1
|
Yadav V, Singhal M, Maralakunte M, Sharma N, Sharma A, Lal A. Comparison of Dual-Energy Computed Tomography Pulmonary Angiography-Derived Contrast Enhancement with Standard Dual-Energy Pulmonary Angiography in Diagnosing Subsegmental Pulmonary Embolism: A Prospective Study. Indian J Radiol Imaging 2023; 33:456-462. [PMID: 37811170 PMCID: PMC10556308 DOI: 10.1055/s-0043-1764489] [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: 10/10/2023] Open
Abstract
Objective In this study, we compare the diagnostic accuracy of dual-energy (DE) computed tomography pulmonary angiography (CTPA) derived contrast enhancement (DECTPA, CTPA images with iodine maps) with standard dual-energy pulmonary angiography (SCTPA) for diagnosis of subsegmental pulmonary embolism in the cases with clinical suspicion of acute pulmonary embolism (APE). Materials and Methods We included 50 cases with clinical suspicion of APE that were referred for CTPA. All the patients underwent CTPA in the dual-energy protocol. Two radiologists evaluated the images. The first radiologist interpreted the SCTPA images (vascular images) and the second radiologist interpreted the DECTPA (CTPA images with iodine maps) for findings of APE. We calculated the sensitivity, specificity, and negative predictive value of DECTPA vis-à-vis SCTPA images. Results The DECTPA with the advantage of iodine map utilization yielded higher detection of thrombi in peripheral subsegmental arteries (72 vs. 99; p = - 0.001) as compared to the SCTPA images by identification of 18 new perfusion defects (interquartile range [IQR]: 0-1) that were consistent with APE. Filling defects were identified in 27 (IQR: 0-4) more subsegmental arteries supplying these 18 areas, which were not detected on SCTPA alone. These 18 perfusion defects were identified in 13 cases. In these 13 cases, 4 new cases were diagnosed that were negative on CTPA ( p = -0.125). In the evaluation of the APE, sensitivity and specificity were calculated and it was found that DECTPA showed 100% sensitivity and 86% specificity with 100% negative predictive value in the detection of thrombi as compared to the routine CTPA. Conclusion DECTPA has higher sensitivity and negative predictive value in the detection of the subsegmental perfusion defect identification as compared to SCTPA.
Collapse
Affiliation(s)
- Vivek Yadav
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muniraju Maralakunte
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Sharma
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anupam Lal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
2
|
Brolund-Napier CN, Ffrench-Constant AE, Neumann S, Paull JC, Fenton NK, Jones CA, Lyen S, Manghat NE, Hamilton MCK. CT pulmonary angiography: optimising acute thoracic imaging by fixed-timing contrast medium delivery with a modified breathing instruction. Clin Radiol 2023; 78:e237-e242. [PMID: 36588065 DOI: 10.1016/j.crad.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/03/2022] [Accepted: 11/13/2022] [Indexed: 12/31/2022]
Abstract
AIM To compare the thoracic vascular opacification achieved using the standard bolus-tracking protocol (BTP) with a fixed-timing protocol (FTP) with a modified breathing instruction during computed tomography pulmonary angiography (CTPA) examinations. MATERIALS AND METHODS A single-centre review of CTPA examinations performed between July 2018 and January 2019 using the BTP or FTP and weight-based contrast dosing of 20 mg iodine/kg body weight/s for 20 seconds at 100 kV tube potential. Radiodensity (in Hounsfield units) was analysed in the right ventricle, main pulmonary artery (MPA), left atrium, left ventricle, and ascending and descending thoracic aorta (DTA). A p-value of <0.05 was considered significant. RESULTS Of 782 examinations, 88 BTP and 90 FTP examinations were included. Mean attenuation of the MPA was similar in the FTP (396 ± 106 HU) and BTP (362 ± 119 HU; p=0.06); however, good-quality (≥250 HU) MPA opacification was achieved in more FTP examinations (87/90, 96.7%) compared to the BTP (73/88, 82.9%; p=0.002). Mean attenuation of the DTA was better in the FTP (325 ± 72 HU) than the BTP (228 ± 75 HU; p <0.0001), with good-quality opacification (≥250 HU) in 76/90 (84.4%) FTP examinations compared with 36/88 (40.9%) BTP examinations (p <0.001). CONCLUSION The FTP achieves better opacification of the MPA and DTA compared to the BTP.
Collapse
Affiliation(s)
- C N Brolund-Napier
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - A E Ffrench-Constant
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - S Neumann
- University of Bristol, Faculty of Health Sciences, Queens Road, Bristol BS8 1QU, UK
| | - J C Paull
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - N K Fenton
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - C A Jones
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - S Lyen
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - N E Manghat
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - M C K Hamilton
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK.
| |
Collapse
|
3
|
Hsia CCW, Bates JHT, Driehuys B, Fain SB, Goldin JG, Hoffman EA, Hogg JC, Levin DL, Lynch DA, Ochs M, Parraga G, Prisk GK, Smith BM, Tawhai M, Vidal Melo MF, Woods JC, Hopkins SR. Quantitative Imaging Metrics for the Assessment of Pulmonary Pathophysiology: An Official American Thoracic Society and Fleischner Society Joint Workshop Report. Ann Am Thorac Soc 2023; 20:161-195. [PMID: 36723475 PMCID: PMC9989862 DOI: 10.1513/annalsats.202211-915st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Multiple thoracic imaging modalities have been developed to link structure to function in the diagnosis and monitoring of lung disease. Volumetric computed tomography (CT) renders three-dimensional maps of lung structures and may be combined with positron emission tomography (PET) to obtain dynamic physiological data. Magnetic resonance imaging (MRI) using ultrashort-echo time (UTE) sequences has improved signal detection from lung parenchyma; contrast agents are used to deduce airway function, ventilation-perfusion-diffusion, and mechanics. Proton MRI can measure regional ventilation-perfusion ratio. Quantitative imaging (QI)-derived endpoints have been developed to identify structure-function phenotypes, including air-blood-tissue volume partition, bronchovascular remodeling, emphysema, fibrosis, and textural patterns indicating architectural alteration. Coregistered landmarks on paired images obtained at different lung volumes are used to infer airway caliber, air trapping, gas and blood transport, compliance, and deformation. This document summarizes fundamental "good practice" stereological principles in QI study design and analysis; evaluates technical capabilities and limitations of common imaging modalities; and assesses major QI endpoints regarding underlying assumptions and limitations, ability to detect and stratify heterogeneous, overlapping pathophysiology, and monitor disease progression and therapeutic response, correlated with and complementary to, functional indices. The goal is to promote unbiased quantification and interpretation of in vivo imaging data, compare metrics obtained using different QI modalities to ensure accurate and reproducible metric derivation, and avoid misrepresentation of inferred physiological processes. The role of imaging-based computational modeling in advancing these goals is emphasized. Fundamental principles outlined herein are critical for all forms of QI irrespective of acquisition modality or disease entity.
Collapse
|
4
|
Ahuja J, Palacio D, Jo N, Strange CD, Shroff GS, Truong MT, Wu CC. Pitfalls in the imaging of pulmonary embolism. Semin Ultrasound CT MR 2022; 43:221-229. [PMID: 35688533 DOI: 10.1053/j.sult.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pulmonary embolism (PE) can present with a wide spectrum of clinical symptoms that can overlap considerably with other cardiovascular diseases. To avoid PE related morbidity and mortality, it is vital to identify this disease accurately and in a timely fashion. Several clinical criteria have been developed to standardize the diagnostic approach for patients with suspected PE. Computed tomographic pulmonary angiogram has significantly improved the detection of pulmonary embolism and is considered the imaging modality of choice to diagnose this disease. However, there are several potential pitfalls associated with this modality which can make diagnosis of PE challenging. In this review, we will discuss various pitfalls routinely encountered in the diagnostic work up of patients with suspected PE, approaches to mitigate these pitfalls and incidental pulmonary embolism.
