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Naydenska S, Grudkov K, Petrova D, Zlatareva D, Radoslav B, Krasimirova D, Pencheva V. Diagnostic value of hybrid perfusion SPECT/CT and CTPA for detection of pulmonary embolism. BIOTECHNOL BIOTEC EQ 2023. [DOI: 10.1080/13102818.2022.2153081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Sevda Naydenska
- Department of Propedeutics of Internal Diseases, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Konstantin Grudkov
- Department of Surgery, Faculty of Medicine, Sofia University St. Kliment, Sofia, Bulgaria
| | - Daniela Petrova
- Department of Propedeutics of Internal Diseases, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Dora Zlatareva
- Department of Diagnostic Imaging, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Bilyukov Radoslav
- Department of Propedeutics of Internal Diseases, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Daniela Krasimirova
- Department of Propedeutics of Internal Diseases, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Ventsislava Pencheva
- Department of Propedeutics of Internal Diseases, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
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Lastella G, Esposito A, Scarabelli A, Plensich GG, Stellato E, Avola E, Giannitto C, Castellani M, Cuzzocrea M, Bonomo L, Carrafiello G. Lung Perfusion Assessment in Pulmonary Embolism: Novel Semi-Automatic Lung Perfusion Software in Computed Tomography Pulmonary Angiography Compared to Traditional Lung Perfusion Scintigraphy. REPORTS IN MEDICAL IMAGING 2022. [DOI: 10.2147/rmi.s355965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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3
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Systematic review and meta-analysis of test accuracy for the diagnosis of suspected pulmonary embolism. Blood Adv 2021; 4:4296-4311. [PMID: 32915980 DOI: 10.1182/bloodadvances.2019001052] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/02/2020] [Indexed: 11/20/2022] Open
Abstract
Pulmonary embolism (PE) is a common, potentially life-threatening yet treatable condition. Prompt diagnosis and expeditious therapeutic intervention is of paramount importance for optimal patient management. Our objective was to systematically review the accuracy of D-dimer assay, compression ultrasonography (CUS), computed tomography pulmonary angiography (CTPA), and ventilation-perfusion (V/Q) scanning for the diagnosis of suspected first and recurrent PE. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. 2 investigators screened and abstracted data. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We pooled estimates of sensitivity and specificity. The review included 61 studies. The pooled estimates for D-dimer sensitivity and specificity were 0.97 (95% confidence interval [CI], 0.96-0.98) and 0.41 (95% CI, 0.36-0.46) respectively, whereas CTPA sensitivity and specificity were 0.94 (95% CI, 0.89-0.97) and 0.98 (95% CI, 0.97-0.99), respectively, and CUS sensitivity and specificity were 0.49 (95% CI, 0.31-0.66) and 0.96 (95% CI, 0.95-0.98), respectively. Three variations of pooled estimates for sensitivity and specificity of V/Q scan were carried out, based on interpretation of test results. D-dimer had the highest sensitivity when compared with imaging. CTPA and V/Q scans (high probability scan as a positive and low/non-diagnostic/normal scan as negative) both had the highest specificity. This systematic review was registered on PROSPERO as CRD42018084669.
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Zhou C, Chan HP, Chughtai A, Patel S, Kuriakose J, Hadjiiski LM, Wei J, Kazerooni EA. Variabilities in Reference Standard by Radiologists and Performance Assessment in Detection of Pulmonary Embolism in CT Pulmonary Angiography. J Digit Imaging 2021; 32:1089-1096. [PMID: 31073815 DOI: 10.1007/s10278-019-00228-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Annotating lesion locations by radiologists' manual marking is a key step to provide reference standard for the training and testing of a computer-aided detection system by supervised machine learning. Inter-reader variability is not uncommon in readings even by expert radiologists. This study evaluated the variability of the radiologist-identified pulmonary emboli (PEs) to demonstrate the importance of improving the reliability of the reference standard by a multi-step process for performance evaluation. In an initial reading of 40 CTPA PE cases, two experienced thoracic radiologists independently marked the PE locations. For markings from the two radiologists that did not agree, each radiologist re-read the cases independently to assess the discordant markings. Finally, for markings that still disagreed after the second reading, the two radiologists read together to reach a consensus. The variability of radiologists was evaluated by analyzing the agreement between two radiologists. For the 40 cases, 475 and 514 PEs were identified by radiologists R1 and R2 in the initial independent readings, respectively. For a total of 545 marks by the two radiologists, 81.5% (444/545) of the marks agreed but 101 marks in 36 cases differed. After consensus, 65 (64.4%) and 36 (35.6%) of the 101 marks were determined to be true PEs and false positives (FPs), respectively. Of these, 48 and 17 were false negatives (FNs) and 14 and 22 were FPs by R1 and R2, respectively. Our study demonstrated that there is substantial variability in reference standards provided by radiologists, which impacts the performance assessment of a lesion detection system. Combination of multiple radiologists' readings and consensus is needed to improve the reliability of a reference standard.
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Affiliation(s)
- Chuan Zhou
- Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Heang-Ping Chan
- Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Aamer Chughtai
- Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Smita Patel
- Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Jean Kuriakose
- Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Lubomir M Hadjiiski
- Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Jun Wei
- Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Ella A Kazerooni
- Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
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5
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American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. Blood Adv 2019; 2:3226-3256. [PMID: 30482764 DOI: 10.1182/bloodadvances.2018024828] [Citation(s) in RCA: 224] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 10/02/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Modern diagnostic strategies for venous thromboembolism (VTE) incorporate pretest probability (PTP; prevalence) assessment. The ability of diagnostic tests to correctly identify or exclude VTE is influenced by VTE prevalence and test accuracy characteristics. OBJECTIVE These evidence-based guidelines are intended to support patients, clinicians, and health care professionals in VTE diagnosis. Diagnostic strategies were evaluated for pulmonary embolism (PE), deep vein thrombosis (DVT) of the lower and upper extremity, and recurrent VTE. METHODS The American Society of Hematology (ASH) formed a multidisciplinary panel including patient representatives. The McMaster University GRADE Centre completed systematic reviews up to 1 October 2017. The panel prioritized questions and outcomes and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations. Test accuracy estimates and VTE population prevalence were used to model expected outcomes in diagnostic pathways. Where modeling was not feasible, management and accuracy studies were used to formulate recommendations. RESULTS Ten recommendations are presented, by PTP for patients with suspected PE and lower extremity DVT, and for recurrent VTE and upper extremity DVT. CONCLUSIONS For patients at low (unlikely) VTE risk, using D-dimer as the initial test reduces the need for diagnostic imaging. For patients at high (likely) VTE risk, imaging is warranted. For PE diagnosis, ventilation-perfusion scanning and computed tomography pulmonary angiography are the most validated tests, whereas lower or upper extremity DVT diagnosis uses ultrasonography. Research is needed on new diagnostic modalities and to validate clinical decision rules for patients with suspected recurrent VTE.
