrast enhanced magnetic resonance angiography for the diagnosis of pulmonary embolism, the indirect findings of atelectasis and pleural effusion had better interobserver reproducibility than the direct findings of vessel cutoff and bright clot.
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Affiliation(s)
- Nanae Tsuchiya
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
- Department of Radiology, University of Ryukyus, Okinawa, Japan
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
- Corresponding author at: Department of Radiology, University of the Ryukyus, Okinawa, Japan.
| | - Donald G. Benson
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
- Department of Radiology, University of Arkansas for Medical Science College of Medicine, Little Rock, AR, United States
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
| | - Colin Longhurst
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, United States
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
| | - Christopher J. François
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
| | - Scott B. Reeder
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Michael D. Repplinger
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Mark L. Schiebler
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
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Tajbakhsh N, Shin JY, Gotway MB, Liang J. Computer-aided detection and visualization of pulmonary embolism using a novel, compact, and discriminative image representation. Med Image Anal 2019; 58:101541. [PMID: 31416007 DOI: 10.1016/j.media.2019.101541] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 01/15/2023]
Abstract
Diagnosing pulmonary embolism (PE) and excluding disorders that may clinically and radiologically simulate PE poses a challenging task for both human and machine perception. In this paper, we propose a novel vessel-oriented image representation (VOIR) that can improve the machine perception of PE through a consistent, compact, and discriminative image representation, and can also improve radiologists' diagnostic capabilities for PE assessment by serving as the backbone of an effective PE visualization system. Specifically, our image representation can be used to train more effective convolutional neural networks for distinguishing PE from PE mimics, and also allows radiologists to inspect the vessel lumen from multiple perspectives, so that they can report filling defects (PE), if any, with confidence. Our image representation offers four advantages: (1) Efficiency and compactness-concisely summarizing the 3D contextual information around an embolus in only three image channels, (2) consistency-automatically aligning the embolus in the 3-channel images according to the orientation of the affected vessel, (3) expandability-naturally supporting data augmentation for training CNNs, and (4) multi-view visualization-maximally revealing filling defects. To evaluate the effectiveness of VOIR for PE diagnosis, we use 121 CTPA datasets with a total of 326 emboli. We first compare VOIR with two other compact alternatives using six CNN architectures of varying depths and under varying amounts of labeled training data. Our experiments demonstrate that VOIR enables faster training of a higher-performing model compared to the other compact representations, even in the absence of deep architectures and large labeled training sets. Our experiments comparing VOIR with the 3D image representation further demonstrate that the 2D CNN trained with VOIR achieves a significant performance gain over the 3D CNNs. Our robustness analyses also show that the suggested PE CAD is robust to the choice of CT scanner machines and the physical size of crops used for training. Finally, our PE CAD is ranked second at the PE challenge in the category of 0 mm localization error.
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Affiliation(s)
- Nima Tajbakhsh
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, USA
| | - Jae Y Shin
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, USA
| | | | - Jianming Liang
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, USA.
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Awareness and management of pulmonary embolism among physicians in China: a nationwide cross-sectional study. J Thromb Thrombolysis 2019; 47:436-443. [PMID: 30612330 DOI: 10.1007/s11239-018-1788-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pulmonary embolism (PE) is a leading cause of cardiovascular mortality. We intended to evaluate the awareness and management status of PE among Chinese physicians and provide the basis for establishing Chinese clinical guidelines on PE. We designed a nationwide survey to collect data on physicians' awareness of diagnosis, treatment and follow-up on PE. The questionnaires were distributed to physicians during offline academic meetings and by the online platforms from August 2016 to October 2016. Also, results were sub-grouped by age, hospital grades, departments and trained or not. A total of 2954 valid questionnaires were collected. We observed that there were several defects in the management of PE among Chinese physicians. First, a considerable proportion of physicians chose the incorrect clinical prediction rules for acute PE. Second, a considerable percentage of hospitals could not carry out computed tomographic pulmonary angiography (22.4%) or ventilation-perfusion scintigraphy (65.2%). Third, only a few physicians knew the use of new oral anticoagulants clearly (33.4%). Fourth, only 49% of physicians achieved follow-up management in over half of their patients. Additionally, physicians in the tertiary hospitals, aged > 35 years, trained and from respiratory department have a better knowledge of the management of PE. In conclusion, our survey demonstrates the enhancement of PE-related trainings, especially for physicians in lower-level hospitals, aged ≤ 35 years and from non-respiratory department, can help to improve the management of PE in Chinese physicians. And our study also highlights the need for the establishment of national guidelines for the management of PE in China.
