Combined CT venography and pulmonary angiography: a new diagnostic technique for suspected thromboembolic disease.

Loud, Peter A.; Grossman, Zachary D.; Klippenstein, Donald; Ray, Charles E.

doi:10.2214/ajr.170.4.9530042

Cited by 140 publications

(56 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…13,14,16 If CT is used as the primary imaging test for suspected PE, the feasibility of combining CT angiography of the pulmonary arteries with CT venography of the deep venous system for a comprehensive evaluation for venous thromboembolism has been demonstrated. 17,18 Finally, echocardiography is not recommended as a routine imaging test to diagnose suspected acute PE. Instead, echo- cardiography is most useful for risk stratification and prognostication after the diagnosis of PE has been established.…”

mentioning

confidence: 99%

Spiral Computed Tomography for Acute Pulmonary Embolism

2004

View full text Add to dashboard Cite

There is still considerable debate about the optimal diagnostic imaging modality for acute pulmonary embolism. If imaging is deemed necessary from an initial clinical evaluation such as D-dimer testing, options include nuclear medicine scanning, catheter pulmonary angiography, and spiral CT. In many institutions, spiral CT is becoming established as the first-line imaging test in daily clinical practice. With spiral CT, thrombus is directly visualized, and both mediastinal and parenchymal structures are evaluated, which may provide important alternative or additional diagnoses. However, limitations for the accurate diagnosis of small peripheral emboli, with a reported miss rate of up to 30% with single-slice spiral CT so far, have prevented the unanimous embrace of spiral CT as the new standard of reference for imaging pulmonary embolism. The clinical significance of the detection and treatment of isolated peripheral pulmonary emboli is uncertain. Evidence is accumulating that it is safe practice to withhold anticoagulation in patients with suspected pulmonary embolism on the basis of a negative spiral CT study. Remaining concerns about the accuracy of spiral CT for pulmonary embolism detection may be overcome by the introduction of multidetector-row spiral CT. This widely available technology has improved visualization of peripheral pulmonary arteries and detection of small emboli. The most recent generation of multidetector-row spiral CT scanners appears to outperform competing imaging modalities for the accurate detection of central and peripheral pulmonary embolism. In this review, we assess the current role and future potential of CT in the diagnostic algorithm of acute pulmonary embolism.

show abstract

mentioning

confidence: 99%

Spiral Computed Tomography for Acute Pulmonary Embolism

2004

View full text Add to dashboard Cite

show abstract

“…The so-called "combined CTA-indirect CTV" technique in which use of pulmonary CTA is coupled with indirect CTV to screen leg veins, is the most commonly used method for this purpose (7,(18)(19). Novadays this investigation can be rapidly performed by means of MDCT whose use is ever becoming more common.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Pulmonary Embolism By 64-Detector MDCT Combined with Doppler Ultrasonography and Indirect CTV of The Leg: A Different Protocol

Nayman¹,

Ödev

2013

ELECTRON J GEN MED

View full text Add to dashboard Cite

The aim of our study was to investigate the contribution of CT angiography in cases with a presumptive PTE diagnosis, evaluating lower extremity veins with CT venography and color Doppler ultrasonography (CDU) Erlangen, Germany). Before the procedure a vascular access was attained on antecubital vein with a 18-20 G catheter. Patients were appropriately positioned to be able to examine lower extremities as well. 100 mL nonionic contrast medium was infused by means of an automated injector at a rate of 4 mL/second from the antecubital vein. Sections were started to be taken just after contrast density reached 180 HU at pulmonary truncus. Twently mililiter and 40 mL isotonic saline were injected via automatic injector before and after contrast medium injection, respectively. The patients were asked to hold their breath during the examination. Investigation was performed at supine position with hands over head levvel to preclude artefacts. CT imaging parameters from the level of diaphragm to the lung apex: 100 kv, 135 mAs, 64X0,6 colimation, pitch value 0.9 and start delay 5 seconds. Then reconstruction images were created as 1 and 5 mm section thicknesses. Vascular structures were evaluated from the images with 1 mm section thickness. Pulmonary paranchymal structures were evaluated from images with 5 mm section thickness. Indirect CTV was performed as to range from iliac crests to the level of femoral heads and from popliteal fossa up to 10 cm proximal of it. This procedure was started 3 minutes after contrast administration and extra contrast was not used for indirect CTV. CTV images were acquired at cranio-caudal direction with the following imaging parameters: 120 kv, 100 mAs, 64x0.6 colimation, section interval 0.8 mm and section thickness 2 mm. Pulmonay CTA and CTV images were evaluated in terms of PTE and DVT, respectively. Whether venous opacification degree is optimal was checked via density measurement in the main femoral vein. Whereas the minimum and maximum values measured from main femoral vein were 75 and 140 Hounsfield Units (HU), respectively, the mean value was determined as 95 HU. In 3 patients, values <70 HU was measured, hence these patients were excluded due to insufficient contrast density. After CTA procedure in patients who were referred with symptoms suggestive of pulmonary embolism such as shortness of breath, chest pain and hemopthysis CT images were evaluated rapidly within 1-2 minutes.

show abstract

“…Over the past 20 years, the diagnostic strategies for PE have been marked by an excessive number of sequential tests, long workup periods and the frequent need for invasive procedures 10 . The introduction of pulmonary CTA 11 and subsequently lower extremities CTV 12 has presented the possibility of overcoming most of the above limitations of older diagnostic strategies. The current study confirms the significant incremental diagnostic value of CTV, which can be used in place of CUS, and the clinical utility of CTA/CTV for safely ruling out the diagnosis of PE as a sole diagnostic test.…”

Section: Discussionmentioning

confidence: 99%