Collapse
Affiliation(s)
- Jitesh Ahuja
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Diana Palacio
- Department of Radiology, The University of Texas Medical Branch, UTMB. Galveston TX
| | - Nahyun Jo
- Department of Radiology, The University of Texas Medical Branch, UTMB. Galveston TX
| | - Chad D Strange
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Girish S Shroff
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mylene T Truong
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carol C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
5
|
Kutsogiannis DJ, Alharthy A, Balhamar A, Faqihi F, Papanikolaou J, Alqahtani SA, Memish ZA, Brindley PG, Brochard L, Karakitsos D. Mortality and Pulmonary Embolism in Acute Respiratory Distress Syndrome From COVID-19 vs. Non-COVID-19. Front Med (Lausanne) 2022; 9:800241. [PMID: 35308552 PMCID: PMC8931188 DOI: 10.3389/fmed.2022.800241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/31/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose There may be a difference in respiratory mechanics, inflammatory markers, and pulmonary emboli in COVID-19 associated ARDS vs. ARDS from other etiologies. Our purpose was to determine differences in respiratory mechanics, inflammatory markers, and incidence of pulmonary embolism in patients with and without COVID-19 associated ARDS admitted in the same period and treated with a similar ventilation strategy. Methods A cohort study of COVID-19 associated ARDS and non COVID-19 patients in a Saudi Arabian center between June 1 and 15, 2020. We measured respiratory mechanics (ventilatory ratio (VR), recruitability index (RI), markers of inflammation, and computed tomography pulmonary angiograms. Results Forty-two patients with COVID-19 and 43 non-COVID patients with ARDS comprised the cohort. The incidence of “recruitable” patients using the recruitment/inflation ratio was slightly lower in COVID-19 patients (62 vs. 86%; p = 0.01). Fifteen COVID-19 ARDS patients (35.7%) developed a pulmonary embolism as compared to 4 (9.3%) in other ARDS patients (p = 0.003). In COVID-19 patients, a D-Dimer ≥ 5.0 mcg/ml had a 73% (95% CI 45–92%) sensitivity and 89% (95% CI 71–98%) specificity for predicting pulmonary embolism. Crude 60-day mortality was higher in COVID-19 patients (35 vs. 15%; p = 0.039) but three multivariate analysis showed that independent predictors of 60-day mortality included the ventilatory ratio (OR 3.67, 95% CI 1.61–8.35), PaO2/FIO2 ratio (OR 0.93; 95% CI 0.87–0.99), IL-6 (OR 1.02, 95% CI 1.00–1.03), and D-dimer (OR 7.26, 95% CI 1.11–47.30) but not COVID-19 infection. Conclusion COVID-19 patients were slightly less recruitable and had a higher incidence of pulmonary embolism than those with ARDS from other etiologies. A high D-dimer was predictive of pulmonary embolism in COVID-19 patients. COVID-19 infection was not an independent predictor of 60-day mortality in the presence of ARDS.
Collapse
Affiliation(s)
- Demetrios J. Kutsogiannis
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, The University of Alberta, Edmonton, AB, Canada
- *Correspondence: Demetrios J. Kutsogiannis
| | | | - Abdullah Balhamar
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Fahad Faqihi
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - John Papanikolaou
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Saleh A. Alqahtani
- Department of Medicine, The Johns Hopkins University Hospital, Baltimore, MD, United States
| | - Ziad A. Memish
- Research and Innovation Center, King Saud Medical City, Riyadh, Saudi Arabia
| | - Peter G. Brindley
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, The University of Alberta, Edmonton, AB, Canada
| | - Laurent Brochard
- Department of Critical Care, Keenan Research Center and Li Ka Shing Institute, St. Michael's Hospital, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Dimitrios Karakitsos
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Department of Internal Medicine, University of South Carolina, School of Medicine, Columbia, SC, United States
- Critical Care Department, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| |
Collapse
|
6
|
Inoue Y, Yonekura Y, Nagahara K, Uehara A, Ikuma H. Conversion from dose-length product to effective dose in computed tomography venography of the lower extremities. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:011521. [PMID: 35008078 DOI: 10.1088/1361-6498/ac49d6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
For radiation dose assessment of computed tomography (CT), effective dose (ED) is often estimated by multiplying the dose-length product (DLP), provided automatically by the CT scanner, by a conversion factor. We investigated such conversion in CT venography of the lower extremities performed in conjunction with CT pulmonary angiography. The study subjects consisted of eight groups imaged using different scanners and different imaging conditions (five and three groups for the GE and Siemens scanners, respectively). Each group included ten men and ten women. The scan range was divided into four anatomical regions (trunk, proximal thigh, knee and distal leg), and DLP was calculated for each region (regional DLP). Regional DLP was multiplied by a conversion factor for the respective region, to convert it to ED. The sum of the ED values for the four regions was obtained as standard ED. Additionally, the sum of the four regional DLP values, an approximate of the scanner-derived DLP, was multiplied by the conversion factor for the trunk (0.015 mSv mGy cm-1), as a simplified method to obtain ED. When using the simplified method, ED was overestimated by 32.3%-70.2% and 56.5%-66.2% for the GE and Siemens scanners, respectively. The degree of overestimation was positively and closely correlated with the contribution of the middle and distal portions of the lower extremities to total radiation exposure. ED/DLP averaged within each group, corresponding to the conversion factor, was 0.0089-0.0114 and 0.0091-0.0096 mSv mGy cm-1for the GE and Siemens scanners, respectively. In CT venography of the lower extremities, ED is greatly overestimated by multiplying the scanner-derived DLP by the conversion factor for the trunk. The degree of overestimation varies widely depending on the imaging conditions. It is recommended to divide the scan range and calculate ED as a sum of regional ED values.
Collapse
Affiliation(s)
- Yusuke Inoue
- Department of Diagnostic Radiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Yuka Yonekura
- Department of Diagnostic Radiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Kazunori Nagahara
- Department of Radiology, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Ayuka Uehara
- Department of Radiology, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Hideki Ikuma
- Department of Radiology, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| |
Collapse
|
7
|
Faqihi F, Alharthy A, Abdulaziz S, Balhamar A, Alomari A, AlAseri Z, Tamim H, Alqahtani SA, Kutsogiannis DJ, Brindley PG, Karakitsos D, Memish ZA. Therapeutic plasma exchange in patients with life-threatening COVID-19: a randomised controlled clinical trial. Int J Antimicrob Agents 2021; 57:106334. [PMID: 33838224 PMCID: PMC8024223 DOI: 10.1016/j.ijantimicag.2021.106334] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/16/2021] [Accepted: 03/27/2021] [Indexed: 01/08/2023]
Abstract
Assessment of efficacy of therapeutic plasma exchange (TPE) following life-threatening COVID-19. This was an open-label, randomised clinical trial of ICU patients with life-threatening COVID-19 (positive RT-qPCR plus ARDS, sepsis, organ failure, hyperinflammation). Study was terminated after 87/120 patients enrolled. Standard treatment plus TPE (n = 43) versus standard treatment (n = 44), and stratified by PaO2/FiO2 ratio (>150 vs. ≤150), were compared. Primary outcomes were 35-day mortality and TPE safety. Secondary outcomes were association between TPE and mortality, improvement in SOFA score, change in inflammatory biomarkers, days on mechanical ventilation (MV), and ICU length of stay (LOS). Eighty-seven patients [median age 49 (IQR 34-63) years; 82.8% male] were randomised (44 standard care; 43 standard care plus TPE). Days on MV (P = 0.007) and ICU LOS (P = 0.02) were lower in the TPE group. 35-Day mortality was non-significantly lower in the TPE group (20.9% vs. 34.1%; Kaplan-Meier, P = 0.582). TPE was associated with increased lymphocytes and ADAMTS-13 activity and decreased serum lactate, lactate dehydrogenase, ferritin, d-dimers and interleukin-6. Multivariable regression analysis provided several predictors of 35-day mortality: PaO2/FiO2 ratio (HR, 0.98, 95% CI 0.96-1.00; P = 0.02]; ADAMTS-13 activity (HR, 0.89, 95% CI 0.82-0.98; P = 0.01); pulmonary embolism (HR, 3.57, 95% CI 1.43-8.92; P = 0.007). Post-hoc analysis revealed a significant reduction in SOFA score for TPE patients (P < 0.05). In critically-ill COVID-19 patients, addition of TPE to standard ICU therapy was associated with faster clinical recovery and no increased 35-day mortality.