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The use of 80 kV versus 100 kV in pulmonary CT angiography: An evaluation of the impact on radiation dose and image quality on two CT scanners. Radiography (Lond) 2019; 25:58-64. [DOI: 10.1016/j.radi.2018.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 10/13/2018] [Accepted: 10/20/2018] [Indexed: 11/17/2022]
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Weidman EK, Plodkowski AJ, Halpenny DF, Hayes SA, Perez-Johnston R, Zheng J, Moskowitz C, Ginsberg MS. Dual-Energy CT Angiography for Detection of Pulmonary Emboli: Incremental Benefit of Iodine Maps. Radiology 2018; 289:546-553. [PMID: 30204073 DOI: 10.1148/radiol.2018180594] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine if there is added benefit of using iodine maps from dual-energy (DE) CT in addition to conventional CT angiography images to diagnose pulmonary embolism (PE). Materials and Methods In this retrospective analysis, 1144 consecutive dual-energy CT angiography examinations performed from January through September 2014 at an oncologic referral center to evaluate for PE were reviewed. The 1144 examinations included 1035 patients (mean age, 58.7 years; range, 15-99 years). First, the location, level, and type (occlusive vs nonocclusive) of PEs on conventional CT angiograms were recorded. Iodine maps were then reviewed for defects suggestive of PE. Last, CT angiograms were rereviewed to detect additional PEs suggested by the iodine map. Consensus reviews were performed for examinations with PEs. The confidence interval of percentages was calculated by using the Clopper-Pearson method. Results On 147 of 1144 (12.8%) CT angiograms, a total of 372 PEs were detected at initial review. After review of the DE CT iodine map, 27 additional PEs were found on 26 of 1144 CT angiograms (2.3%; 95% confidence interval [CI]: 1.5%, 3.3%). Of the 27 additional PEs, six (22.2%) were segmental, 21 (77.8%) were subsegmental, 24 (88.9%) were occlusive, and three (11.1%) were nonocclusive. Eleven of 1144 (1.0%; 95% CI: 0.5%, 1.7%) CT angiograms had a new diagnosis of PE after review of the DE CT iodine maps. Conclusion Dual-energy CT iodine maps show a small incremental benefit for the detection of occlusive segmental and subsegmental pulmonary emboli. © RSNA, 2018.
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Affiliation(s)
- Elizabeth K Weidman
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Andrew J Plodkowski
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Darragh F Halpenny
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Sara A Hayes
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Rocio Perez-Johnston
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Junting Zheng
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Chaya Moskowitz
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Michelle S Ginsberg
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
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Benson DG, Schiebler ML, Nagle SK, François CJ. Magnetic Resonance Imaging for the Evaluation of Pulmonary Embolism. Top Magn Reson Imaging 2017; 26:145-151. [PMID: 28777163 DOI: 10.1097/rmr.0000000000000133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pulmonary embolism (PE) is a leading cause of acute cardiovascular death throughout the world. Although computed tomography angiography (CTA) is the primary imaging study used to diagnose acute PE, pulmonary magnetic resonance angiography (MRA) is increasingly being used in patients with contraindications for CTA. This manuscript reviews the MRA techniques used for the diagnosis of PE and discuss how these techniques can be implemented in routine clinical practice. In addition, the efficacy and effectiveness of these techniques will be compared to other modalities.
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Affiliation(s)
- Donald G Benson
- *Department of Radiology †Department of Medical Physics ‡Department of Pediatrics, University of Wisconsin-Madison, Madison, WI
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17
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Li Y, Dai Y, Deng L, Yu N, Guo Y. Computer-aided detection for the automated evaluation of pulmonary embolism. Technol Health Care 2017; 25:135-142. [PMID: 28582900 DOI: 10.3233/thc-171315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Yan Li
- Department of Radiology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yongliang Dai
- Department of Radiology, the Weapons Industry of 521 Hospital, Xi’an, Shaanxi, China
| | - Lei Deng
- Department of Radiology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Nan Yu
- Department of Radiology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Youmin Guo
- Department of Radiology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
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18
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Clinical Significance of Late Phase of Lung Perfusion Blood Volume (Lung Perfusion Blood Volume) Quantified by Dual-Energy Computed Tomography in Patients With Pulmonary Thromboembolism. J Thorac Imaging 2017; 32:43-49. [PMID: 27846051 DOI: 10.1097/rti.0000000000000250] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Using dual-energy computed tomography (DECT), we quantified the lung perfusion blood volume (PBV) in the late phase, which may reflect both the pulmonary artery and systemic collateral flow. We then investigated the clinical significance of late-phase lung PBV values. MATERIALS AND METHODS We retrospectively studied 206 patients (266 scans) who underwent early-phase and late-phase DECT. The patients were divided into 2 groups depending on whether or not they had pulmonary thromboembolism (PTE) (n=94 and 112). Patients with PTE were further divided into 2 subgroups, depending on whether they had acute PTE or chronic PTE (n=66 and 28). Pulmonary artery enhancement (PAenh) was measured on DECT. We then calculated the [lung PBV/PAenh] ratio in all patients during both the early and late phases for adjustment of timing. RESULTS The [late-phase lung PBV/PAenh] ratio was 0.092±0.029 in the group with PTE and 0.108±0.030 in the group without PTE, showing a significant difference between the 2 groups (P<0.0001). The [early-phase lung PBV values/PAenh]/[late-phase lung PBV values/PAenh] ratio was 0.68±0.19 and 0.84±0.20, respectively, also showing a significant difference between the 2 groups (P<0.0001). Finally, the [early-phase lung PBV/PAenh]/[late-phase lung PBV/PAenh] ratio was 0.71±0.19 in patients with acute PTE and 0.56±0.16 in patients with chronic PTE, and there was a significant difference between these 2 subgroups (P=0.0004). CONCLUSIONS It may be useful to determine late-phase lung PBV values in patients with PTE, because this parameter may reflect the systemic collateral flow, which is increased in chronic PTE.
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Carpenter N. Massive Pulmonary Embolism and Thrombolytic Therapy: Case Study. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2017. [DOI: 10.1177/8756479317691271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute pulmonary embolism is the third most common acute cardiovascular disease, with about 600,000 cases annually in the United States. Pulmonary embolism requires a multimodality diagnosis and immediate treatment. Although computed tomography and ventilation perfusion scans are the most commonly used modalities to diagnose pulmonary embolisms, many supplemental tests are necessary. Treatment options for pulmonary embolism include anticoagulation therapy, thrombolytic therapy, or insertion of an inferior vena cava filter when anticoagulation is contraindicated. The long-term benefits of thrombolytic therapy have made it an increasingly popular option in many institutions. The following case study describes a patient who presented to the hospital with shortness of breath for five months and was found to have extensive pulmonary embolisms upon admission. The patient underwent three days of thrombolytic therapy that significantly reduced his pulmonary arterial pressures and resulted in an almost complete resolution of his pulmonary embolisms.