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Dai L, Shi G, Li Y, Zhao B. Values of thoracic contrast-enhanced computed tomography in detecting incidental pulmonary thromboembolism in patients with malignant tumors. Oncol Lett 2019; 17:355-359. [PMID: 30655774 PMCID: PMC6313221 DOI: 10.3892/ol.2018.9578] [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] [Received: 04/02/2018] [Accepted: 10/04/2018] [Indexed: 11/20/2022] Open
Abstract
This study aimed to evaluate the values of thoracic multi-slice spiral computed tomography (CT) in the diagnosis of incidental pulmonary thromboembolism (IPTE) in patients with malignant tumors. The clinical data and imaging features of a total of 1,684 patients with malignant tumors, treated in the Fourth Hospital of Hebei Medical University, were analyzed retrospectively in order to investigate the types of malignancies, the patients' clinical features, and the emboli-preferred sites. Among the 1,684 patients, 60 patients had experienced IPTE (3.56%), 35 were females (58.33%), 25 were males (41.67%). Lung cancer had the highest incidence (n=22, 36.67%). The most common site of IPTE was the left lower lobe of pulmonary artery (n=46, 76.67%). The imaging results revealed that in 5 patients (8.33%) IPTE did not occur. Thoracic multi-slice spiral CT has a high detection rate of IPTE in patients with malignant tumors. Early diagnosis is helpful for early clinical treatment and has significant importance for patients' prognosis.
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Affiliation(s)
- Lijuan Dai
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Gaofeng Shi
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Yang Li
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Bo Zhao
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
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7
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Belzile D, Jacquet S, Bertoletti L, Lacasse Y, Lambert C, Lega JC, Provencher S. Outcomes following a negative computed tomography pulmonary angiography according to pulmonary embolism prevalence: a meta-analysis of the management outcome studies. J Thromb Haemost 2018; 16:1107-1120. [PMID: 29645405 DOI: 10.1111/jth.14021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Indexed: 12/01/2022]
Abstract
Essentials Computed tomographic pulmonary angiography (CTPA) is used to exclude pulmonary embolism. This meta-analysis explores the occurrence of venous thromboembolic events (VTE) after a CTPA. Occurrence of VTE after a negative CTPA is ˜8% in study subgroups with a prevalence of PE ≥ 40%. CTPA may be insufficient to safely rule out VTE as a stand-alone diagnostic test for this subgroup. SUMMARY Background Outcome studies have reported the safety of computed tomographic pulmonary angiography (CTPA) as a stand-alone imaging technique to rule out pulmonary embolism (PE). Whether this can be applied to all clinical probabilities remains controversial. Objectives We performed a meta-analysis to determine the proportion of patients with venous thromboembolic events (VTE) despite a negative CTPA according to pretest PE prevalence. Methods We searched MEDLINE, EMBASE and the Cochrane Library (January 1990 to May 2017) for outcome studies recruiting patients with suspected PE using CTPA as a diagnostic strategy. The primary outcome was the cumulative occurrence of VTE at 3 months following a negative CTPA. Results Twenty-two different studies were identified. VTE was confirmed in 2.4% of patients (95% CI, 1.3-3.8%) either at the time of the index event or in the 3 months follow-up. Subgroup analyses suggested that the cumulative occurrence of VTE was related to pretest prevalence of PE, as VTE occurred in 1.8% (95% CI, 0.5-3.7%), 1.4% (95% CI, 0.7-2.3%), 1.0% (95% CI, 0.5-1.8%) and 8.1% (95% CI, 3.5-14.5%) of subgroups of patients with a PE prevalence < 20%, 20-29%, 30-39% and ≥ 40%, respectively. This was further confirmed using meta-regression analysis. Conclusions The negative predictive value of CTPA for VTE varies according to pretest prevalence of PE, and is likely to be insufficient to safely rule out VTE as a stand-alone diagnostic test amongst patients at the highest pretest probability of VTE. Prospective studies are required to validate the appropriate diagnostic algorithm for this subgroup of patients.
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Affiliation(s)
- D Belzile
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Quebec City, Canada
| | - S Jacquet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Quebec City, Canada
| | - L Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
- INSERM, CIC-1408, CHU Saint-Etienne, Saint-Etienne, France
| | - Y Lacasse
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Quebec City, Canada
- Department of Medicine, Université Laval, Québec, Canada
| | - C Lambert
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Quebec City, Canada
| | - J C Lega
- Université Lyon, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, CNRS, Université Claude-Bernard, Lyon 1, Lyon, France
- Service de Médecine Interne-Pathologie Vasculaire, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite Cedex, France
| | - S Provencher
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Quebec City, Canada
- Department of Medicine, Université Laval, Québec, Canada
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Kirsch J, Brown RKJ, Henry TS, Javidan-Nejad C, Jokerst C, Julsrud PR, Kanne JP, Kramer CM, Leipsic JA, Panchal KK, Ravenel JG, Shah AB, Mohammed TL, Woodard PK, Abbara S. ACR Appropriateness Criteria ® Acute Chest Pain-Suspected Pulmonary Embolism. J Am Coll Radiol 2018; 14:S2-S12. [PMID: 28473076 DOI: 10.1016/j.jacr.2017.02.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 01/08/2023]
Abstract
Pulmonary embolism (PE) remains a common and important clinical condition that cannot be accurately diagnosed on the basis of signs, symptoms, and history alone. The diagnosis of PE has been facilitated by technical advancements and multidetector CT pulmonary angiography, which is the major diagnostic modality currently used. Ventilation and perfusion scans remain largely accurate and useful in certain settings. Lower-extremity ultrasound can substitute by demonstrating deep vein thrombosis; however, if negative, further studies to exclude PE are indicated. In all cases, correlation with the clinical status, particularly with risk factors, improves not only the accuracy of diagnostic imaging but also overall utilization. Other diagnostic tests have limited roles. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Jacobo Kirsch
- Principal Author, Cleveland Clinic, Weston, Florida.