Collapse
Affiliation(s)
- Fahad Faqihi
- Critical Care Department, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Abdulrahman Alharthy
- Critical Care Department, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Salman Abdulaziz
- Critical Care Department, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Balhamar
- Critical Care Department, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Awad Alomari
- Department of Critical Care, Dr Sulaiman Al-Habib Group Hospitals, Riyadh, Saudi Arabia
| | - Zohair AlAseri
- Departments of Emergency Medicine and Critical Care Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hani Tamim
- Biostatistics Unit, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Saleh A Alqahtani
- Division of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, MD, USA; Liver Transplant Center, and Biostatistics, Epidemiology, and Scientific Computing Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Demetrios J Kutsogiannis
- Department of Critical Care, Faculty of Medicine and Dentistry, the University of Alberta, Alberta, Canada
| | - Peter G Brindley
- Department of Critical Care, Faculty of Medicine and Dentistry, the University of Alberta, Alberta, Canada
| | - Dimitrios Karakitsos
- Critical Care Department, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia; Department of Internal Medicine, South Carolina University, School of Medicine, Columbia, SC, USA; Critical Care Department, Keck Medical School, University of Southern California, Los Angeles, CA, USA
| | - Ziad A Memish
- Research & Innovation Centre, King Saud Medical City, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| |
Collapse
|
8
|
Hopkins SR. Ventilation/Perfusion Relationships and Gas Exchange: Measurement Approaches. Compr Physiol 2020; 10:1155-1205. [PMID: 32941684 DOI: 10.1002/cphy.c180042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Ventilation-perfusion ( V ˙ A / Q ˙ ) matching, the regional matching of the flow of fresh gas to flow of deoxygenated capillary blood, is the most important mechanism affecting the efficiency of pulmonary gas exchange. This article discusses the measurement of V ˙ A / Q ˙ matching with three broad classes of techniques: (i) those based in gas exchange, such as the multiple inert gas elimination technique (MIGET); (ii) those derived from imaging techniques such as single-photon emission computed tomography (SPECT), positron emission tomography (PET), magnetic resonance imaging (MRI), computed tomography (CT), and electrical impedance tomography (EIT); and (iii) fluorescent and radiolabeled microspheres. The focus is on the physiological basis of these techniques that provide quantitative information for research purposes rather than qualitative measurements that are used clinically. The fundamental equations of pulmonary gas exchange are first reviewed to lay the foundation for the gas exchange techniques and some of the imaging applications. The physiological considerations for each of the techniques along with advantages and disadvantages are briefly discussed. © 2020 American Physiological Society. Compr Physiol 10:1155-1205, 2020.
Collapse
Affiliation(s)
- Susan R Hopkins
- Departments of Medicine and Radiology, University of California, San Diego, California, USA
| |
Collapse
|
9
|
Inoue Y, Itoh H, Nagahara K, Takahashi Y. ESTIMATION OF RADIATION DOSE IN CT VENOGRAPHY OF THE LOWER EXTREMITIES: PHANTOM EXPERIMENTS USING DIFFERENT AUTOMATIC EXPOSURE CONTROL SETTINGS AND SCAN RANGES. RADIATION PROTECTION DOSIMETRY 2020; 188:109-116. [PMID: 31822914 DOI: 10.1093/rpd/ncz265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We performed phantom experiments to assess radiation dose in computed tomography (CT) venography of the lower extremities. CT images of a whole-body phantom were acquired using different automatic exposure control settings and scan ranges, simulating CT venography. Tube current decreased in the lower extremities compared to the trunk. The scout direction and dose modulation strength affected tube current, dose length product (DLP) and effective dose. The middle and distal portions of the lower extremities contributed substantially to DLP but not to effective dose. When effective dose was estimated by multiplying DLP by a single conversion factor, overestimation was evident; this became more pronounced as the scan range narrowed. In CT venography of the lower extremities, the scout direction and modulation strength affect radiation dose. Use of DLP severely overestimates radiation dose and underestimates effects of scan range narrowing.
Collapse
Affiliation(s)
- Yusuke Inoue
- Department of Diagnostic Radiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Hiroyasu Itoh
- Department of Radiology, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Kazunori Nagahara
- Department of Radiology, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Yuka Takahashi
- Department of Radiology, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| |
Collapse
|
10
|
Prevalence and Risk Factors of Preoperative Deep Vein Thrombosis in Patients with End-Stage Knee Osteoarthritis. Ann Vasc Surg 2019; 64:175-180. [PMID: 31626936 DOI: 10.1016/j.avsg.2019.08.089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/11/2019] [Accepted: 08/20/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND The purpose of this study is to determine the prevalence and the risk factors of DVT in end-stage OA patients. METHODS From March 2015 to June 2017, 521 patients with knee degenerative osteoarthritis undergoing knee arthroplasty were enrolled; 458 patients (87.9%) were admitted for primary total knee arthroplasty and 63 patients (12.1%) were admitted for unicompartmental knee arthroplasty. Parameters were compared using χ2 or t-test for both the groups. Binary logistic regression analysis was used to determine risk factors. RESULTS The incidence of preoperative DVT was 6.7% (n = 35). Age in preoperative DVT group was significantly more than the non-DVT group (72.54 ± 6.53 vs. 68.65 ± 7.35, P = 0.002). Preoperative D-dimer >0.5 μg/mL (P < 0.001) was also associated with preoperative DVT in knee osteoarthritis patients. The incidence increased with age significantly (2.17% in <65 years, 6.86% in ≥65 <75 years, and 12.26% in ≥75 years) (P = 0.008). Thus, age (P = 0.041, OR 1.075, 95% CI [1.002-1.110]) and D-dimer >0.5 μg/mL (P < 0.001, OR 4.441, 95% CI [1.942-10.153]) were the independent risk factors for preoperative DVT in knee osteoarthritis patients. CONCLUSIONS The incidence of DVT in end-stage osteoarthritis was 6.7%. The results suggest that older people aged over 75 and D-dimer > 0.5 μg/mL were risk factors for DVT among patients admitted to the hospital for total knee arthroplasty. Instrumental screening should be encouraged, especially in subgroups at higher risk for preoperative DVT.