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20
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Ponto JA. Changes in Patterns of 99mTc-Macroaggregated Albumin Use Between 2000 and 2015. J Nucl Med Technol 2017; 45:111-113. [DOI: 10.2967/jnmt.117.192401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 03/16/2017] [Indexed: 12/31/2022] Open
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Benson DG, Schiebler ML, Repplinger MD, François CJ, Grist TM, Reeder SB, Nagle SK. Contrast-enhanced pulmonary MRA for the primary diagnosis of pulmonary embolism: current state of the art and future directions. Br J Radiol 2017; 90:20160901. [PMID: 28306332 DOI: 10.1259/bjr.20160901] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
CT pulmonary angiography (CTPA) is currently considered the imaging standard of care for the diagnosis of pulmonary embolism (PE). Recent advances in contrast-enhanced pulmonary MR angiography (MRA) techniques have led to increased use of this modality for the detection of PE in the proper clinical setting. This review is intended to provide an introduction to the state-of-the-art techniques used in pulmonary MRA for the detection of PE and to discuss possible future directions for this modality. This review discusses the following issues pertinent to MRA for the diagnosis of PE: (1) the diagnostic efficacy and clinical effectiveness for pulmonary MRA relative to CTPA, (2) the different pulmonary MRA techniques used for the detection of PE, (3) guidance for building a clinical service at their institution using MRA and (4) future directions of PE MRA. Our principal aim was to show how pulmonary MRA can be used as a safe, effective modality for the diagnosis of clinically significant PE, particularly for those patients where there are concerns about ionizing radiation or contraindications/allergies to the iodinated contrast material.
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Affiliation(s)
- Donald G Benson
- 1 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Mark L Schiebler
- 1 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael D Repplinger
- 1 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.,2 Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Thomas M Grist
- 1 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.,3 Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.,4 Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Scott B Reeder
- 1 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.,2 Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA.,3 Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.,4 Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA.,5 Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Scott K Nagle
- 1 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.,3 Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.,6 Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA
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CT Angiography: Post-processed Contrast Enhancement for Improved Detection of Pulmonary Embolism. Acad Radiol 2017; 24:131-136. [PMID: 27863899 DOI: 10.1016/j.acra.2016.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 09/29/2016] [Accepted: 09/30/2016] [Indexed: 11/24/2022]
Abstract
RATIONALE AND OBJECTIVES The study aimed to improve the detection of pulmonary embolism via an iodine contrast enhancement tool in patients who underwent suboptimal enhanced computed tomography angiography (CTA). MATERIALS AND METHODS We evaluated the CT examinations of 41 patients who underwent CTA for evaluation of the pulmonary arteries which suffered from suboptimal contrast enhancement. The contrast enhancement of the reconstructed images was increased via a post-processing tool (vContrast). Image noise and contrast-to-noise ratio (CNR) were assessed in eight different regions: main pulmonary artery, right and left pulmonary arteries, right and left segment arteries, muscle, subcutaneous fat, and bone. For subjective image assessment, three experienced radiologists evaluated the diagnostic quality. RESULTS While employing the post-processing algorithm, the CNR for contrast-filled lumen and thrombus/muscle improves significantly by a factor of 1.7 (CNR without vContrast = 8.48 ± 6.79/CNR with vContrast = 14.46 ± 5.29) (P <0.01). No strengthening of artifacts occurred, and the mean Hounsfield unit values of the muscle, subcutaneous fat, and the bone showed no significant changes. Subjective image analysis illustrated a significant improvement using post-processing for clinically relevant criteria such as diagnostic confidence. CONCLUSIONS vContrast makes CT angiograms with inadequate contrast applicable for diagnostic evaluation, offering an improved visualization of the pulmonary arteries. In addition, vContrast can help in the significant reduction of the iodine contrast material.
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Al-Rammah TY, Alohaly A, Albatsh K. Reducing computed tomography radiation dose in diagnosing pulmonary embolism. Pak J Med Sci 2017; 32:1444-1448. [PMID: 28083042 PMCID: PMC5216298 DOI: 10.12669/pjms.326.11347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Objective: Computed tomography angiography plays a major role in the diagnosis of pulmonary embolism. Radiation dose associated with it is a major concern; therefore it is important to optimize protocols and techniques to ensure minimum radiation dose. Methods: The study compares two protocols i. Conventional Timing Bolus CT protocol and Delayed Timing Bolus protocol used to assist suspected pulmonary embolism patients. Results: A significant reduction in the average effective dose (39%) was noticed when using the delayed timing bolus protocol. Conclusion: Delayed timing bolus protocol has a good impact on radiation dose without affecting the value of the computed tomography angiography study.