| | | | - Travis S Henry
- University of California San Francisco, San Francisco, California
| | - Cylen Javidan-Nejad
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri
| | | | | | - Jeffrey P Kanne
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Christopher M Kramer
- University of Virginia Health System, Charlottesville, Virginia; American College of Cardiology
| | | | | | - James G Ravenel
- Medical University of South Carolina, Charleston, South Carolina
| | - Amar B Shah
- Westchester Medical Center, Valhalla, New York
| | - Tan-Lucien Mohammed
- Specialty Chair, University of Florida College of Medicine, Gainesville, Florida
| | - Pamela K Woodard
- Specialty Chair, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri
| | - Suhny Abbara
- Panel Chair, UT Southwestern Medical Center, Dallas, Texas
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9
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Marschner C, Kristensen A, Rozanski E, McEvoy F, Kühnel L, Taeymans O, de Laforcade A, Sato A, Wiinberg B. Diagnosis of canine pulmonary thromboembolism by computed tomography and mathematical modelling using haemostatic and inflammatory variables. Vet J 2017; 229:6-12. [DOI: 10.1016/j.tvjl.2017.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/19/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
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10
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Sohns JM, Menke J, Bergau L, Weiss BG, Kröhn H, Weiberg D, Derlin T, Schmuck S. Screening of extravascular findings in pulmonary embolism computer tomography: 397 patients with 1950 non-pulmonary artery findings. Vascular 2017; 26:99-110. [DOI: 10.1177/1708538117724628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objectives The aim of this study was to investigate the possible benefits from computed tomography scans of patients with a suspected pulmonary artery embolism with a focus on relevant extravascular findings. Methods A total of 400 consecutive computed tomography pulmonary angiographies were evaluated. Computed tomography scans were analyzed in detail for the presence of pulmonary artery embolisms, as well as any other findings. Extra-artery discoveries were classified into none-relevant (Group A), intermediate (Group B), or relevant (Group C) findings. Results Aggregated computed tomography pulmonary angiographies detected other diagnosis than pulmonary artery embolism in 236 patients (59%). There were 1950 non-pulmonary artery embolism findings (4.9 per patient; n = 397). In the pulmonary artery embolism group, there were 447 extra-pulmonary artery embolism findings (5.2 per patient; n = 86) and in the non-pulmonary artery embolism group, 1503 findings (4.8 per patient; n = 311). Patients with pulmonary artery embolism had a significantly higher rate of pro-coagulate risk factors ( p < 0.001). Conclusions Computed tomography pulmonary angiographies may help to identify further diagnoses. This study represents a retrospective review of a single center experience for incidental computed tomography findings during pulmonary artery embolism work-up and emphasizes the importance of analyzing the whole field-of-view.
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Affiliation(s)
- Jan M Sohns
- Department of Nuclear Medicine, Hannover Medical School, MHH, Hannover, Germany
- German Center for Cardiovascular Research, DZHK, Berlin, Germany
| | - Jan Menke
- Institute for Diagnostic and Interventional Radiology, Georg-August University Göttingen, UMG, Göttingen, Germany
| | - Leonard Bergau
- Department of Cardiology and Pneumology, Georg-August University Göttingen, UMG, Göttingen, Germany
| | - Bernhard G Weiss
- Department of Otorhinolaryngology, University Medical Center Göttingen, UMG, Göttingen, Germany
| | - Hannah Kröhn
- Department of Nuclear Medicine, Hannover Medical School, MHH, Hannover, Germany
| | - Desiree Weiberg
- Department of Nuclear Medicine, Hannover Medical School, MHH, Hannover, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, MHH, Hannover, Germany
| | - Sebastian Schmuck
- Department of Nuclear Medicine, Hannover Medical School, MHH, Hannover, Germany
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11
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Assi AAN, Abu Arra A. Optimization of image quality in pulmonary CT angiography with low dose of contrast material. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2017. [DOI: 10.1515/pjmpe-2017-0008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Aim: The aim of this study was to compare objective image quality data for patient pulmonary embolism between a conventional pulmonary CTA protocol with respect to a novel acquisition protocol performed with optimize radiation dose and less amount of iodinated contrast medium injected to the patients during PE scanning. Materials and Methods: Sixty- four patients with Pulmonary Embolism (PE) possibility, were examined using angio-CT protocol. Patients were randomly assigned to two groups: A (16 women and 16 men, with age ranging from 19-89 years) mean age, 62 years with standard deviation 16; range, 19-89 years) - injected contrast agent: 35-40 ml. B (16 women and 16 men, with age ranging from 28-86 years) - injected contrast agent: 70-80 ml. Other scanning parameters were kept constant. Pulmonary vessel enhancement and image noise were quantified; signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Subjective vessel contrast was assessed by two radiologists in consensus. Result: A total of 14 cases of PE (22 %) were found in the evaluated of subjects (nine in group A, and five in group B). All PE cases were detected by the two readers. There was no significant difference in the size or location of the PEs between the two groups, the average image noise was 14 HU for group A and 19 HU for group B. The difference was not statistically significant (p = 0.09). Overall, the SNR and CNR were slightly higher on group B (24.4 and 22.5 respectively) compared with group A (19.4 and 16.4 respectively), but those differences were not statistically significant (p = 0.71 and p = 0.35, respectively). Conclusion and Discussion: Both groups that had been evaluated by pulmonary CTA protocol allow similar image quality to be achieved as compared with each other’s, with optimize care dose for both protocol and contrast volume were reduced by 50 % in new protocol comparing to the conventional protocol.
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Affiliation(s)
- Abed Al Nasser Assi
- Department of medical imaging, Arab American University, Jenin , Palestine
- Department of medical imaging, An-Najah University, Nablus , Palestine
| | - Ali Abu Arra
- Department of medical imaging, An-Najah University, Nablus , Palestine
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12
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Wan T, Skeith L, Karovitch A, Rodger M, Le Gal G. Guidance for the diagnosis of pulmonary embolism during pregnancy: Consensus and controversies. Thromb Res 2017; 157:23-28. [PMID: 28686913 DOI: 10.1016/j.thromres.2017.06.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 12/20/2022]
Abstract
Pulmonary embolism (PE) is one of the leading causes of maternal mortality despite a low incidence of PE during pregnancy. Several challenges surround the diagnosis of PE in pregnant women and the existing clinical guidelines provide weak recommendations on selecting the appropriate investigations for suspected PE in pregnancy. The purpose of this narrative review is to compare and contrast the recommendations of current clinical guidelines and review the evidence underpinning the recommendations on the evaluation of suspected PE in pregnancy. Consensus and controversies, knowledge gaps and areas requiring further research will be highlighted.