Collapse
|
11
|
Murphy A, Cheng J, Pratap J, Redman R, Coucher J. Dual-Energy Computed Tomography Pulmonary Angiography: Comparison of Vessel Enhancement between Linear Blended and Virtual Monoenergetic Reconstruction Techniques. J Med Imaging Radiat Sci 2019; 50:62-67. [PMID: 30777250 DOI: 10.1016/j.jmir.2018.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/18/2018] [Accepted: 10/18/2018] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Optimal opacification of the pulmonary vasculature is a fundamental factor of a diagnostic quality computed tomography pulmonary angiogram (CTPA). This retrospective study examined the feasibility of utilising a noise-optimised monoenergetic reconstruction of the dual-energy computed tomography pulmonary angiogram (DE-CTPA) as an additional protocol to increase vessel opacification. METHOD The study involved a retrospective analysis of 129 patients, 69 males (average age 58 years), 60 females (average age 56 years) who underwent a DE-CTPA at a tertiary referral hospital. Linear blended 120 kilovoltage (kV) images (LB120) dual-energy (DE) data sets (50% 100 kV and 50% 140 kV) were compared to noise-optimised virtual monoenergetic image reconstruction (VMI+) at 40 kiloelectron volts (VMI+40). The attenuation of the pulmonary trunk measured in Hounsfield units (HU) between the equivalent axial slices of the LB120 data set and the VMI+40 data set underwent statistical analysis via a Wilcoxon paired-sample test. RESULTS VMI+40 (1161.500 HU) yielded a statistically significant increase in median attenuation within the pulmonary trunk compared to the LB120 (304.400 HU), with a median difference between monoenergetic reconstruction and standard dual energy of data sets of 827.5 HU (P < .001). CONCLUSIONS VMI+40 of the DE-CTPA scan demonstrates a statistically significant increase in vessel attenuation in all cases and may have utility in reducing the rates of indeterminate or repeated studies.
Collapse
Affiliation(s)
- Andrew Murphy
- Department of Medical Imaging, British Columbia Children's Hospital, Vancouver, Canada; Department of Medical Imaging, St Paul's Hospital, Vancouver, Canada; Faculty of Health Sciences, The University of Sydney, Discipline of Medical Radiation Sciences, Cumberland Campus, Lidcombe, Australia.
| | - Jeffrey Cheng
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane, Australia
| | - Jit Pratap
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane, Australia
| | - Renae Redman
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane, Australia
| | - John Coucher
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane, Australia
| |
Collapse
|
12
|
Inoue H, Watanabe H, Okami H, Kimura A, Takeshita K. The Rate of Venous Thromboembolism Before and After Spine Surgery as Determined with Indirect Multidetector CT. JB JS Open Access 2018; 3:e0015. [PMID: 30533591 PMCID: PMC6242320 DOI: 10.2106/jbjs.oa.18.00015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This prospective cohort study investigated the rate of venous thromboembolism (VTE) before and after spine surgery as determined with use of indirect multidetector computed tomography (MDCT). METHODS We performed a prospective study of 105 patients (36 women and 69 men ranging in age from 38 to 88 years) undergoing spine surgery at 2 institutions. Indirect MDCT was performed before and 3 days after surgery. Patients with a history of dialysis or drug allergy to contrast medium were excluded. RESULTS No patient had symptomatic VTE preoperatively or postoperatively. The preoperative and postoperative rates of asymptomatic VTE were 4.8% and 13.0%, respectively; the rates of asymptomatic pulmonary embolism were 2.9% and 8.0%, respectively; and the rates of asymptomatic deep venous thrombosis were 3.8% and 6.0%, respectively. Age, sex, height, weight, body mass index, operative time, volume of intraoperative blood loss, and specific comorbidities (diabetes, hypertension, cardiac disease, previous VTE, and previous anticoagulation treatment) were not found to be risk factors. CONCLUSIONS Our findings demonstrated a low rate of preoperative VTE but a high rate of postoperative VTE in association with spine surgery. Surgeons need to be aware of the risk of VTE in patients undergoing spine surgery. MDCT is an effective and convenient technology for the early detection of VTE in such patients. LEVEL OF EVIDENCE Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Hirokazu Inoue
- Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Hideaki Watanabe
- Department of Pediatric Orthopaedic Surgery, Jichi Children's Medical Center, Shimotsuke, Tochigi, Japan
| | - Hitoshi Okami
- Department of Orthopaedic Surgery, Shinkaminokawa Hospital, Kaminokawa, Japan
| | - Atsushi Kimura
- Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke, Japan
| |
Collapse
|
13
|
Inoue H, Watanabe H, Okami H, Kimura A, Seichi A, Takeshita K. D-dimer predicts pulmonary embolism after low-risk spine surgery. Spine Surg Relat Res 2018; 2:113-120. [PMID: 31440656 PMCID: PMC6698502 DOI: 10.22603/ssrr.2017-0054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 09/03/2017] [Indexed: 11/05/2022] Open
Abstract
Introduction Pulmonary embolism (PE) is a risk of mortality following spine surgery. Many studies have demonstrated that deep venous thrombosis (DVT) may affect and actually advance to PE, but few studies have shown how venous thromboembolism (VTE), including PE and DVT, affect blood markers after spine surgery. In this study, we examined changes in blood markers with PE or DVT after low-risk spine surgery, namely cervical laminoplasty or lumbar laminectomy. Methods Seventy-two spine surgery patients were studied. A 16-row multidetector computed tomography was performed before and 3 d after the surgery. Patients with a history of cerebral vascular accident or arterial thrombotic episode or pre-surgical asymptomatic PE or DVT were excluded. Plasma levels of soluble fibrin monomer complex, D-dimer, plasminogen activator inhibitor type-1 (PAI-1), and white blood cell and platelet counts were measured preoperatively and postoperatively at days 1, 3, and 7. Results No patient developed symptomatic post-surgical VTE. Six patients with asymptomatic PE and six with asymptomatic DVT were detected post-surgery, including one patient with both. D-dimer postoperatively at days 3 and 7 was significantly higher in the post-op PE group than in the no-PE group. PAI-1 preoperatively was significantly higher in the DVT and VTE groups than in the no-DVT and no-VTE groups. Conclusions Elevated D-dimer at postoperative days 3 and 7 is a predictive factor for the early diagnosis of PE after spine surgery. Moreover, elevated PAI-1 preoperatively is a predictive factor for the early diagnosis of DVT and VTE. Consequently, PE may occur through a pathway other than DVT.
Collapse
Affiliation(s)
- Hirokazu Inoue
- Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Hideaki Watanabe
- Department of Pediatric Orthopaedic Surgery, Jichi Children's Medical Center, Shimotsuke, Japan
| | - Hitoshi Okami
- Department of Orthopaedic Surgery, Shinkaminokawa Hospital, Kaminokawa, Japan
| | - Atsushi Kimura
- Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Atsushi Seichi
- Department of Orthopaedic Surgery, Mitsuikinen Hospital, Tokyo, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke, Japan
| |
Collapse
|
14
|
Abstract
Acute chest pain is a leading cause of Emergency Department visits. Computed tomography angiography plays a vital diagnostic role in such cases, but there are several common challenges associated with the imaging of acute chest pain, which, if unrecognized, can lead to an inconclusive or incorrect diagnosis. These imaging challenges fall broadly into 3 categories: (1) image acquisition, (2) image interpretation (including physiological and pathologic mimics), and (3) result communication. The aims of this review are to describe and illustrate the most common challenges in the imaging of acute chest pain and to provide solutions that will facilitate accurate diagnosis of the causes of acute chest pain in the emergency setting.
