Acute central thromboembolic disease: posttherapeutic follow-up with spiral CT angiography.

Rémy-Jardin, M.; Louvegny, S; Rémy, Jacques; Artaud, D; Deschildre, F; Bauchart, Jean-Jacques; Théry, C; Duhamel, Alain

doi:10.1148/radiology.203.1.9122389

Cited by 97 publications

(49 citation statements)

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“…5 However, it was reported that in some patients after APE, residual perfusion defects could be detected by control lung scintygraphy or spiral computer tomography even in spite of adequate long-term treatment. 10,11 Moreover, recent studies have shown that in some patients with APE symptomatic pulmonary hypertension might persist or develop despite treatment. This evolution was reported more frequently in patients with more marked signs of RV overload found at the time of diagnosis of APE.…”

Section: Discussionmentioning

confidence: 99%

Long‐term effects of acute pulmonary embolism on echocardiographic doppler indices and functional capacity

Ciurzyński

Kurzyna²,

Bochowicz

et al. 2004

Clinical Cardiology

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SummaryBackground and hypothesis: Hemodynamic and functional consequences of acute pulmonary embolism (APE) are believed to be reversible with antithrombotic treatment. To verify this hypothesis, we reassessed our patients at least 1 year after an episode of APE.Methods: We compared echo Doppler indices and 6-min walking test parameters (6-MWT) of 36 patients (13 men, 23 women, age 66 ± 11 years), studied on average 3.1 ± 2.2 years after an acute episode of pharmacologically treated massive or submassive APE, with data of 30 age-matched subjects (12 men, 18 women, age 67 ± 12 years).Results: At least 1 year after APE, right ventricular (RV) diameter remained increased in patients compared with controls (27 ± 2 vs. 23 ± 2 mm, p < 0.001). Also, acceleration time of pulmonary ejection (AcT) was markedly shorter (97 ± 19 vs. 123 ± 19 ms, p < 0.001) and the diameter of the pulmonary trunk was significantly larger in patients than in controls (21 ± 2.6 vs. 18 ± 2.2, p < 0.001). Although the mean value of the tricuspid valve peak systolic gradient (TVPG) in the APE group at follow-up was similar to that in controls, TVPG > 30 mmHg was recorded in three patients with APE (8.3%). There was no difference in the distance of 6-MWT between both groups; however, the mean desaturation after 6-MWT was higher in the APE group than in controls (3.04 ± 2.08 vs. 1.45 ± 0.69%, p = 0.0005).

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Section: Discussionmentioning

confidence: 99%

Long‐term effects of acute pulmonary embolism on echocardiographic doppler indices and functional capacity

Ciurzyński

Kurzyna²,

Bochowicz

et al. 2004

Clinical Cardiology

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“…Spiral CT is feasible even for critically ill or intubated patients, and spiral CT is now the first imaging method of choice at the author9s institution for intensive care patients with suspected PE. In addition, spiral CT can be useful for monitoring patients who undergo thrombolytic therapy [42,43]. In these patients, CT allows the visualization of embolic material without the need for a central venous puncture.…”

Section: Limitations Of Spiral Computed Tomography Angiographymentioning

confidence: 99%

Spiral computed tomography of pulmonary embolism

Herold¹

2002

Eur Respir J

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Spiral computed tomography of pulmonary embolism. C.J. Herold. #ERS Journals Ltd 2002. ABSTRACT: Within the last several years, spiral computed tomography angiography (SCTA) of the pulmonary arteries has emerged as a noninvasive angiographic modality for the evaluation of patients with suspected pulmonary embolism (PE). SCTA is based on continuous computed tomography (CT) data acquisition during patient transport through the rotating X-ray tube and detector system, where scanning is performed in the time period in which the injected contrast material passes through the pulmonary arteries. Single detector spiral CT has a sensitivity of y85-90% and a specificity between 88-95%. Sensitivity and specificity are very likely to increase with the use of multidetector spiral CT scanners that allow scanning of large lung volumes with a scan collimation as narrow as 1 mm.Currently, SCTA is most commonly used as a primary imaging method in patients with suspected PE, and as a second-line method in cases with inconclusive ventilation/ perfusion scintigraphy results. SCTA has proven to be cost-effective, especially in combination with ultrasound of the lower extremities.Limitations of the method include a decreased sensitivity for the detection of small isolated clots in the peripheral pulmonary arterial bed, and a potentially reduced image quality in patients with coexistent cardiopulmonary disorders.Despite these limitations, several studies have now documented that, in patients with suspected pulmonary embolism, it is safe to withhold anticoagulation therapy if a spiral computed tomography exam of the pulmonary arteries is negative and no lower extremity venous thrombosis is present. In the future, multislice computed tomography scanning of the pulmonary arteries with multiplanar reformation and one-stop shopping, i.e. scanning of the pulmonary arteries and the lower extremity veins in a single session, will further enhance the role of computed tomography angiography in the examination of patients with suspected pulmonary embolism. Pulmonary embolism (PE) is often encountered both in the hospital setting and in private clinical practice. Because untreated PE is associated with a greatly increased mortality risk, accurate diagnosis of PE is of critical importance [1,2]. However, because clinical findings, laboratory tests, and signs and symptoms at physical examination are often nonspecific, imaging methods are a significant part of the diagnostic evaluation of patients with suspected PE.Since PE is not an isolated disorder but, rather, a symptom of the entire venous thromboembolism complex, imaging studies of the lower extremities and the pelvis, the most common source of pulmonary emboli, are a fundamental requirement for the diagnostic work-up of patients with suspected PE. Various imaging modalities have been attempted in this evaluation process within the last few decades. For many years, ventilation/perfusion (V/Q) scintigraphy has served as the noninvasive procedure of choice for the assessment of patients with susp...