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Affiliation(s)
- Tony Wan
- Division of Hematology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Leslie Skeith
- Division of Hematology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Alan Karovitch
- Division of General Internal Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc Rodger
- Division of Hematology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Grégoire Le Gal
- Division of Hematology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
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13
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Gonzalez Della Valle A, Blanes Perez A, Lee YY, Saboeiro GR, Konin GP, Endo Y, Sharrock NE, Salvati EA. The Clinical Severity of Patients Diagnosed With an In-Hospital Pulmonary Embolism Following Modern, Elective Joint Arthroplasty Is Unrelated to the Location of Emboli in the Pulmonary Vasculature. J Arthroplasty 2017; 32:1304-1309. [PMID: 28012721 DOI: 10.1016/j.arth.2016.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 11/07/2016] [Accepted: 11/13/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In the event of a postoperative pulmonary embolism (PE), it is generally believed that patients with centrally located emboli will have worse clinical symptoms than those with segmental or subsegmental ones. We studied if a relationship exists between the clinical severity at the time of PE diagnosis and the location of the emboli within the pulmonary vasculature. METHODS All 269 patients who developed an in-hospital, computed tomography pulmonary angiography-proved, PE following elective total hip arthroplasty or total knee arthroplasty in our institution were studied. The clinical severity of the PE was calculated using the Pulmonary Embolism Severity Index (PESI) that classifies patients in 5 classes (class 5: most severe). All computed tomography pulmonary angiographies were re-reviewed to determine the location of the emboli within the pulmonary vasculature (central, segmental, or subsegmental-unilateral or bilateral). The association between PESI and the PE location was examined. RESULTS The most proximal location of the emboli was central in 62, segmental in 139, and subsegmental in 68. There were 180 unilateral and 89 bilateral PE patients. There was no association between the PESI and the location of the emboli within the pulmonary vasculature (P = .32). Patients with bilateral or unilateral lung involvement had similar PESI (P = .78). CONCLUSION The PESI, a recognized, validated predictor of mortality after PE was similar in patients with central, segmental, or subsegmental PE; and in patients with unilateral or bilateral lung involvement. The present study may aid clinicians while assessing and discussing the severity of PE symptoms with patients at the time of diagnosis.
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Affiliation(s)
| | - Alvaro Blanes Perez
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Yuo-Yu Lee
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Gregory R Saboeiro
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Gabrielle P Konin
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Yoshimi Endo
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Nigel E Sharrock
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Eduardo A Salvati
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
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14
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Kristensen AW, Mortensen J, Berg RMG. Pulmonary thromboembolism as a complication of lung transplantation. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.12922] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Anna Warncke Kristensen
- Department of Clinical Physiology, Nuclear Medicine & PET; University Hospital Rigshospitalet; Copenhagen Denmark
| | - Jann Mortensen
- Department of Clinical Physiology, Nuclear Medicine & PET; University Hospital Rigshospitalet; Copenhagen Denmark
| | - Ronan M. G. Berg
- Department of Clinical Physiology and Nuclear Medicine; Bispebjerg and Frederiksberg Hospitals; Copenhagen Denmark
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Detection of incidental pulmonary embolism with multi-slice computed tomography in cancer patients. Clin Imaging 2017; 41:106-111. [DOI: 10.1016/j.clinimag.2016.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 10/16/2016] [Accepted: 10/21/2016] [Indexed: 11/18/2022]
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Doğan H, de Roos A, Geleijins J, Huisman MV, Kroft LJM. The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism. Diagn Interv Radiol 2016; 21:307-16. [PMID: 26133321 DOI: 10.5152/dir.2015.14403] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Pulmonary embolism (PE) is a potentially life threatening condition requiring adequate diagnosis and treatment. Computed tomography pulmonary angiography (CTPA) is excellent for including and excluding PE, therefore CT is the first-choice diagnostic imaging technique in patients suspected of having acute PE. Due to its wide availability and low invasiveness, CTPA tends to be overused. Correct implementation of clinical decision rules in diagnostic workup for PE improves adequate use of CT. Also, CT adds prognostic value by evaluating right ventricular (RV) function. CT-assessed RV dysfunction and to lesser extent central emboli location predicts PE-related mortality in normotensive and hypotensive patients, while PE embolic obstruction index has limited prognostic value. Simple RV/left ventricular (LV) diameter ratio measures >1.0 already predict risk for adverse outcome, whereas ratios <1.0 can safely exclude adverse outcome. Consequently, assessing the RV/LV diameter ratio may help identify patients who are potential candidates for treatment at home instead of treatment in the hospital. A minority of patients develop chronic thromboembolic pulmonary hypertension (CTEPH) following acute PE, which is a life-threatening condition that can be diagnosed by CT. In proximal CTEPH, involving the more central pulmonary arteries, thrombectomy usually results in good outcome in terms of both functional status and long-term survival rate. CT is becoming the imaging method of choice for diagnosing CTEPH as it can identify patients who may benefit from thrombectomy. New CT developments such as distensibility measurements and dual-energy or subtraction techniques may further refine diagnosis and prognosis for improved patient care.
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Affiliation(s)
- Halil Doğan
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
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Osman AM, Abdeldayem EH, Osman NM. MR pulmonary angiography: Can it be used as an alternative for CT angiography in diagnosis of major pulmonary thrombosis? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ibáñez-Bravo S, Banzo I, Quirce R, Martínez-Rodríguez I, Jiménez-Bonilla J, Martínez-Amador N, Parra J, González-Macías J, Carril J. Ventilation/Perfusion SPECT lung scintigraphy and computed tomography pulmonary angiography in patients with clinical suspicion of pulmonary embolism. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.remnie.2015.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bhatia KD, Ambati C, Dhaliwal R, Paschkewitz R, Hsu E, Ho B, Young A, Emmett L. SPECT-CT/VQ versus CTPA for diagnosing pulmonary embolus and other lung pathology: Pre-existing lung disease should not be a contraindication. J Med Imaging Radiat Oncol 2016; 60:492-7. [PMID: 27461384 DOI: 10.1111/1754-9485.12471] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 04/11/2016] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Single Photon Emission Computed Tomography-Ventilation-Perfusion (SPECT-VQ) with low-dose CT (SPECT-CT/VQ) has equivalent diagnostic accuracy to CTPA for diagnosing pulmonary embolus (PE) while using lower radiation doses, but is underutilized owing to perceived inaccuracy of scintigraphy in the setting of pre-existing lung disease. This study assesses the accuracy of SPECT-CT/VQ compared with CTPA for the diagnosis of PE, including in patients with pre-existing lung disease. METHODS Retrospective non-inferiority cohort study of all patients who underwent SPECT-CT/VQ scanning at St Vincent's Hospital, NSW, from June 2012 to November 2013, who also had a CTPA within the same admission and <72 h apart (n = 102). RESULTS SPECT-CT/VQ had 100% sensitivity and 94.4% specificity when compared with CTPA. Of the 102 patients, 14 were lung transplant patients, and 27 had other pre-existing lung disease (41/102, 40.2%), with SPECT-CT/VQ having a sensitivity of 100% and specificity of 97.2% in this patient group. Non-inferiority of SPECT-CT/VQ was demonstrated at a significance level of 0.005. CONCLUSION SPECT-CT/VQ has high sensitivity and specificity for diagnosing PE compared with CTPA, even among patients with pre-existing lung disease, with lower radiation doses.