Collapse
|
15
|
Fukuda I, Daitoku K. Surgical Embolectomy for Acute Pulmonary Thromboembolism. Ann Vasc Dis 2017; 10:107-114. [PMID: 29034035 PMCID: PMC5579785 DOI: 10.3400/avd.ra.17-00038] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 04/19/2017] [Indexed: 12/18/2022] Open
Abstract
Acute pulmonary thromboembolism is a catastrophic event, especially for hospitalized patients. The prognosis of pulmonary thromboembolism depends on the degree of pulmonary arterial occlusion. The mortality of massive pulmonary embolism is reportedly as high as 25% without cardiopulmonary arrest and 65% with cardiopulmonary arrest. In patients with unstable hemodynamics due to pulmonary thromboembolism, surgical pulmonary embolectomy is indicated for patients with a contraindication to thrombolysis, failed catheter therapy, or failed thrombolysis. Thrombolytic therapy adds an additional burden on patients who are at risk of potential hemorrhagic complications. It is also indicated if patients are already on a veno-arterial extra-corporate membrane oxygenator for circulatory collapse or cardiopulmonary arrest. The outcome for patients who require cardiopulmonary resuscitation for longer than 30 minutes is poor. Therefore, early triage for massive and sub-massive pulmonary embolism is crucial. A team approach including a cardiovascular surgeon may be effective to save critically ill patients. Prompt removal of emboli reduces the right ventricular load with quick recovery of cardiopulmonary function in the early postoperative period. A recent series reported excellent results, with in-hospital mortality of less than 10%. Surgical pulmonary embolectomy is an effective, safe, and easy procedure to save critical patients due to pulmonary thromboembolism.
Collapse
Affiliation(s)
- Ikuo Fukuda
- Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Kazuyuki Daitoku
- Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| |
Collapse
|
16
|
Meesa IR, Junewick J, Hoff A, Blumer A, Daro R, Linna N, McElliott M, Meeusen C, Beckmann R, Luttenton C. Incidence of pulmonary emboli on chest computed tomography angiography based upon referral patterns. Emerg Radiol 2016; 23:251-4. [PMID: 27026032 DOI: 10.1007/s10140-016-1391-4] [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: 02/05/2016] [Accepted: 03/18/2016] [Indexed: 11/24/2022]
Abstract
Pulmonary embolism (PE) is a potentially lethal condition, and the diagnosis of PE can be difficult. The purpose of this study is to evaluate the incidence of PE on chest computed tomography angiography (CTA) studies ordered in the inpatient, outpatient, and emergency department (ED) settings and further segregated based on the adult and pediatric populations, and by the ordering clinician (attending physicians, resident physicians, or physician extenders). A retrospective review of chest CTA examinations performed between July 1,2009 and June 30, 2010 was performed. Of 5848 adult CTA studies, PE was diagnosed in 594 (10.1 %). Of these positive studies, 315 (53 %) were inpatient, 234 (39.4 %) were ED patients, and 45 (7.6 %) were outpatient. Four hundred sixty-four of 4445 (10.4 %) CTA examinations ordered by attending physicians were positive for PE. Seventy-four of the 801 (9.2 %) CTA examinations ordered by resident physicians were positive for PE. Fifty-six of the 608 CTA examinations ordered by physician extenders were positive for PE. Thirty-three pediatric CTA studies for PE met criteria and none of them indicated PE. There is no significant difference in the incidence of PE in chest CTA based on setting or ordering clinician.
Collapse
Affiliation(s)
- Indu Rekha Meesa
- Summit Radiology, 5001 US Highway 30 W. Ste D, Fort Wayne, IN, 46818, USA.
| | - Joseph Junewick
- Helen DeVos and Spectrum Health Hospitals, Michigan State University, Division of Radiology and Biomedical Imaging, Advanced Radiology Services, PC, Grand Rapids, MI, USA
| | | | - Alyssa Blumer
- Helen Devos Childrens Hospital, Grand Rapids, MI, USA
| | - Ryan Daro
- University of Maryland Medical Center, Baltimore, MD, USA
| | - Nathaniel Linna
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | - Charles Luttenton
- Helen DeVos and Spectrum Health Hospitals, Michigan State University, Division of Radiology and Biomedical Imaging, Advanced Radiology Services, PC, Grand Rapids, MI, USA
| |
Collapse
|
17
|
Behzadi C, Groth M, Henes FO, Schwarz D, Deibele A, Begemann PGC, Adam G, Regier M. Intraindividual comparison of image quality using retrospective and prospective respiratory gating for the acquisition of thin sliced four dimensional multidetector CT of the thorax in a porcine model. Exp Lung Res 2015; 41:489-98. [DOI: 10.3109/01902148.2015.1083635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
18
|
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
|
19
|
Kim J, Azagury D, Eisenberg D, DeMaria E, Campos GM. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis 2015; 11:739-48. [DOI: 10.1016/j.soard.2015.05.001] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
20
|
Abstract
Pulmonary vascular diseases encompass a large and diverse group of underlying pathologies ranging from venous thromboembolism to congenital malformations to inflammatory vasculitides. As a result, patients can present either acutely with dyspnea and chest pain or chronically with dyspnea on exertion, hypoxia, and right heart failure. Imaging, particularly with multidetector CT, plays a key role in the evaluation and management of patients with suspected pulmonary vascular disease and, given the widespread routine use of high-quality CT pulmonary angiography, it is imperative that radiologists be familiar these pathologies.
Collapse
Affiliation(s)
- Kristopher W Cummings
- Cardiothoracic Radiology, Mayo Clinic Arizona, 5777 E. Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Sanjeev Bhalla
- Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis, 510 South Kingshighway Boulevard, Box 8131, St Louis, MO 63110, USA.
| |
Collapse
|
21
|
Palacio D, Benveniste MF, Betancourt-Cuellar SL, Gladish GW. Multidetector computed tomography pulmonary angiography pitfalls in the evaluation of pulmonary embolism with emphasis in technique. Semin Roentgenol 2015; 50:217-25. [PMID: 26002242 DOI: 10.1053/j.ro.2015.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Diana Palacio
- Department of Medical Imaging, The University of Arizona College of Medicine, Tucson, Arizona USA; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Marcelo F Benveniste
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Gregory W Gladish
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
22
|
Isma'eel H, Taher A, Alam S, Arnaout MS. Massive pulmonary embolism in a Lebanese patient doubly heterozygous for MTHFR and Factor V Leiden presenting with syncope and treated with tenecteplase. J Thromb Thrombolysis 2014; 21:179-84. [PMID: 16622615 DOI: 10.1007/s11239-006-4663-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Hussain Isma'eel
- American University of Beirut Medical Center, P.O. Box: 11- 0236/A19, Riad El Solh, 11072020, Beirut, Lebanon
| | | | | | | |
Collapse
|
23
|
Green O, Lempel J, Kolodziej A, Sandhu R, Castro-Pereira D, Wang Y, Lee R, Fine JM. Treatment of single peripheral pulmonary emboli: patient outcomes and factors associated with decision to treat. J Hosp Med 2014; 9:42-7. [PMID: 24339431 DOI: 10.1002/jhm.2128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 11/11/2013] [Accepted: 11/12/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Increasing use of computed tomography pulmonary angiography together with higher-resolution scanners has increased the detection of peripheral filling defects. Physicians face the dilemma of whether to treat patients with these findings, especially single defects. The aims of this study were to compare the outcomes of treated and untreated patients with single peripheral filling defects (SPFD) and identify factors associated with treatment. METHODS All cases with SPFDs over 66 months in a single institution were identified. Patient and treatment information were abstracted and data on 90-day mortality and postdischarge venous thromboembolism (VTE) were collected. RESULTS A total of 4906 computed tomography pulmonary angiograms were reviewed. A SPFD was identified in 3.1% (n = 153). Of the 153 patients, 134 met criteria for study inclusion. In 99 of 134 (73.9%) studies, the defect was called a pulmonary embolus (PE) by the initial radiologist. Treatment was administered to 61 of 134 (45.5%) patients; 5 patients died in each group. Postdischarge VTE occurred in 3 treated and 2 untreated patients. In 52 of 153 cases, an additional study was performed. None of the patients with normal ventilation perfusion scan and compression ultrasound received treatment. Immobility (odds ratio [OR]: 3.90, 95% confidence interval [CI]: 1.45-10.60), previous VTE (OR: 3.72, 95% CI: 1.18-11.70), and determination of PE by the radiologist (OR: 24.68, 95% CI: 5.40-112.90) were associated with treatment. CONCLUSIONS There was no difference in 90-day mortality or recurrence between treated and untreated patients. The most influential factor associated with treatment was the radiologist's interpretation. When secondary lung imaging studies were negative, no patient received treatment.