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Affiliation(s)
- Tamader Y Al-Rammah
- Tamader Y. AL-Rammah, Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Amani Alohaly
- Amani Alohaly, Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Kamal Albatsh
- Kamal Albatsh, King Khalid University Hospital, King Saud University, Saudi Arabia
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Main C, Abbas A, Shambrook JS, Peebles C, Harden S. Clot or not? An unusual case of false positive CTPA and an approach to diagnosis. BJR Case Rep 2016; 3:20160021. [PMID: 30363258 PMCID: PMC6159287 DOI: 10.1259/bjrcr.20160021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 06/06/2016] [Indexed: 11/28/2022] Open
Abstract
The case involves a 69-year-old female with severe, longstanding bronchiectasis secondary to childhood pertussis infection. She presented to the hospital and was thought clinically to have a pulmonary embolus. A CT pulmonary angiogram was performed, which was technically satisfactory. This revealed multiple, bilateral filling defects that were fairly convincing for pulmonary emboli. Further review of the CT scan not only revealed the extent of her bronchiectasis but also a number of enlarged bronchial arteries supplying the diseased lung. The pulmonary arterial filling defects arose suspiciously close to the bronchial arteries and the possibility of bronchial to pulmonary artery anastomoses was considered. Could the admixture of highly contrast-opacified pulmonary arterial blood with partially opacified systemic arterial blood cause the apparent filling defects? After further consideration, a second electrocardiography-gated CT angiogram was performed—this time in the systemic arterial phase but planned with two regions of interest sited over the main pulmonary artery and the aorta with the aim of triggering the scan with maximum contrast in the bronchial arteries, and as much contrast washout as possible in the pulmonary arteries. This study revealed a reversal of the CT pulmonary angiogram appearances with contrast now seen in the bronchial arteries and opacifying the sites of the previous filling defects in the pulmonary arteries. Thus, the filling defects were actually false positives caused by an admixture of highly opacified and part-opacified blood via bronchial artery anastomoses. In the context of a false-positive finding of pulmonary embolus on a background of severe bronchiectasis, unnecessary anticoagulation could have increased the risk of complications such as haemoptysis. This case report illustrates the importance of knowledge of potential false-positive findings in CT pulmonary angiography and describes a novel approach based on cardiac CT techniques to prove this.
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Affiliation(s)
- Cheryl Main
- Department of Radiology, University Hospital Southampton, Southampton, UK
| | - Ausami Abbas
- Department of Cardiothoracic Radiology, University Hospital Southampton, Southampton, UK
| | - James S Shambrook
- Department of Cardiothoracic Radiology, University Hospital Southampton, Southampton, UK
| | - Charles Peebles
- Department of Cardiothoracic Radiology, University Hospital Southampton, Southampton, UK
| | - Stephen Harden
- Department of Cardiothoracic Radiology, University Hospital Southampton, Southampton, UK
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Reliability of D-Dimer test results in deciding the necessity of performing CTA in high risk population to establish the diagnosis of PE. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Tajbakhsh N, Shin JY, Gurudu SR, Hurst RT, Kendall CB, Gotway MB. Convolutional Neural Networks for Medical Image Analysis: Full Training or Fine Tuning? IEEE TRANSACTIONS ON MEDICAL IMAGING 2016; 35:1299-1312. [PMID: 26978662 DOI: 10.1109/tmi.2016.2535302] [Citation(s) in RCA: 973] [Impact Index Per Article: 121.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Training a deep convolutional neural network (CNN) from scratch is difficult because it requires a large amount of labeled training data and a great deal of expertise to ensure proper convergence. A promising alternative is to fine-tune a CNN that has been pre-trained using, for instance, a large set of labeled natural images. However, the substantial differences between natural and medical images may advise against such knowledge transfer. In this paper, we seek to answer the following central question in the context of medical image analysis: Can the use of pre-trained deep CNNs with sufficient fine-tuning eliminate the need for training a deep CNN from scratch? To address this question, we considered four distinct medical imaging applications in three specialties (radiology, cardiology, and gastroenterology) involving classification, detection, and segmentation from three different imaging modalities, and investigated how the performance of deep CNNs trained from scratch compared with the pre-trained CNNs fine-tuned in a layer-wise manner. Our experiments consistently demonstrated that 1) the use of a pre-trained CNN with adequate fine-tuning outperformed or, in the worst case, performed as well as a CNN trained from scratch; 2) fine-tuned CNNs were more robust to the size of training sets than CNNs trained from scratch; 3) neither shallow tuning nor deep tuning was the optimal choice for a particular application; and 4) our layer-wise fine-tuning scheme could offer a practical way to reach the best performance for the application at hand based on the amount of available data.
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Yazdani M, Lau CT, Lempel JK, Yadav R, El-Sherief AH, Azok JT, Renapurkar RD. Historical Evolution of Imaging Techniques for the Evaluation of Pulmonary Embolism. Radiographics 2016; 35:1245-62. [PMID: 26172362 DOI: 10.1148/rg.2015140280] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
As we celebrate the 100th anniversary of the founding of the Radiological Society of North America (RSNA), it seems fitting to look back at the major accomplishments of the radiology community in the diagnosis of pulmonary embolism. Few diseases have so consistently captured the attention of the medical community. Since the first description of pulmonary embolism by Virchow in the 1850s, clinicians have struggled to reach a timely diagnosis of this common condition because of its nonspecific and often confusing clinical picture. As imaging tests started to gain importance in the 1900s, the approach to diagnosing pulmonary embolism also began to change. Rapid improvements in angiography, ventilation-perfusion imaging, and cross-sectional imaging modalities such as computed tomography (CT) and magnetic resonance imaging have constantly forced health care professionals to rethink how they diagnose pulmonary embolism. Needless to say, the way pulmonary embolism is diagnosed today is distinctly different from how it was diagnosed in Virchow's era; and imaging, particularly CT, now forms the cornerstone of diagnostic evaluation. Currently, radiology offers a variety of tests that are fast and accurate and can provide anatomic and functional information, thus allowing early diagnosis and triage of cases. This review provides a historical journey into the evolution of these imaging tests and highlights some of the major breakthroughs achieved by the radiology community and RSNA in this process. Also highlighted are areas of ongoing research and development in this field of imaging as radiologists seek to combat some of the newer challenges faced by modern medicine, such as rising health care costs and radiation dose hazards.