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Affiliation(s)
- Kartik Dev Bhatia
- Department of Medical Imaging, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Chaitanya Ambati
- Department of Medical Imaging, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Rajiv Dhaliwal
- Department of Medical Imaging, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Royce Paschkewitz
- Department of Medical Imaging, St Vincent's Hospital, Darlinghurst, New South Wales, Australia.,Department of Radiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Eugene Hsu
- Department of Medical Imaging, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Bao Ho
- Department of Medical Imaging, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Andy Young
- Department of Medical Imaging, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Louise Emmett
- Department of Medical Imaging, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
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Leuschner G, Wenter V, Milger K, Zimmermann GS, Matthes S, Meinel FG, Lehner S, Neurohr C, Behr J, Kneidinger N. Suspected pulmonary embolism in patients with pulmonary fibrosis: Discordance between ventilation/perfusion SPECT and CT pulmonary angiography. Respirology 2016; 21:1081-7. [PMID: 27061739 DOI: 10.1111/resp.12797] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/30/2015] [Accepted: 02/01/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Pulmonary embolism (PE) is a common differential diagnosis in patients with pulmonary fibrosis presenting with a clinical deterioration. Both ventilation/perfusion (V/Q)-single photon emission computed tomography (SPECT) and computed tomographic pulmonary angiography (CTPA) are routinely used to detect PE. However, the value of V/Q-SPECT and CTPA in this scenario has not been studied so far. We aimed to investigate the concordance of V/Q-SPECT and CTPA in patients with pulmonary fibrosis and suspicion of pulmonary embolism. METHODS A total of 22 consecutive patients with pulmonary fibrosis and clinical deterioration who underwent both V/Q-SPECT and CTPA were included in the study and analyzed for the presence of pulmonary embolism. RESULTS Nine of 22 patients (41%) had evidence for pulmonary embolism in V/Q-SPECT, and two of these patients had matching evidence for pulmonary embolism in CTPA. In the other seven patients with positive findings in V/Q-SPECT, no evidence of pulmonary embolism was found in CTPA. None of the 13 patients with a negative V/Q-SPECT had evidence for pulmonary embolism in CTPA. CONCLUSION In patients with pulmonary fibrosis and suspected pulmonary embolism, pulmonary embolism is detected more frequently by V/Q-SPECT than by CTPA. Thromboembolic disease is identified on CTPA only in a minority of patients with positive findings on V/Q-SPECT. When making treatment decisions, clinicians should be aware of the high rate of discordant findings in V/Q-SPECT and CTPA in this specific patient population.
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Affiliation(s)
- Gabriela Leuschner
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Vera Wenter
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Gregor S Zimmermann
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Sandhya Matthes
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Felix G Meinel
- Institute for Clinical Radiology, University of Munich, Munich, Germany
| | - Sebastian Lehner
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | - Claus Neurohr
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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Influence of Respiratory Position on Contrast Attenuation in Pulmonary CT Angiography: A Prospective Randomized Clinical Trial. AJR Am J Roentgenol 2016; 206:481-6. [DOI: 10.2214/ajr.15.15176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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One-Year All-Cause Mortality of Patients Diagnosed as Having In-Hospital Pulmonary Embolism After Modern Elective Joint Arthroplasty Is Low And Unaffected By Radiologic Severity. J Arthroplasty 2016; 31:473-9. [PMID: 26461488 DOI: 10.1016/j.arth.2015.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/01/2015] [Accepted: 09/09/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We studied the 1-year complication rate of patients diagnosed as having a pulmonary embolism (PE) after elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) surgery and the distribution of emboli in the pulmonary circulation, and determined if a relationship exists between the location of the PE and age, gender, body mass index, preoperative predisposing factors, American Society of Anesthesiology classification, type of surgery, prophylaxis, hospital stay, transfer to a higher level of care, and mortality. METHODS Two hundred sixty-nine patients who developed an in-hospital PE proved by computed tomography pulmonary angiography after elective THA or TKA between 2005 and 2012 were studied. RESULTS The most proximal location of the emboli was central in 62, segmental in 139, and subsegmental in 68. Nineteen patients (7%) developed a bleeding complication during PE treatment. Twenty-nine patients (11%) were readmitted during the first year. Two patients (0.74%) died: one had a segmental PE after TKA. He died 11 months after surgery due to an autopsy-proven sepsis. The second patient developed a segmental PE after THA. She was anticoagulated, developed an intracranial bleed, and died 8 months after surgery. Multivariate analysis showed that demographic variables, American Society of Anesthesiology class, preoperative comorbidities (with the exception of arrhythmia), and the presence of preoperative predisposing factors had no effect in the location of the PE. CONCLUSION The 1-year mortality rate of these patients is low. Death can be caused by bleeding complications secondary to anticoagulation or by unrelated conditions. This information may aid clinicians while counseling patients who developed a PE after surgery, particularly those with small subsegmental emboli.
