Clinical utility of ultra high pitch dual source thoracic CT imaging of acute pulmonary embolism in the emergency department: Are we one step closer towards a non-gated triple rule out?

Hou, Daniel J.; Tso, David K.; Davison, Chris; Inácio, J.; Louis, Luck J.; Nicolaou, Savvas; Reimann, Anja

doi:10.1016/j.ejrad.2013.05.003

Cited by 41 publications

(28 citation statements)

References 19 publications

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“…Only one examination from a total of 106 evaluated in this study was deemed to be diagnostically suboptimal for the detection and exclusion of acute PE. The authors believe that the high rates of successful contrast opacification of the pulmonary arterial tree and relative absence of respiratory and other motion artifacts is related to the use of a dual source, high pitch, technique in both SV and RV protocols which substantially reduces scan time and almost fully eradicates motion artifact in CTPA [8], free breathing thoracic CT [22] and in coronary CTA examinations in patients with a heart rate of less than 55bpm [23].…”

Section: Discussionmentioning

confidence: 99%

“…Dual source CT systems now allow CTPA to be acquired using ultra high pitch values of up to 3.2, scan time is substantially reduced and temporal resolution is in the order of 75ms. Ultra high pitch CTPA has been shown to result in motion free evaluation of most cardiac structures including the proximal coronary arteries and thereby expands the range of alternate diagnoses to acute cardiac pathologies [8].…”

Section: Introductionmentioning

confidence: 99%

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High pitch, low voltage dual source CT pulmonary angiography: assessment of image quality and diagnostic acceptability with hybrid iterative reconstruction

et al. 2014

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Increased use of CT Pulmonary angiography in suspected pulmonary embolism (PE) has driven research to minimize radiation dose while maintaining image quality and diagnostic accuracy. Following institutional review board approval, we performed a retrospective comparison study in patients with suspected PE. Patients were scanned using an ultra high pitch dual source technique (pitch=2.6) using 120 kV (SVCTPA) (n=54) or 100 kV (RV-CTPA) (n=52). SV-CTPA images were reconstructed using filtered back projection (SV-wFBP) and RV-CTPA images were reconstructed using both FBP (RV-wFBP) and Iterative Reconstruction (RV-IR). Comparison of radiation dose, diagnostic ability, subjective image noise, quality, and sharpness, diagnostic agreement, signal to noise (SNR) and contrast to noise ratios (CNR) were performed. Mean effective dose was 2.56± 0.19 mSv for the RV protocol compared to 5.36±0.60 mSv for the SV. The RV-CTPA protocol resulted in a mean DLP reduction of 52 % and mean CTDI reduction of 51 %. Pulmonary artery SNR and CNR were significantly higher on RV-IR images than SV-wFBP (p=0.007, p=0.003). Mean subjective image noise, quality and sharpness scores did not differ significantly between the SV-wFBP and RVIR images (p>0.05). Subjective quality scores were significantly better for the RV-IR group compared to the RV-wFBP group (p<0.001). Agreement between readers for presence or absence of pulmonary emboli on RV-IR images was almost perfect (κ=0.891, p<0.001). Iterative reconstruction complements ultra high pitch dual source CTPA examinations acquired using a reduced voltage resulting in higher mean pulmonary artery SNR and CNR when compared to both RVwFBP and SV-CTPA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High pitch, low voltage dual source CT pulmonary angiography: assessment of image quality and diagnostic acceptability with hybrid iterative reconstruction

et al. 2014

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“…Employing high-pitch acquisition is another radiation dose reduction strategy in CTPA that is available on newer dualsource CT systems [74]. Again, the high-pitch acquisition technique is typically limited to normal-weight and mildly overweight individuals.…”

Section: Reduced Radiation Dose Strategiesmentioning

confidence: 99%

“…This is because X-ray tubes have technical limits in the tube current they can provide, and may not allow the emission of sufficient photons during the very short acquisition time of high-pitch protocols to achieve good image quality in obese patients. Compared with a standard-pitch protocol, Hou et al [74] showed that a 47 % radiation dose reduction can be achieved with high-pitch CTPA. In addition to reducing radiation dose, high-pitch image acquisition also improves temporal resolution, making it possible to image patients unable to complete a sufficient breath hold, reducing motion artefacts, and improving diagnostic evaluation of cardiovascular structures [75].…”

Section: Reduced Radiation Dose Strategiesmentioning

confidence: 99%

Computed tomography of acute pulmonary embolism: state-of-the-art

Zhang

Meinel

et al. 2015

Eur Radiol

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Multidetector computed tomography (CT) plays an important role in the detection, risk stratification and prognosis evaluation of acute pulmonary embolism. This review will discuss the technical improvements for imaging peripheral pulmonary arteries, the methods of assessing pulmonary embolism severity based on CT findings, a multidetector CT technique for pulmonary embolism detection, and lastly, how to avoid overutilization of CT pulmonary angiography and overdiagnosis of pulmonary embolism. Key Points • We describe clinical prediction rules and D-dimers for pulmonary embolism evaluation. • Overutilization of CT pulmonary angiography and overdiagnosis of pulmonary embolism should be avoided. • We discuss technical improvements for imaging peripheral pulmonary arteries. • Pulmonary embolism severity can be assessed based on CT findings. • We discuss multidetector CT techniques for pulmonary embolism detection.

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“…Presence of coronary artery disease (CAD) has been reported in initial diagnosis and follow-up of patients with aortic dissection and aortic aneurysm (1)(2)(3)(4) and it has also been reported to affect mortality after surgical repair (5). Furthermore, triple-rule-out CT has been widely used to evaluate the cause of acute chest pain such as aortic disease, pulmonary thromboembolism, and coronary artery disease (6,7). Even though the heart is included in triple-rule-out CT, additional electrocardiogram (ECG)-gated, coronary CT is needed for the evaluation of CAD to minimize cardiac motion artifact.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Coronary Artery in High-Pitch, Dual-Source CT Aortography Without ECG Synchronization

et al. 2017

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Clinical utility of ultra high pitch dual source thoracic CT imaging of acute pulmonary embolism in the emergency department: Are we one step closer towards a non-gated triple rule out?

Cited by 41 publications

References 19 publications

High pitch, low voltage dual source CT pulmonary angiography: assessment of image quality and diagnostic acceptability with hybrid iterative reconstruction

High pitch, low voltage dual source CT pulmonary angiography: assessment of image quality and diagnostic acceptability with hybrid iterative reconstruction

Computed tomography of acute pulmonary embolism: state-of-the-art

Assessment of the Coronary Artery in High-Pitch, Dual-Source CT Aortography Without ECG Synchronization

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