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Affiliation(s)
- Milad Yazdani
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Charles T Lau
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Jason K Lempel
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Ruchi Yadav
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Ahmed H El-Sherief
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Joseph T Azok
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Rahul D Renapurkar
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
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Nagle SK, Schiebler ML, Repplinger MD, François CJ, Vigen KK, Yarlagadda R, Grist TM, Reeder SB. Contrast enhanced pulmonary magnetic resonance angiography for pulmonary embolism: Building a successful program. Eur J Radiol 2015; 85:553-63. [PMID: 26860667 DOI: 10.1016/j.ejrad.2015.12.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/09/2015] [Accepted: 12/12/2015] [Indexed: 01/08/2023]
Abstract
The performance of contrast enhanced pulmonary magnetic resonance angiography (MRA) for the diagnosis of pulmonary embolism (PE) is an effective non-ionizing alternative to contrast enhanced computed tomography and nuclear medicine ventilation/perfusion scanning. However, the technical success of these exams is very dependent on careful attention to the details of the MRA acquisition protocol and requires reader familiarity with MRI and its artifacts. Most practicing radiologists are very comfortable with the performance and interpretation of computed tomographic angiography (CTA) performed to detect pulmonary embolism but not all are as comfortable with the use of MRA in this setting. The purpose of this review is to provide the general radiologist with the tools necessary to build a successful pulmonary embolism MRA program. This review will cover in detail image acquisition, image interpretation, and some key elements of outreach that help to frame the role of MRA to consulting clinicians and hospital administrators. It is our aim that this resource will help build successful clinical pulmonary embolism MRA programs that are well received by patients and physicians, reduce the burden of medical imaging radiation, and maintain good patient outcomes.
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Affiliation(s)
- Scott K Nagle
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States; Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States; Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States.
| | - Mark L Schiebler
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Michael D Repplinger
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States; Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | | | - Karl K Vigen
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Rajkumar Yarlagadda
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States; Diagnostic Radiology, P.C., Omaha, NE, United States
| | - Thomas M Grist
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States; Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States; Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States; Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States; Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States
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Software-Based Hybrid Perfusion SPECT/CT Provides Diagnostic Accuracy When Other Pulmonary Embolism Imaging Is Indeterminate. Nucl Med Mol Imaging 2015; 49:303-11. [PMID: 26550050 DOI: 10.1007/s13139-015-0359-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/22/2015] [Accepted: 07/28/2015] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To investigate the diagnostic performance of perfusion single-photon emission computed tomography/computed tomography (Q-SPECT/CT) in patients suspected to have pulmonary embolism (PE) but with indeterminate computed tomographic pulmonary angiography (CTPA) or planar ventilation/perfusion (V/Q) scans. METHODS This retrospective study included two groups of patients. Group I consisted of 49 patients with nondiagnostic CTPA. These 49 patients underwent subsequent V/Q scans. Further Q-SPECTs were obtained in patients with indeterminate planar images and fused with existing CTPA. Group II consisted of 182 non-CTPA patients with indeterminate V/Q scans. These 182 patients underwent further Q-SPECT and separate noncontrast low-dose CT chest. Fusion Q-SPECT/CT scans were obtained through FDA-approved software and interpreted according to published criteria as positive, negative, or indeterminate for PE. Upon retrospective analyses, the final diagnosis was made using composite reference standards including all available clinical and imaging information for at least 6-month follow-up. RESULTS In group I patients, 1 was positive, 24 were negative, and another 24 (49 %, 24/49) were indeterminate. In the subsequent 24 Q-SPECT/CTPAs, 4 were positive, 19 were negative, and 1 was indeterminate (4.2 %, 1/24). In group II patients, 9 (4.9 %, 9/182) were indeterminate, 33 were positive, and 140 were negative. The combined nondiagnostic rate for Q-SPECT/CT was only 4.9 % (10/206). There was six false-negative and one false-positive Q-SPECT/CT examinations. The sensitivity, specificity, and positive and negative predictive value of Q-SPECT/CT were 85.7 % (36/42), 99.4 % (153/154), 97.3 % (36/37) and 96.2 % (153/159), respectively. CONCLUSIONS Q-SPECT/CT improves the diagnostic rate with promising accuracy in diagnosing PE that yields a satisfactory clinical verdict, especially when the CTPA and planar V/Q scan are indeterminate.
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Small, nonfatal pulmonary emboli. is computed tomographic pulmonary angiography the culprit? Ann Am Thorac Soc 2015. [PMID: 26203607 DOI: 10.1513/annalsats.201505-257ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Moriarty JM, Bolster F, O'Connor C, Fitzpatrick P, Lawler LP, Kavanagh EC, MacMahon PJ, Murray JG. Frequency of nonthromboembolic imaging abnormalities in pregnant women referred for computed tomography pulmonary arteriography. Can Assoc Radiol J 2015; 66:24-9. [PMID: 25623008 DOI: 10.1016/j.carj.2014.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/07/2014] [Accepted: 11/26/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The study sought to determine the frequency of nonthromboembolic imaging abnormalities in pregnant women referred for computed tomography pulmonary arteriography (CTPA). MATERIALS AND METHODS CTPA studies on 100 consecutive pregnant women performed over a 5-year period were reviewed independently by 2 radiologists, with conflicts resolved by consensus. Age range was 18-43 years (mean 28 years). The presence or absence of pulmonary embolism and of nonthromboembolic imaging abnormalities was recorded. These were graded as A if the abnormalities were thought to provide potential alternative explanations for acute symptoms, B if findings were incidental that required clinical or radiologic follow-up, and C if the findings did not require further action. RESULTS Pulmonary embolism was seen in 5 women. In 2 of these additional findings of consolidation and infarction were seen. Ninety-five women did not have pulmonary embolism. Eleven women (12%) had grade A abnormalities; 6 cases of consolidation, 2 cases of lobar collapse, and 3 cases of heart failure with pleural effusions. One woman had a grade B abnormality due to the presence of pulmonary nodules. Ten women had incidental grade C abnormalities. CONCLUSION Pulmonary embolism occurs in 5% of pregnant women referred for CTPA. In pregnant women without embolism on CTPA, potential alternative causes for patient symptoms are seen on CT in 12% of cases.