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Ibáñez-Bravo S, Banzo I, Quirce R, Martínez-Rodríguez I, Jiménez-Bonilla J, Martínez-Amador N, Parra JA, González-Macías J, Carril JM. Ventilation/Perfusion SPECT lung scintigraphy and computed tomography pulmonary angiography in patients with clinical suspicion of pulmonary embolism. Rev Esp Med Nucl Imagen Mol 2016; 35:215-20. [PMID: 26838481 DOI: 10.1016/j.remn.2015.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/18/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED The aim was to compare ventilation/perfusion SPECT lung scintigraphy (V/Q-SPECT) and computed tomography pulmonary angiography (CTPA) in patients with suspicion of pulmonary embolism (PE). MATERIAL AND METHODS This prospectively designed study included 53 patients with intermediate or high clinical probability of PE. A V/Q-SPECT and CTPA was performed on all patients. The V/Q-SPECT was interpreted according to the European Association of Nuclear Medicine and Molecular Imaging (EANMMI) guidelines. CTPA was reported as positive, negative, or indeterminate. RESULTS CTPA was positive in 22 cases, negative in 28, and indeterminate in 3. V/Q-SPECT was positive in 27 cases, negative in 24, and non-diagnostic in 2. In the 22 with positive CTPA, V/Q-SPECT was positive in 18, negative in 3, and non-diagnostic in 1. In the 28 with negative CTPA, V/Q-SPECT was positive in 8, negative in 19, and non-diagnostic in 1. In the 3 with indeterminate CTPA, V/Q-SPECT was positive in 1 and negative in 2. In the 2 non-diagnostic cases V/Q-SPECT, CTPA was positive in 1 and negative in one. In the 10 high clinical probabilities, CTPA and V/Q-SPECT were positive in 7, negative in 2, and in 1, CTPA was positive and V/Q-SPECT negative. In the 38 intermediate probability group, CTPA and V/Q-SPECT were positive in 11, negative in 17, with CTPA negative and V/Q-SPECT positive in 8, and in 2 CTPA was positive and V/Q-SPECT negative. The results show that V/Q-SPECT detected PE in 5 patients more than CTPA. CONCLUSION Our results show a 77% concordance of both techniques. Overall V/Q-SPECT detected PE in 18% more patients than CTPA in the intermediate group. Both techniques have a complementary role when a diagnosis cannot be made with one of them.
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Affiliation(s)
- S Ibáñez-Bravo
- Nuclear Medicine Department, University Hospital "Marqués de Valdecilla", Cantabria University, Molecular Imaging Group IDIVAL, Santander, Spain.
| | - I Banzo
- Nuclear Medicine Department, University Hospital "Marqués de Valdecilla", Cantabria University, Molecular Imaging Group IDIVAL, Santander, Spain
| | - R Quirce
- Nuclear Medicine Department, University Hospital "Marqués de Valdecilla", Cantabria University, Molecular Imaging Group IDIVAL, Santander, Spain
| | - I Martínez-Rodríguez
- Nuclear Medicine Department, University Hospital "Marqués de Valdecilla", Cantabria University, Molecular Imaging Group IDIVAL, Santander, Spain
| | - J Jiménez-Bonilla
- Nuclear Medicine Department, University Hospital "Marqués de Valdecilla", Cantabria University, Molecular Imaging Group IDIVAL, Santander, Spain
| | - N Martínez-Amador
- Nuclear Medicine Department, University Hospital "Marqués de Valdecilla", Cantabria University, Molecular Imaging Group IDIVAL, Santander, Spain
| | - J A Parra
- Radiology Department, University Hospital "Marqués de Valdecilla", Cantabria University, Santander, Spain
| | - J González-Macías
- Internal Medicine Department, University Hospital "Marqués de Valdecilla", Cantabria University, Santander, Spain
| | - J M Carril
- Nuclear Medicine Department, University Hospital "Marqués de Valdecilla", Cantabria University, Molecular Imaging Group IDIVAL, Santander, Spain
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Prevalence of Venous Thromboembolic Events After Elective Major Thoracolumbar Degenerative Spine Surgery. ACTA ACUST UNITED AC 2015; 28:E310-5. [DOI: 10.1097/bsd.0b013e31828b7d82] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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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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Performance Quality Improvement Projects: Suggestions for the Body Imager. J Am Coll Radiol 2015; 12:201-3. [DOI: 10.1016/j.jacr.2014.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 10/13/2014] [Accepted: 10/18/2014] [Indexed: 11/15/2022]
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Enhancement of the pulmonary arteries and thoracic aorta: comparison of a biphasic contrast injection and fixed delay protocol with a monophasic injection and a timing bolus protocol. Emerg Radiol 2014; 22:231-7. [DOI: 10.1007/s10140-014-1269-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
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Chen YA, Gray BG, Bandiera G, MacKinnon D, Deva DP. Variation in the utilization and positivity rates of CT pulmonary angiography among emergency physicians at a tertiary academic emergency department. Emerg Radiol 2014; 22:221-9. [DOI: 10.1007/s10140-014-1265-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 08/27/2014] [Indexed: 01/17/2023]
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Raptis CA, Fowler KJ, Narra VR, Menias CO, Bhalla S. Emergency thoracic vascular magnetic resonance imaging: protocols and clinical considerations. Semin Roentgenol 2014; 49:157-68. [PMID: 24836491 DOI: 10.1053/j.ro.2014.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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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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Abstract
Pulmonary embolism represents a major public healthcare problem and it also imposes frequent clinical diagnostic issues. Despite the availability of the D-dimer tests, imaging remains the mainstay for its diagnosis. Computed tomography pulmonary angiography (CTPA) is now the most widely used diagnostic test and its utility has been well validated in a large number of trials. Nuclear medicine techniques, which are also well established, are now used significantly less frequently. Magnetic resonance pulmonary angiography is developing as an alternative to CTPA in patients who have contraindications to iodinated contrast media. Catheter pulmonary angiography remains the gold standard, although it is being used increasingly less frequently. In this article, we review the current knowledge on the imaging diagnosis of acute pulmonary embolism with special emphasis on the noninvasive techniques.
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Affiliation(s)
- Ugur Bozlar
- University of Virginia Health System, Department of Radiology, Charlottesville, VA 22908, USA.
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Sun S, Semionov A, Xie X, Kosiuk J, Mesurolle B. Detection of central pulmonary embolism on non-contrast computed tomography: a case control study. Int J Cardiovasc Imaging 2014; 30:639-46. [DOI: 10.1007/s10554-013-0356-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022]
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Mortensen J, Gutte H. SPECT/CT and pulmonary embolism. Eur J Nucl Med Mol Imaging 2013; 41 Suppl 1:S81-90. [PMID: 24213621 PMCID: PMC4003400 DOI: 10.1007/s00259-013-2614-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/10/2013] [Indexed: 11/04/2022]
Abstract
Acute pulmonary embolism (PE) is diagnosed either by ventilation/perfusion (V/P) scintigraphy or pulmonary CT angiography (CTPA). In recent years both techniques have improved. Many nuclear medicine centres have adopted the single photon emission CT (SPECT) technique as opposed to the planar technique for diagnosing PE. SPECT has been shown to have fewer indeterminate results and a higher diagnostic value. The latest improvement is the combination of a low-dose CT scan with a V/P SPECT scan in a hybrid tomograph. In a study comparing CTPA, planar scintigraphy and SPECT alone, SPECT/CT had the best diagnostic accuracy for PE. In addition, recent developments in the CTPA technique have made it possible to image the pulmonary arteries of the lungs in one breath-hold. This development is based on the change from a single-detector to multidetector CT technology with an increase in volume coverage per rotation and faster rotation. Furthermore, the dual energy CT technique is a promising modality that can provide functional imaging in combination with anatomical information. Newer high-end CT scanners and SPECT systems are able to visualize smaller subsegmental emboli. However, consensus is lacking regarding the clinical impact and treatment. In the present review, SPECT and SPECT in combination with low-dose CT, CTPA and dual energy CT are discussed in the context of diagnosing PE.