Collapse
Affiliation(s)
- O'Neil Green
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut; Department of Internal Medicine, Norwalk Hospital, Norwalk, Connecticut
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Parthasarathy S. CON: thoughtful steps informed by more comparative effectiveness research is needed in home testing. J Clin Sleep Med 2013; 9:9-12. [PMID: 23319898 PMCID: PMC3525996 DOI: 10.5664/jcsm.2326] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
25
|
Indirect Computed Tomography Venography of the Lower Extremities Using Single-Source Dual-Energy Computed Tomography: Advantage of Low-Kiloelectron Volt Monochromatic Images. J Vasc Interv Radiol 2012; 23:879-86. [DOI: 10.1016/j.jvir.2012.04.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Revised: 04/01/2012] [Accepted: 04/06/2012] [Indexed: 11/17/2022] Open
|
26
|
Rosenfeld HE, Tsokos M, Byard RW. The Association Between Body Mass Index and Pulmonary Thromboembolism in an Autopsy Population. J Forensic Sci 2012; 57:1336-8. [DOI: 10.1111/j.1556-4029.2012.02140.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
27
|
Watanabe H, Sekiya H, Kariya Y, Hoshino Y, Sugimoto H, Hayasaka S. The incidence of venous thromboembolism before and after total knee arthroplasty using 16-row multidetector computed tomography. J Arthroplasty 2011; 26:1488-93. [PMID: 21316910 DOI: 10.1016/j.arth.2011.01.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 01/04/2011] [Indexed: 02/01/2023] Open
Abstract
We performed a prospective study to determine the incidence of venous thromboembolism (VTE) using 16-row multidetector computed tomography (MDCT). The study included 71 patients who underwent total knee arthroplasty between September 2004 and March 2009. Multidetector computed tomography was performed 4 days before and after surgery. No patient had any presurgical symptoms of VTE. Presurgical and postsurgical incidences of pulmonary thromboembolism plus deep vein thrombosis were 0% and 13%, respectively; pulmonary thromboembolism alone, 1% and 3%, respectively; and deep vein thrombosis alone, 8% and 34%, respectively. Because asymptomatic VTE was noted in 9% of patients before surgery and 51% after surgery, we conclude that performing MDCT before and after total knee arthroplasty may be useful to clarify the incidence of VTE and to develop appropriate strategies for treatment and prevention.
Collapse
Affiliation(s)
- Hideaki Watanabe
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | | | | | | | | | | |
Collapse
|
28
|
|
29
|
Multimodality imaging of the peripheral venous system. Int J Biomed Imaging 2011; 2007:54616. [PMID: 18521181 PMCID: PMC1987337 DOI: 10.1155/2007/54616] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2006] [Accepted: 09/28/2006] [Indexed: 11/17/2022] Open
Abstract
The purpose of this article is to review the spectrum of
image-based diagnostic tools used in the investigation of suspected deep vein thrombosis (DVT). Summary of the experience gained by the author as well as relevant publications, regarding vein imaging modalities taken from a computerized database, was reviewed. The imaging modalities reviewed include phlebography, color Doppler duplex ultrasonography (CDDUS), computerized tomography angiography (CTA) and venography (CTV), magnetic resonance venography (MRV), and radionuclide venography (RNV).
CDDUS is recommended as the modality of choice for the diagnosis of DVT. A strategy combining clinical score and D-dimer test refines the selection of patients.
Phlebography is reserved for discrepant noninvasive studies.
Collapse
|
30
|
Intraindividual comparison of gadolinium- and iodine-enhanced 64-slice multidetector CT pulmonary angiography for the detection of pulmonary embolism in a porcine model. Emerg Radiol 2010; 18:189-95. [DOI: 10.1007/s10140-010-0926-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
|
31
|
Mamlouk MD, vanSonnenberg E, Gosalia R, Drachman D, Gridley D, Zamora JG, Casola G, Ornstein S. Pulmonary Embolism at CT Angiography: Implications for Appropriateness, Cost, and Radiation Exposure in 2003 Patients. Radiology 2010; 256:625-32. [DOI: 10.1148/radiol.10091624] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
32
|
Tatco VR, Piedad HH. The validity of hyperdense lumen sign in non-contrast chest CT scans in the detection of pulmonary thromboembolism. Int J Cardiovasc Imaging 2010; 27:433-40. [PMID: 20658266 DOI: 10.1007/s10554-010-9673-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 07/13/2010] [Indexed: 10/19/2022]
Abstract
It is possible to identify high-attenuation clots in pulmonary thromboembolism using non-contrast computed tomography (CT) of the chest. Such detection may be crucial for timely initiation of appropriate therapy. This study was undertaken to determine the validity of the hyperdense lumen (high-attenuation clot) sign in unenhanced chest CT in detecting pulmonary thromboembolism. Non-contrast and contrast-enhanced CT images of the chest of 121 patients who had undergone standard CT pulmonary angiography (pulmonary CTA) were reviewed separately. The absence or presence of luminal hyperdensities within the pulmonary arteries in the non-contrast images was determined. The average CT attenuation differences between the high attenuation clots and pulmonary arteries were computed. Findings in the non-contrast images were correlated with the contrast-enhanced images. Twenty-five patients were positive for pulmonary thromboembolism in the pulmonary CTAs. Of these 25 patients, nine were positive for the hyperdense lumen sign in the non-contrast CT images. The hyperdense lumen sign has an over-all sensitivity of 36.0%, specificity of 99.0%, PPV of 90.0%, and NPV of 85.6% (κ=0.449; P-value<0.001). In detecting central thromboembolism, the sensitivity, specificity, PPV, and NPV of this sign were 66.7, 99.1, 88.9, and 96.4%, respectively (κ=0.740; P-value<0.001). The sign was less sensitive in peripheral thromboembolism (κ=0.358; P-value<0.001). The mean (±SD) attenuation difference between the clot and pulmonary blood pool was 22.76 (±4.20) HU (P-value<0.001). The hyperdense lumen sign is a useful indicator of acute pulmonary thromboembolism in non-contrast chest CT scans particularly in cases involving the central pulmonary arteries.
Collapse
Affiliation(s)
- Vincent R Tatco
- Radiological Sciences Division, Philippine Heart Center, Quezon City, Philippines.
| | | |
Collapse
|
33
|
Henes FOG, Groth M, Regier M, Bley T, Nagel HD, Adam G, Begemann PGC. Prospective respiratory-triggered 64-slice CT pulmonary angiography for detection of pulmonary embolism--a feasibility study in a porcine model. Emerg Radiol 2010; 17:465-71. [PMID: 20607338 DOI: 10.1007/s10140-010-0887-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 06/16/2010] [Indexed: 10/19/2022]
Abstract
The objective of this study is to investigate the feasibility of prospectively respiratory-triggered CT pulmonary angiography (CTPA) for detection of pulmonary embolism (PE) in a porcine model. A free-breathing respiratory-triggered multislice CTPA (120 kV, 140 mAs(eff), 2.5-mm slice thickness) and two CTPA in breath-hold technique (120 kV, 140 mAs(eff.) and 250mAs(eff), 1-mm and 3-mm image reconstruction) were performed in six pigs with pulmonary embolism. Diagnostic accuracy was computed, and differences in detection rates between both techniques were assessed on a per-embolus basis with the Wilcoxon test. Thin-sliced 1-mm images, acquired with 250mAs(eff), served as the standard of reference. Respiratory-triggered CTPA reached high diagnostic accuracy in detection of lobar and segmental PE equal to the results with the breath-hold technique (p > 0.05). For detection of subsegmental emboli, standard breath-hold techniques performed significantly better than respiratory-gated CTPA (sensitivity, 68.3% versus 24.4%; p < 0.05). Free-breathing respiratory-triggered CTPA is feasible for detection of lobar and segmental PE, with diagnostic accuracy equivalent to that of a standard CTPA in breath-hold. Although this technique is not recommended for assessment of emboli in the subsegmental vasculature, prospective respiratory-triggered CTPA may be of added value in patients who cannot hold their breath appropriately for CTPA scanning.