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Affiliation(s)
- John M Moriarty
- David Geffen School of Medicine at UCLA, Diagnostic Cardiovascular Imaging, Los Angeles, California, USA
| | - Ferdia Bolster
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Clare O'Connor
- Department of Obstetrics and Gynaecology, The Rotunda Hospital, Dublin, Ireland
| | - Patricia Fitzpatrick
- School of Public Health and Population Science, University College Dublin, Dublin, Ireland
| | - Leo P Lawler
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eoin C Kavanagh
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peter J MacMahon
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John G Murray
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
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Zhang LJ, Lu GM, Meinel FG, McQuiston AD, Ravenel JG, Schoepf UJ. Computed tomography of acute pulmonary embolism: state-of-the-art. Eur Radiol 2015; 25:2547-57. [DOI: 10.1007/s00330-015-3679-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 02/17/2015] [Indexed: 12/13/2022]
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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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Khadir MM, Chaturvedi A, Nguyen MS, Wandtke JC, Hobbs S, Chaturvedi A. Looking beyond the thrombus: essentials of pulmonary artery imaging on CT. Insights Imaging 2014; 5:493-506. [PMID: 25001069 PMCID: PMC4141338 DOI: 10.1007/s13244-014-0340-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 05/15/2014] [Accepted: 05/28/2014] [Indexed: 01/30/2023] Open
Abstract
Background Pulmonary arteries are not just affected by thrombus. Congenital and acquired conditions can also involve the pulmonary arteries. An awareness of these conditions is important for the radiologist interpreting chest computed tomography (CT). Methods The anatomy of the pulmonary arteries was reviewed. CT and magnetic resonance (MR) acquisition protocols for imaging the pulmonary arteries were discussed. The imaging appearances of congenital and acquired anomalies involving the pulmonary arteries, using CT and other modalities, were presented. Results Imaging features of congenital anomalies presented include pulmonary agenesis, partial pulmonary artery agenesis, patent ductus arteriosus, pulmonary artery sling, congenital pulmonary artery stenosis and coronary to pulmonary artery fistula. Acquired pulmonary artery anomalies discussed include arteritis, infected aneurysm and sarcoma. Pulmonary artery filling defects besides thromboembolism are also discussed, including foreign body emboli. Imaging features of bronchogenic carcinoma and mediastinal fibrosis demonstrating compression of the pulmonary arteries are presented, followed by a brief discussion of post repair appearance of the pulmonary arteries for congenital heart disease. Conclusions Congenital and acquired pulmonary artery anomalies have a characteristic appearance on a variety of imaging modalities. An acquaintance with the imaging features of these anomalies is needed to avoid misinterpretation and reach the correct diagnosis. Teaching Points • Discuss a variety of congenital and acquired anomalies of the pulmonary arteries. • Discuss the imaging appearance of the presented congenital or acquired pulmonary artery anomalies. • Describe CT and MR acquisition protocols for imaging the pulmonary arteries. • Review the anatomy of the pulmonary arteries.
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Affiliation(s)
- Mohammed M Khadir
- Cardiothoracic Imaging Section, Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA,
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Hayes SA, Soff GA, Zabor EC, Moskowitz CS, Liu CC, Ginsberg MS. Clinical consequences of an indeterminate CT pulmonary angiogram in cancer patients. Clin Imaging 2014; 38:637-40. [PMID: 24928823 DOI: 10.1016/j.clinimag.2014.04.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 04/03/2014] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
Abstract
Our aim was to evaluate clinical management and outcomes in cancer patients who had an indeterminate Computed Tomographic Pulmonary Angiogram (CTPA) for the assessment of pulmonary embolus. We reviewed 1000 CTPA studies and identified 251 limited (indeterminate) CTPA. We examined follow-up imaging and reviewed clinical management decisions and any positive diagnosis of venous thromboembolic disease (VTE) within the subsequent 90 days. 60 patients (23.9%) had a follow-up imaging study within five days. 8 had a positive study for VTE disease within 5 days. 3 patients (1.2%) were placed on anticoagulation therapy based on the limited CT result.
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Affiliation(s)
- Sara A Hayes
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065.
| | - Gerald A Soff
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, 410 East 68th Street, New York, NY 10065.
| | - Emily C Zabor
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 East 63rd Street, New York, NY 10065.
| | - Chaya S Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 East 63rd Street, New York, NY 10065.
| | - Corinne C Liu
- Winthrop Radiology Associates, 259 1st St, Mineola, NY 11501.
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065.