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Affiliation(s)
- Jann Mortensen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen University Hospital, 2100, Copenhagen, Denmark,
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Kilinc G, Dogan OT, Berk S, Epozturk K, Ozsahin SL, Akkurt I. Significance of serum cardiac troponin I levels in pulmonary embolism. J Thorac Dis 2013. [PMID: 23205283 DOI: 10.3978/j.issn.2072-1439.2012.10.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Some biomarkers can be helpful in the diagnosis of pulmonary embolism (PE) and determining of severity and prognosis of the disease. In this study, we aimed to analyze the elevated cardiac troponin I (cTnI) levels and its association with electrocardiography (ECG) and transthoracic echocardiography (TTE) findings in patients with PE. METHODS Totally 106 patients with suspected PE were included in the study. PE was confirmed in 63 of them, whereas it was excluded in the remaining 43 patients. Levels of cTnI were measured in all patients before the prescription of the anticoagulation therapy. RESULTS High cTnI levels were found in 50.8% of patients with PE, and in 11.6% of patients without PE (P<0.001). Sensitivity and specificity of the test for the diagnosis of PE were 50.7%, 88.3% respectively. ECG findings were similar in PE patients having either elevated or normal cTnI levels. Approximately 75% of the PE patients with high cTnI had normal ECG findings; the most common pathological changes seen in ECG were S1Q3T3 pattern (~31%). TTE findings were not found to be distinguishing in the patients with suspected PE and high cTnI levels. Pulmonary hypertension (PHT) was the most common echocardiographic finding (~74%) in patients with PE and elevated cTnI levels. However, there was not a statistically significant difference between TTE findings in PE patients with increased and normal cTnI levels. CONCLUSIONS In patients presenting with clinical, electrocardiographic and echocardiographic features suggesting pulmonary embolism, increased serum cTnI levels endorse the diagnosis of severe PE.
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Affiliation(s)
- Gonca Kilinc
- Nafiz Kurt Bafra Public Hospital, Department of Chest Diseases, Samsun, Turkey
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V/Q SPECT imaging of acute pulmonary embolus — A practical perspective. Clin Radiol 2012; 67:941-8. [DOI: 10.1016/j.crad.2012.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Revised: 04/07/2012] [Accepted: 04/11/2012] [Indexed: 11/18/2022]
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Bahloul M, Chaari A, Ben Algia N, Bouaziz M. Pulmonary embolism in intensive care unit “literature review”. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2012. [DOI: 10.1016/j.tacc.2011.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Hunt JM, Bull TM. Clinical review of pulmonary embolism: diagnosis, prognosis, and treatment. Med Clin North Am 2011; 95:1203-22. [PMID: 22032435 DOI: 10.1016/j.mcna.2011.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Pulmonary embolism (PE) is a common disease causing significant morbidity, mortality, and substantial socioeconomic costs. The correct diagnosis and management of PE, however, offers many challenges. As a result, ongoing research continues to develop and refine new and existing diagnostic and prognostic tools, as well as therapeutic interventions, leading to significant improvements in the care of PE over the past 2 decades. This article summarizes the current literature to aid the clinician in the correct integration and implementation of these advances in the treatment of PE.
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Affiliation(s)
- James M Hunt
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO 80045, USA.
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Moores LK, King CS, Holley AB. Current approach to the diagnosis of acute nonmassive pulmonary embolism. Chest 2011; 140:509-518. [PMID: 21813530 DOI: 10.1378/chest.10-2468] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Pulmonary embolism is a common and potentially lethal disease. Given the variable presentation and associated morbidity of this condition, an accurate and efficient diagnostic algorithm is required. Clinical pretest probability serves as the root of any diagnostic approach. We, thus, review several clinical decision rules that may help standardize this determination. Using a review of the literature, the accuracy, predictive values, and likelihood ratios for several diagnostic tests are described. The combination of these tests, based on the pretest probability of disease, can be used in a Bayesian fashion to make accurate treatment decisions. A completely noninvasive diagnostic algorithm for patients presenting with suspected acute pulmonary embolism is proposed.
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Affiliation(s)
- Lisa K Moores
- Department of Medicine, the Uniformed Services University of the Health Sciences, Bethesda, MD.
| | - Christopher S King
- Pulmonary and Critical Care Medicine Service, William Beaumont Army Medical Center, El Paso, TX
| | - Aaron B Holley
- Pulmonary, Critical Care, and Sleep Medicine Service, Walter Reed Army Medical Center, Washington, DC
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O’Connor C, Moriarty J, Walsh J, Murray J, Coulter-Smith S, Boyd W. The application of a clinical risk stratification score may reduce unnecessary investigations for pulmonary embolism in pregnancy. J Matern Fetal Neonatal Med 2011; 24:1461-4. [DOI: 10.3109/14767058.2011.614652] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Singh T, Lam KV, Murray C. Low volume contrast CTPA in patients with renal dysfunction. J Med Imaging Radiat Oncol 2011; 55:143-8. [PMID: 21501402 DOI: 10.1111/j.1754-9485.2011.02243.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The study aims to evaluate a method for and technical feasibility of performing CT pulmonary angiography (CTPA) with just 30 mL of contrast. METHODS Twenty-four patients with renal dysfunction suspected of having pulmonary embolus underwent CTPA using 30 mL of contrast. A modified acquisition protocol was employed where sequential monitoring of the central superior vena cava (SVC) was performed following injection of contrast. Scanning was triggered at the first visualised arrival of contrast within the SVC. Hounsfield unit (HU) measurements were performed at the main pulmonary artery to the subsegmental branches to determine the adequacy of each study. RESULTS The level of pulmonary arterial enhancement achieved was high, averaging 247 HU across all measured arteries. Average enhancement within more peripheral lobar, segmental and subsegmental arteries was also greater than 200. Only one study was considered non-diagnostic. CONCLUSION Low-volume CTPA is technically feasible and provides excellent enhancement of the pulmonary arterial tree.