Collapse
Affiliation(s)
- Frank Oliver G Henes
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | | | | | | | | | | | | |
Collapse
|
34
|
|
35
|
A United Kingdom based survey of clinical practice in the diagnosis of suspected pulmonary embolism. Nucl Med Commun 2010; 31:112-20. [PMID: 19898262 DOI: 10.1097/mnm.0b013e3283304a29] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
36
|
|
37
|
Ultralow contrast medium doses at CT to diagnose pulmonary embolism in patients with moderate to severe renal impairment: a feasibility study. Eur Radiol 2009; 20:1321-30. [DOI: 10.1007/s00330-009-1691-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 10/21/2009] [Accepted: 10/22/2009] [Indexed: 12/21/2022]
|
38
|
Thoracic causes of acute abdominal pain. Eur Radiol 2009; 20:1414-23. [PMID: 20016901 DOI: 10.1007/s00330-009-1687-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Revised: 10/05/2009] [Accepted: 10/29/2009] [Indexed: 10/20/2022]
Abstract
The origin of abdominal pain may be extra-abdominal, caused by a thoracic illness. This article illustrates the various thoracic disorders that may present with acute abdominal pain. An erroneous focus on the abdomen alone can easily lead to misdiagnosis and incorrect treatment. In cases of unexplained acute abdominal pain, radiologists should be aware of also viewing beyond the borders of the abdomen. The key to most of these thoracic diagnoses is detection of pulmonary consolidation, pleural fluid or pericardial fluid.
Collapse
|
39
|
Interobserver Agreement Between On-Call Radiology Residents and Radiology Specialists in the Diagnosis of Pulmonary Embolism using Computed Tomography Pulmonary Angiography. J Comput Assist Tomogr 2009; 33:952-5. [DOI: 10.1097/rct.0b013e3181a2f7fa] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
40
|
Radiation Dose for Body CT Protocols: Variability of Scanners at One Institution. AJR Am J Roentgenol 2009; 193:1141-7. [PMID: 19770340 DOI: 10.2214/ajr.09.2330] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
41
|
Hoey ETD, Gopalan D, Agrawal SKB, Screaton NJ. Cardiac causes of pulmonary arterial hypertension: assessment with multidetector CT. Eur Radiol 2009; 19:2557-68. [DOI: 10.1007/s00330-009-1460-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 03/19/2009] [Accepted: 04/27/2009] [Indexed: 11/29/2022]
|
42
|
Yavas US, Calisir C, Ozkan IR. The interobserver agreement between residents and experienced radiologists for detecting pulmonary embolism and DVT with using CT pulmonary angiography and indirect CT venography. Korean J Radiol 2009; 9:498-502. [PMID: 19039265 PMCID: PMC2627244 DOI: 10.3348/kjr.2008.9.6.498] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective We wanted to prospectively evaluate the interobserver agreement between radiology residents and expert radiologists for interpreting CT images for making the diagnosis of pulmonary embolism (PE). Materials and Methods We assessed 112 consecutive patients, from April 2007 to August 2007, who were referred for combined CT pulmonary angiography and indirect CT venography for clinically suspected acute PE. CT scanning was performed with a 64×0.5 collimation multi-detector CT scanner. The CT studies were initially interpreted by the radiology residents alone and then the CT images were subsequently interpreted by a consensus of the resident plus an experienced general radiologist and an experienced chest radiologist. Results Two of the 112 CTs were unable to be interpreted (1.7%). Pulmonary artery clots were seen on 36 of the thoracic CT angiographies (32%). The interobserver agreement between the radiology residents and the consensus interpretation was good (a kappa index of 0.73). All of the disagreements (15 cases) were instances of overcall by the resident on the initial interpretation. Deep venous thrombosis was detected in 72% (26 of 36) of the patients who had PE seen on thoracic CT. The initial and consensus interpretations of the CT venography images disagreed for two cases (kappa statistic: 0.96). Conclusion It does not seem adequate to base the final long-term treatment of PE on only the resident's reading, as false positives occurred in 13% of such cases. Timely interpretation of the CT pulmonary angiography and CT venography images should be performed by experienced radiologists for the patients with suspected PE.
Collapse
Affiliation(s)
- Ulas Savas Yavas
- Department of Radiology, Eskisehir Osmangazi University, Medical Faculty, Eskisehir, Turkey
| | | | | |
Collapse
|
43
|
Abstract
OBJECTIVE The objective of the study was to compare two scoring methods to predict the risk of pulmonary embolism (PE) as diagnosed with computed tomography angiography (CTA) and/or CT venography (CTV). METHODS Prospectively over a 8-month period, emergency department patients and hospital inpatients with suspected PE were consecutively examined and their Wells and Revised Geneva scores calculated to stratify them into a risk group for PE probability. Then all patients were examined with CTA and CTV to determine the presence or absence of PE, as diagnosed by experienced radiology staff physicians. RESULTS During the study period, 167 patients were suspected of having a PE and were interviewed for the calculation of their Wells and Revised Geneva scores. All patients underwent CTA or CTV, but the images of only 148 patients were adequate enough to make a certain diagnosis regarding PE. The data of these 148 patients were used for the study. The rates of PE in high, moderate, and low PE risk groups determined according to the Wells score and the Revised Geneva score were 89.6, 26.4, 7.8 and 83.3, 25.6, 0%, respectively. Among both inpatients and ED patients the area under the Wells score receiver operating characteristic curve was higher (P=0.04). When data from only ED patients were analyzed (104 patients) the scoring systems was not significantly different (P=0.07). CONCLUSION The Wells rule seems to be more accurate among both inpatients and emergency department patients. The Revised Geneva score can be used in emergency department patients with high reliability.
Collapse
|
44
|
Cronin P, Weg JG, Kazerooni EA. The role of multidetector computed tomography angiography for the diagnosis of pulmonary embolism. Semin Nucl Med 2009; 38:418-31. [PMID: 19331836 DOI: 10.1053/j.semnuclmed.2008.07.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
From a radiological point of view, computed tomography pulmonary angiography (CTPA) has effectively become the de-facto first-line imaging test for the evaluation of pulmonary embolism (PE), as patients with a high-quality negative CTPA do not require further examination or treatment for suspected PE. We are likely to see further technical developments in CT technology in the near future. These advances will most likely further improve image quality. Several questions or issues remain, including strategies for further imaging when CT is inconclusive or contraindicated, issues regarding radiation exposure, the prevalence of PE in specific populations, best tests and pathways in specific patient groups, including patients with specific comorbidities such as oncology patients or patients with chronic obstructive pulmonary disease. Also, the question whether all PE patients need anticoagulation, the clinical effect of follow-up imaging, and the accuracy of different clinical prediction rules, remains.