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“…DVT seyri sırasında % 30 mortaliteye sahip PTE gelişebilir. Bazı çalışmalarda V/P sintigrafisi ve pulmoner anjiyografi değerlen-dirilmesi sonucunda %40-60 sessiz (asemptomatik) PTE rapor edilmiştir [5][6][7]. Bizim yaptığımız çalış-mada da 25 DVT hastasının 10 tanesinde MDBT anjiyografi ile asemptomatik PTE tespit edildi ve bu oran %40 olarak bulundu.…”

Section: Discussionunclassified

“…Görüntüler tecrübeli bir radyolog tarafınca değerlendirilerek ana, lober, segmental ve subsegmental pulmoner emboli varlığı araştırıldı. Değer-lendirmeler yapılırken Remy-Jardin ve arkadaşları-nın kullandığı modifite kriterler kullanıldı [5]. Bu kriterlere göre; 1. santral ya da marjinal, düzgün ya da düzensiz sınırlı, çevresinden kontrast geçişi gösteren intraluminal hipodens dolum defekti, 2. arter lümenini dolduran, çevresinde kontrast geçişi göstermeyen hipodens dolum defekti, 3. arter duvarında izlenen hipodens mural defekt, 4. arter içinde uzanan, akımla yer değiştirebilen intravasküler dolum defekti PTE olarak kabul edildi.…”

Section: Yöntemlerunclassified

Comparison of ventilation/perfusion scintigraphy and multi-detector computerized tomography in diagnosis of asymptomatic pulmonary embolism after deep vein thrombosis

Yücedağ¹

2014

Diclemedj

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Objective: Pulmonary thromboembolism (PTE) named due to migration of clots formed in systemic venous system to pulmonary vascular bed is a serious clinical table. After acute DVT, asymptomatic PTE is seen about 40-60% and this situation can not be discovered because of silent clinical course. In this study, we aimed to compare sensivity and spesifity of multi detector computerized tomography (MDCT), which is used extensively in recent years, with ventilation-perfusion (V/P) scintigraphy which is used formerly for diagnosis of asymptomatic PTE developed after acute lower extremity DVT. Methods:The study was carried out 25 patients who were admitted to our clinic and treated for lower extremity acute DVT. Pregnants, and cases with recurrent DVT, presence of symptomatic PTE during admission, thrombosis extending to vena cava, and history of passed PTE were excluded from the study. DVTs in patients were diagnosed by color doppler, and confirmed by D-dimer test. After patients's admission, V/P scintigraphy and MDCT were used to detects asymptomatic PTE at 1 st and 8 th day of the admission.Results: D-dimer was measured as higher in 24 of 25 patients with asymptomatic PTE. Ten patients were diagnosed by MDCT. Development of asymptomatic PTE related to acute DVT was determined as 40%. Conclusion:In terms of diagnostic value, MDCT was found more useful than V/P scintigraphy.Key words: Pulmonary, embolism, scintigraphy, tomography ÖZET Amaç: Pulmoner tromboemboli (PTE) sistemik venöz sistemde oluşan pıhtıların pulmoner vasküler yatağa göçü ile ortaya çıkan klinik tabloya verilen isimdir. Akut derin ven trombozu (DVT) sonrası ortalama %40-60 oranında asemptomatik PTE görülmekte ve bu durum sessiz klinik seyir nedeniyle fark edilmemektedir. Bu çalışmamızda akut alt ekstremite DVT'sine bağlı gelişen asemptomatik PTE tanısında hala günümüzde önemli bir yer tutan ventilasyon-perfüzyon (V/P) sintigrafisi ile son yıllarda kullanılmaya başlanan multi-detektor bilgisayarlı tomografinin (MDBT) sensitivite ve spesifitesini karşılaştırmayı amaçladık.Yöntemler: Çalışma alt ekstremite akut DVT nedeniyle kliniğimize yatırılarak tedavisi planlanan 25 hastada gerçekleştirildi. Gebeler, nüks DVT vakaları, müracaat esnasında semptomatik PTE tablosu olanlar, vena kavaya uzanım gösteren trombüsü olanlar, önceden geçirilmiş PTE öyküsü olanlar çalışmaya dahil edilmedi. Hastalarda DVT tanısı renkli doppler USG ile konulup, D-dimer testiyle teyit edildi. Hastalara yatışının 1.ve 8. günlerinde V/P sintigrafisi ve MDBT yapılarak asemptomatik PTE varlığı araştırıldı. Bulgular:Pulmoner tromboemboli açısından asemptomatik olan 25 DVT hastasının 24'ünde D-dimer normalin üstünde ölçüldü. MDBT ile 10 hastaya PTE tanısı konuldu. Akut DVT'ye bağlı %40 oranında asemptomatik PTE geliştiği tespit edildi.Sonuç: Multi-detektor bilgisayarlı tomografi tanı değeri açısından V/P sintigrafisinden daha faydalı bulundu.

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Acute central thromboembolic disease: posttherapeutic follow-up with spiral CT angiography.

Abstract: Spiral CT enabled noninvasive detection of unresolved PE and of newly developed chronic PE.

Cited by 97 publications

References 0 publications

Long‐term effects of acute pulmonary embolism on echocardiographic doppler indices and functional capacity

Long‐term effects of acute pulmonary embolism on echocardiographic doppler indices and functional capacity

Spiral computed tomography of pulmonary embolism

Comparison of ventilation/perfusion scintigraphy and multi-detector computerized tomography in diagnosis of asymptomatic pulmonary embolism after deep vein thrombosis

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