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Affiliation(s)
- Tushar Singh
- Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.
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Strategies for diagnosis and prevention of venous thromboembolism during pregnancy. J Pregnancy 2011; 2011:206858. [PMID: 21869932 PMCID: PMC3159016 DOI: 10.1155/2011/206858] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 04/28/2011] [Accepted: 05/23/2011] [Indexed: 11/17/2022] Open
Abstract
Pregnancy and the postpartum period have an increased incidence of venous thromboembolism (VTE). The condition is unique during this period for several reasons. Primarily, because there is complexity in diagnosing this condition in view of altered physiology and preexisting edema in pregnancy and also because there are restrictions on the use of certain drugs and a need for vigilant monitoring of anticoagulant activities of drugs during the period. The problem is compounded and assumes the highest order of significance since two lives are involved and all the investigations and management done should also take into account the potential adverse effects on the foetus. In order to prevent the development of VTE during pregnancy, sound clinical evaluation for risk factors, risk stratification, and optimal use of resource both mechanical and pharmacological is necessary. This paper details strategies in preventing development of deep vein thrombosis and treatment of VTEs.
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Pulmonary embolism in pregnancy: a diagnostic dilemma. Ann Nucl Med 2011; 25:603-8. [DOI: 10.1007/s12149-011-0515-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 06/29/2011] [Indexed: 10/18/2022]
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Xiong L, Trout AT, Bailey JE, Brown RK, Kelly AM. Comparison of Discrepancy Rates in Resident and Faculty Interpretations of On-Call PE CT and V/Q Scans: Is One Study More Reliable During Off Hours? J Am Coll Radiol 2011; 8:415-21. [DOI: 10.1016/j.jacr.2010.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 12/10/2010] [Indexed: 11/27/2022]
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Seon HJ, Kim KH, Lee WS, Choi S, Yoon HJ, Ahn Y, Kim YH, Jeong MH, Cho JG, Park JC, Kang JC. Usefulness of Computed Tomographic Pulmonary Angiography in the Risk Stratification of Acute Pulmonary Thromboembolism - Comparison With Cardiac Biomarkers -. Circ J 2011; 75:428-36. [DOI: 10.1253/circj.cj-10-0361] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hyun Ju Seon
- Department of Radiology, Chonnam National University Hospital, The Research Institute of Medical Sciences of Chonnam National University
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, The Research Institute of Medical Sciences of Chonnam National University
| | - Woo Seok Lee
- Department of Cardiovascular Medicine, Chonnam National University Hospital, The Research Institute of Medical Sciences of Chonnam National University
| | - Song Choi
- Department of Radiology, Chonnam National University Hospital, The Research Institute of Medical Sciences of Chonnam National University
| | - Hyun Ju Yoon
- Department of Cardiovascular Medicine, Chonnam National University Hospital, The Research Institute of Medical Sciences of Chonnam National University
| | - Youngkeun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Hospital, The Research Institute of Medical Sciences of Chonnam National University
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, The Research Institute of Medical Sciences of Chonnam National University
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, The Research Institute of Medical Sciences of Chonnam National University
| | - Jeong Gwan Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, The Research Institute of Medical Sciences of Chonnam National University
| | - Jong Chun Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, The Research Institute of Medical Sciences of Chonnam National University
| | - Jung Chaee Kang
- Department of Cardiovascular Medicine, Chonnam National University Hospital, The Research Institute of Medical Sciences of Chonnam National University
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Henzler T, Barraza JM, Nance JW, Costello P, Krissak R, Fink C, Schoepf UJ. CT imaging of acute pulmonary embolism. J Cardiovasc Comput Tomogr 2011; 5:3-11. [DOI: 10.1016/j.jcct.2010.10.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 10/05/2010] [Indexed: 02/07/2023]
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Attinà D, Valentino M, Galiè N, Modolon C, Buia F, de Luca F, Bacchi-Reggiani ML, Zompatori M. Application of a new pulmonary artery obstruction score in the prognostic evaluation of acute pulmonary embolism: comparison with clinical and haemodynamic parameters. Radiol Med 2010; 116:230-45. [PMID: 21311989 DOI: 10.1007/s11547-010-0613-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 03/10/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Evaluation of computed tomography (CT) pulmonary angiography parameters revealing pulmonary embolism (PE) severity with particular attention to pulmonary obstruction indexes. Comparison with clinical and hemodynamic data and determination of predictive role in the development of chronic pulmonary heart disease. MATERIALS AND METHODS This retrospective study analyzes 45 not consecutive patients from November 2007 to December 2008 with CT angiography diagnosis of acute PE. Included in the study are patients at the first documented episode of acute PE, with 6 month follow-up. Patients with severe pre-existent cardiopulmonary pathology or neoplastic diseases were excluded from the study. CT angiography evaluated right ventricular (RV)/left ventricular (LV) ratio, obstruction index according to Qanadli and Total Clot Burden (Ghanima score). PE indexes were compared with Troponin I measurement and echocardiography result; at last hospitalization and intensive care time were reported. RESULTS A significant association was found between Ghanima and Qanadli score: the two indexes are equivalent in quantification of pulmonary arterial obstruction (p<0.001). Among others CT parameters, the new Ghanima score evidenced the best accuracy to detect patients evolving to chronic pulmonary heart disease (76%). This value is higher than that of echocardiography (71%). Troponins showed highest accuracy (82%). CONCLUSIONS Ghanima score can be used in emergency CT angiography diagnosis as prognostic marker for a quickly risk stratification of pulmonary heart disease or death in patients with acute PE. This approach allows to obtain, with just one test, both the diagnosis and a rather accurate acute PE risk stratification.
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Affiliation(s)
- D Attinà
- U.O. Radiologia Cardio-Toracica, Azienda Ospedaliera-Universitaria di Bologna, Policlinico S. Orsola-Malpighi SSD, Via Massarenti 9, 40100, Bologna, Italy
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Unsuspected Pulmonary Emboli in Oncology Patients Undergoing Routine Computed Tomography Imaging. J Thorac Oncol 2010; 5:798-803. [DOI: 10.1097/jto.0b013e3181d6153a] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Huppmann MV, Johnson WB, Javitt MC. Radiation Risks from Exposure to Chest Computed Tomography. Semin Ultrasound CT MR 2010; 31:14-28. [DOI: 10.1053/j.sult.2009.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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