Collapse
Affiliation(s)
- Paul Cronin
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan Medical Center, Ann Arbor, MI 48109-5030, USA.
| | | | | |
Collapse
|
45
|
ASMBS guideline on the prevention and detection of gastrointestinal leak after gastric bypass including the role of imaging and surgical exploration. Surg Obes Relat Dis 2009; 5:293-6. [PMID: 19356997 DOI: 10.1016/j.soard.2009.02.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Accepted: 02/04/2009] [Indexed: 12/22/2022]
Abstract
The following position statement is issued by the American Society for Metabolic and Bariatric Surgery in response to numerous inquiries made to the Society by patients, physicians, society members, hospitals, health insurance payors, the media, and others, regarding the complication of gastrointestinal leak after gastrointestinal bariatric procedures. In this statement, available data regarding leak are summarized and suggestions made regarding reasonable approaches to the prevention and postoperative detection based on current knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The intent of issuing such a statement is to provide objective information about the complication of leak. The statement is not intended as, and should not be construed as, stating or establishing a local, regional, or national standard of care. The statement will be revised in the future as additional evidence becomes available.
Collapse
|
46
|
Evaluation of pulmonary embolism in a pediatric population with high clinical suspicion. Pediatr Radiol 2009; 39:35-41. [PMID: 19005649 DOI: 10.1007/s00247-008-1037-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2007] [Revised: 09/03/2008] [Accepted: 09/22/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pulmonary embolism (PE) is an underdiagnosed entity in the pediatric population in part because of the low level of suspicion and awareness in the clinical world. OBJECTIVE To examine its relative prevalence, associated risk factors and imaging features in our pediatric population. MATERIALS AND METHODS A total of 92 patients age 21 years and younger with a high clinical suspicion of PE and who had available radiographic studies were identified from January 2003 to September 2006. Patients with a positive CT scan or a high probability ventilation/perfusion scan formed the case group; patients with a high clinical suspicion of PE and no radiographic evidence of PE or deep venous thrombosis (DVT), randomly matched in age and sex, became the matched control group. We reviewed the charts of both groups and analyzed the imaging studies. RESULTS In our hospital, the prevalence of PE in patients with a strong suspicion of PE was 14%. The overall prevalence of thromboembolic disease (PE and/or DVT) was 25%. Recent surgery or orthopedic procedure, blood dyscrasias and contraceptive use were more common in patients with PE. No child died of PE in our study. The youngest child with PE in our study was 13 years. Girls were twice as likely to develop PE as boys. CONCLUSION PE is a relatively common diagnosis in our tertiary care pediatric population when the clinical suspicion is high. We suggest increased awareness and index of suspicion in order to initiate prompt diagnostic imaging and treatment.
Collapse
|
47
|
MDCT of 220 consecutive patients with suspected acute pulmonary embolism: incidence of pulmonary embolism and of other acute or non-acute thoracic findings. Radiol Med 2008; 113:373-84. [PMID: 18493774 DOI: 10.1007/s11547-008-0262-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE This study was undertaken to evaluate the incidence of pulmonary embolism (PE) and other clinically relevant thoracic findings discovered on contrast-enhanced multidetector computed tomography (MDCT) examination in patients with a suspicion of acute PE. MATERIALS AND METHODS We retrospectively reviewed 220 reports of 40-row MDCT exams in consecutive patients (101 men, 119 women; mean age 55 years+/-18) suspected for acute PE. Presenting symptoms and risk factors were recorded. Image quality and incidence of PE and other clinically relevant thoracic findings were evaluated. RESULTS MDCT were diagnostic in 96.8% of patients. Nineteen patients (8.6%) were positive for PE. Signs and symptoms were present in 82.7% (182) and risk factors in 38.2% (84) of the population. Clinically relevant thoracic findings were detected in 45.9% (101) of the patients. Ten patients had PE and other thoracic findings. Half of the patients (110) had neither PE nor other clinically relevant thoracic findings. CONCLUSIONS Chest MDCT, with an excellent overall image quality, provided an explanation for the clinical presentation in about 50% of emergency department patients studied and was useful in detecting PE and other thoracic diseases with symptoms mimicking PE. However, half of the exams were negative.
Collapse
|
48
|
CT angiography in suspected pulmonary embolism: impact of patient characteristics and different venous lines on vessel enhancement and image quality. AJR Am J Roentgenol 2008; 190:W351-9. [PMID: 18492877 DOI: 10.2214/ajr.07.3402] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of our study was to compare image quality, patient characteristics, and different catheters in pulmonary CT angiography (CTA) performed with bolus tracking and z-axis automated tube current modulation (ATCM) in patients with suspected pulmonary embolism. SUBJECTS AND METHODS One hundred twenty-six patients were referred to undergo pulmonary CTA with bolus tracking and ATCM. Besides patient characteristics, the type, position, size, and side of venous catheters were documented. 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. RESULTS Patient age showed a moderate but significant positive correlation to vessel enhancement (r = 0.244, p = 0.006), CNR (r = 0.178, p = 0.046), and subjective image quality (r = 0.344, p < 0.001). Patient weight revealed a significant negative correlation to vessel enhancement (r = -0.496, p < 0.001), SNR (r = -0.446, p < 0.001), CNR (r = -0.425, p < 0.001), and subjective image quality (r = -0.422, p < 0.001). In univariate analysis, SNR and CNR were significantly higher in patients who received contrast medium through peripheral catheters (30 +/- 13 and 27 +/- 13, respectively) than in those in whom central catheters were used (22 +/- 8 and 19 +/- 7, p = 0.041 and p = 0.029, respectively). Neither patient sex nor catheter size, position, or side had any significant impact on image quality. CONCLUSION Patient age and weight showed significant impact on vascular attenuation and image quality in pulmonary CTA with bolus tracking and ATCM, whereas patient sex and different peripheral catheters did not significantly influence image parameters.
Collapse
|
49
|
Herrero HG, Asensio SG, Asensio MTMB, de Toledo LSO, Cabrejas RC, Morales AF. [Indirect CT venography in patients with clinical suspicion of pulmonary thromboembolism: our experience and possible indications for the test]. RADIOLOGIA 2008; 50:147-52. [PMID: 18367065 DOI: 10.1016/s0033-8338(08)71948-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Our objective was to evaluate the sensitivity of indirect computed tomography (CT) venography in the evaluation of deep vein thrombosis and to establish possible general indications for this technique in cases with clinical suspicion of thromboembolic disease. MATERIAL AND METHODS We studied 76 patients with clinical suspicion of pulmonary thromboembolism who underwent CT angiography of the pulmonary arteries and indirect CT venography. We correlated the results with those of ultrasound examination of the limbs in 63 cases to determine the sensitivity of the test. We analyzed the cases in which the findings at indirect CT venography changed the management of the patient. RESULTS The concordance between indirect CT venography and ultrasound was 92%. Thromboembolic disease was diagnosed in 40% of the cases. In these cases, CT angiography of the pulmonary arteries was positive in 80% and in the remaining 20% only CT venography was positive. In two cases, abdominal pathology that changed the clinical management of the patients was found. CONCLUSIONS Indirect CT venography is sensitive in the detection of deep vein thrombosis in patients with clinical suspicion of pulmonary thromboembolism. This technique can shorten the time to diagnosis, increase diagnostic precision, and provide additional clinical data that may be important in the patient's management. However, its generalized use is limited because it involves the use of ionizing radiation.
Collapse
Affiliation(s)
- H Gómez Herrero
- Servicio de Radiología, Hospital Reina Sofía, Tudela, Navarra, España.
| | | | | | | | | | | |
Collapse
|
50
|
Salvolini L, Scaglione M, Giuseppetti GM, Giovagnoni A. Suspected pulmonary embolism and deep venous thrombosis: A comprehensive MDCT diagnosis in the acute clinical setting. Eur J Radiol 2008; 65:340-9. [DOI: 10.1016/j.ejrad.2007.09.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 09/07/2007] [Accepted: 09/08/2007] [Indexed: 11/25/2022]
|