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Quirce R, Ibáñez-Bravo S, Jiménez-Bonilla J, Martínez-Rodríguez I, Martínez-Amador N, Ortega-Nava F, Lavado-Pérez C, Bravo-Ferrer Z, Carril J. Contribution of V/Q SPECT to planar scintigraphy in the diagnosis of pulmonary embolism. Rev Esp Med Nucl Imagen Mol 2014. [DOI: 10.1016/j.remnie.2014.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Quirce R, Ibáñez-Bravo S, Jiménez-Bonilla J, Martínez-Rodríguez I, Martínez-Amador N, Ortega-Nava F, Lavado-Pérez C, Bravo-Ferrer Z, Carril JM. Contribution of V/Q SPECT to planar scintigraphy in the diagnosis of pulmonary embolism. Rev Esp Med Nucl Imagen Mol 2014; 33:153-8. [PMID: 24485808 DOI: 10.1016/j.remn.2013.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 12/20/2013] [Accepted: 12/21/2013] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the feasibility of V/Q SPECT and analyze its contribution to planar V/Q lung scintigraphy in the diagnosis of pulmonary embolism (PE). MATERIAL AND METHODS A total of 109 patients with suspected PE showing Wells score>2 and elevated D-dimer were studied. The V/Q could not be completed in 7 patients, so they were excluded. Ventilation and perfusion scans were done using Technegas and (99m)Tc-MAA. Planar study included 8 projections on a 256×256 matrix and 128 projections on a 128×128 matrix were acquired for the SPECT study, applying an iterative method. Planar images were interpreted according to modified PIOPED criteria, and SPECT by the guidelines of the EANMMI. The results with both techniques were compared. RESULTS V/Q planar scintigraphy and SPECT could be performed in 102 patients. V/Q planar scintigraphy was considered "diagnostic" in 39 of the 102 patients, and "non-diagnostic" in 63. Of the 39 "diagnostic" studies, 31 were reported as high probability of PE and 8 as normal. Of the 63 "non-diagnostic", 26 corresponded to intermediate, 29 to low, and 8 to very low probability. The SPECT study was "diagnostic" in 97 and indeterminate in only 5. All patients with a high probability planar scintigraphy had a positive SPECT. In the 8 patients with a normal planar scintigraphy SPECT was negative in 5 and positive in 3. In the 63 patients with a "non-diagnostic" planar scintigraphy SPECT was "diagnostic" in 58 of them, positive in 17 and negative in 41. CONCLUSION V/Q SPECT is a feasible technique as it was performed in 102 of the 109 patients who were enrolled in the study (94%). The addition of V/Q SPECT to planar V/Q decreases the number of "non-diagnostic" reports from 62% in planar scintigraphy to 4.9% in SPECT. Therefore, V/Q SPECT should be included in the diagnosis approach of PE due to its high diagnostic yield.
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Affiliation(s)
- R Quirce
- Servicio de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain.
| | - S Ibáñez-Bravo
- Servicio de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain
| | - J Jiménez-Bonilla
- Servicio de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain
| | - I Martínez-Rodríguez
- Servicio de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain
| | - N Martínez-Amador
- Servicio de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain
| | - F Ortega-Nava
- Servicio de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain
| | - C Lavado-Pérez
- Servicio de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain
| | - Z Bravo-Ferrer
- Servicio de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain
| | - J M Carril
- Servicio de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain
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High-pitch ECG-synchronized pulmonary CT angiography versus standard CT pulmonary angiography: a prospective randomized study. AJR Am J Roentgenol 2014; 201:971-6. [PMID: 24147466 DOI: 10.2214/ajr.13.10597] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare high-pitch ECG-synchronized pulmonary CT angiography (CTA) with standard pulmonary CTA with regard to radiation dose and image quality in patients with suspected pulmonary embolism. SUBJECTS AND METHODS This prospective study was approved by the institutional review board, and participants provided informed consent. Patients with suspected pulmonary embolism (60% women; mean age, 57 ± 14 years) were randomized to undergo high-pitch ECG-synchronized pulmonary CTA (n = 26) or standard pulmonary CTA (n = 21). Two independent readers assessed subjective image quality of pulmonary arteries, cardiovascular structures, and pulmonary parenchyma. Signal intensity (SI) was measured in one segmental and three central pulmonary arteries. RESULTS High-pitch ECG-synchronized pulmonary CTA showed higher SI (p < 0.001) for pulmonary arteries. Image quality scores indicated improvement in assessment of cardio-vascular structures (p < 0.001), minimization of motion of central (p < 0.001) pulmonary arteries, and an increase in pulmonary arterial enhancement (p = 0.01) with high-pitch ECG-synchronized pulmonary CTA. Image quality scores for lung assessment were higher for standard pulmonary CTA (p < 0.001). The amount of contrast agent administered was similar between techniques (p = 0.86). Radiation dose was lower for high-pitch ECG-synchronized pulmonary CTA (p < 0.001). CONCLUSION High-pitch ECG-synchronized pulmonary CTA provides higher pulmonary arterial SI, decreased motion of central pulmonary arteries, and improved assessment of cardiovascular structures with similar contrast dose and lower radiation compared with standard pulmonary CTA.
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Hedner C, Sundgren PC, Kelly AM. Associations between presence of relevant information in referrals to radiology and prevalence rates in patients with suspected pulmonary embolism. Acad Radiol 2013; 20:1115-21. [PMID: 23931425 DOI: 10.1016/j.acra.2013.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 04/20/2013] [Accepted: 05/02/2013] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to assess if the presence of information including the pretest probability (Wells score), other known risk factors, and symptoms given on referrals for computed tomography (CT) pulmonary angiography correlated with prevalence rates for pulmonary embolism (PE). Also, to evaluate for differences between a university and a regional hospital setting regarding patient characteristics, amount of relevant information provided on referrals, and prevalence rates for pulmonary embolism. MATERIALS AND METHODS Retrospective review of all consecutive referrals (emergency room, inpatient, and outpatient) for CT performed on children and adults for suspected PE from two sites: a tertiary (university) hospital (site 1) and a secondary (regional) hospital (site 2) over a 5-year period. RESULTS The overall prevalence rate was 510/3641 or 14% of all referrals. Significantly higher number of males had a positive CT compared to women (18% versus 12%, P < .001). Although no statistically significant relationship between a greater amount of relevant information on the referral and the probability for positive finding existed, a slight trend was noted (P = .09). In two categories, "hypoxia" and "signs of deep vein thrombosis," the presence of this information conferred a higher probability for pulmonary embolism, P < .001. In the categories, "chest pain," "malaise," and "smoker/chronic obstructive pulmonary disease", the absence of information conferred a higher probability for pulmonary embolism. CONCLUSIONS The amount of relevant clinical information on the request did not correlate with prevalence rates, which may reflect a lack of documentation on the part of emergency physicians who may use a "gestalt" approach. Request forms likely did not capture all relevant patient risks and many factors may interact with each other, both positively and negatively. Pretest probability estimations were rarely performed, despite their inclusion in major society guidelines.
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Affiliation(s)
- Charlotta Hedner
- Center for Medical Imaging and Physiology, Skåne University Hospital, Lund University, Lund, Sweden
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Four-year cumulative radiation exposure in patients undergoing computed tomography angiography for suspected pulmonary embolism. Radiol Res Pract 2013; 2013:482403. [PMID: 23984065 PMCID: PMC3745975 DOI: 10.1155/2013/482403] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/05/2013] [Accepted: 07/07/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose. The objective of this study was to determine the estimated effective radiation dose of pulmonary CT angiography (CTA) for suspected pulmonary embolism (PE) contributing to total medical radiation exposure over a 4-year period. Materials and Methods. This investigation retrospectively reviewed 300 patients who presented to the emergency department and received a pulmonary CTA scan for suspected PE. We evaluated these patients' electronic medical record to determine their estimated radiation exposure to CT scans during the following four years. Using DLP to E conversion coefficients, we calculated the cumulative effective radiation dose each subject received. Results. A total of 900 CT scans were reviewed in this study. Pulmonary CTA delivered an average effective radiation dose of 10.7 ± 2.5 mSv and accounted for approximately 65% of subjects' 4-year cumulative medical radiation dose. Only 6.3% of subjects had a positive acute PE according to their radiology report. Conclusion. Pulmonary CTA accounted for the majority of subjects' medically related effective radiation dose over a 4-year period. With only a minority of subjects having positive findings for acute PE, increased efforts should be made to clinically assess pretest probability before the consideration of imaging.
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Conti E, Zezza L, Ralli E, Comito C, Sada L, Passerini J, Caserta D, Rubattu S, Autore C, Moscarini M, Volpe M. Pulmonary embolism in pregnancy. J Thromb Thrombolysis 2013; 37:251-70. [DOI: 10.1007/s11239-013-0941-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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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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Pulmonary CT Angiography as First-Line Imaging for PE: Image Quality and Radiation Dose Considerations. AJR Am J Roentgenol 2013; 200:522-8. [PMID: 23436840 DOI: 10.2214/ajr.12.9928] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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47
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Pena E, Dennie C. Acute and Chronic Pulmonary Embolism: An In-depth Review for Radiologists Through the Use of Frequently Asked Questions. Semin Ultrasound CT MR 2012; 33:500-21. [DOI: 10.1053/j.sult.2012.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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48
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Komissarova M, Chong S, Frey K, Sundaram B. Imaging of acute pulmonary embolism. Emerg Radiol 2012; 20:89-101. [PMID: 23151968 DOI: 10.1007/s10140-012-1080-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 10/01/2012] [Indexed: 12/26/2022]
Abstract
Acute pulmonary thromboembolism (PE) is a cardiovascular emergency associated with significant morbidity and a 5-35 % mortality for untreated pulmonary embolism. If promptly diagnosed and treated, the mortality rate can be significantly reduced. Diagnosis of acute PE continues to be a clinical challenge, with diagnostic imaging playing an important role. This review discusses the clinical challenges of diagnosing acute PE, presents an evidence-based review of the current tests and ever-evolving imaging technology, and highlights special considerations related to radiation dose, contrast media use, and pregnant patients.
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Affiliation(s)
- Maria Komissarova
- Divisions of Emergency, Cardiothoracic and Nuclear Radiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, TC B1-140D, Ann Arbor, MI 48109, USA
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Sarma A, Heilbrun ME, Conner KE, Stevens SM, Woller SC, Elliott CG. Radiation and Chest CT Scan Examinations. Chest 2012; 142:750-760. [PMID: 22948579 DOI: 10.1378/chest.11-2863] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Asha Sarma
- Department of Medicine, Intermountain Medical Center, Murray, UT.
| | - Marta E Heilbrun
- Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT
| | - Karen E Conner
- Department of Radiology, Intermountain Medical Center, Murray, UT
| | - Scott M Stevens
- Division of General Internal Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Scott C Woller
- Division of General Internal Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - C Gregory Elliott
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
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50
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Wang Z, Pei C, Ma L, Wang D, Zhou J, Wang W, Shen J, Xu Z, He J. Acute pulmonary embolism after pneumonectomy. J Thorac Dis 2012; 4:76-82. [PMID: 22295170 DOI: 10.3978/j.issn.2072-1439.2011.10.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 10/05/2011] [Indexed: 12/31/2022]
Abstract
Pulmonary embolism (PE) by occlusion of the pulmonary arterial bed may lead to acute life-threatening but potentially reversible right ventricular failure, one of the most severe complications of thoracic surgery. Still, the incidence of acute pulmonary embolism after surgery is reduced by comprehensive anticoagulant prevention, improved surgical techniques, appropriate perioperative management and early ambulation. However, there is difficulty in diagnosing PE after thoracic surgery due to the lack of specific clinical manifestations. So that optimal diagnostic strategy and management according to the clinical presentation and estimated risk of an adverse outcome is fundamental.
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Affiliation(s)
- Zongfei Wang
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical College; Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou, China
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