Complications and validity of pulmonary angiography in acute pulmonary embolism.

Stein, P D; Athanasoulis, Christos A.; Alavi, Abass; Greenspan, Richard H.; Hales, Charles A.; Saltzman, Herbert A.; Vreim, Carol E.; Terrin, Michael L.; Weg, John G.

doi:10.1161/01.cir.85.2.462

Cited by 644 publications

(291 citation statements)

References 21 publications

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“…However, subsegmental pulmonary emboli are more diYcult to visualise in this setting, with both the test sensitivity and specificity decreasing from 94% 8 to a sensitivity of 63% and a specificity of 89% in the detection of peripheral thrombi. 9 In a small study, 10 these subsegmental emboli seemed to be less clinically relevant, although larger studies need to be instituted to confirm these preliminary findings.…”

Section: Clinical Diagnosismentioning

confidence: 98%

D-Dimer testing: the role of the clinical laboratory in the diagnosis of pulmonary embolism

Mavromatis¹,

Kessler²

2001

Journal of Clinical Pathology

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Pulmonary embolism is a common, yet often unsuspected and unrecognised disease associated with a high mortality. New, objective, "user friendly" and cost eVective diagnostic strategies are being explored. D-Dimers, the fibrinolytic degradation products of crosslinked fibrin, have emerged as the most useful of the procoagulant activity and ongoing fibrinolysis markers. D-Dimer measurements are very sensitive in excluding a diagnosis of pulmonary embolism in the setting of normal values, a low clinical suspicion, and nondiagnostic lung scans. Several assays have been developed and are reviewed. (J Clin Pathol 2001;54:664-668)

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Section: Clinical Diagnosismentioning

confidence: 98%

D-Dimer testing: the role of the clinical laboratory in the diagnosis of pulmonary embolism

Mavromatis¹,

Kessler²

2001

Journal of Clinical Pathology

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“…6 PE was diagnosed by pulmonary angiography when there was at least one intravascular filling defect in a pulmonary artery using a standard protocol. 7 …”

Section: Spiral Computed Tomography Ventilation Perfusion Scan and mentioning

confidence: 99%

Incremental prognostic value of troponin I and echocardiography in patients with acute pulmonary embolism

Kucher¹,

Wallmann²,

Carone³

2004

ACC Current Journal Review

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Background To test the hypothesis that troponin I and echocardiography have an incremental prognostic value in patients with pulmonary embolism (PE). Methods and resultsIn 91 patients with acute PE, echocardiography was performed within 4 h of admission. Troponin I levels were obtained on admission and 12 h thereafter. The 0.06 µg/l troponin I cut-off level was identified as the most useful, high-sensitivity cut-off level for the prediction of adverse outcome by receiver operating characteristic analysis with a sensitivity and specificity of 86%, respectively. Twenty-eight (31%) patients had elevated troponin I levels (4.9±3.8 µg/l). Twenty-one (23%) patients had adverse clinical outcomes including in-hospital death in five, cardiopulmonary resuscitation in four, mechanical ventilation in six, pressors in 14, thrombolysis in 14, catheter fragmentation in three, and surgical embolectomy in three. The area under the receiver operating characteristic curve from multivariate regression models for predicting adverse outcome without troponin I and echocardiography (0.765), with troponin I (0.890) or echocardiography alone (0.858), and the combination of both tests (0.900) was incremental. Three-month survival rate was highest in patients with both a normal troponin I level and a normal echocardiogram (98%). Positive predictive value for adverse clinical outcomes of the combination of echocardiography and troponin I was higher (75% (95%CI 55-88%)) compared with each test alone (echocardiography: 41%, 95% CI 28-56%; troponin I: 64%, 95% CI 46-79%). Conclusions While troponin I measurements added most of the prognostic information for identifying high-risk patients, a normal echocardiogram combined with a negative troponin I level was most useful to identify patients at lowest risk for early death.

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“…X-ray pulmonary angiography is the accepted gold standard for diagnosing PE. Still, this test is invasive, with 0.5% mortality (12); in addition, interobserver agreement is only 66% for subsegmental emboli (13). Alternatively, the initial diagnosis of PE is often done using planar ventilation-perfusion (V/Q) scanning.…”

Section: Discussionmentioning

confidence: 99%

Indirect detection of lung perfusion using susceptibility‐based hyperpolarized gas imaging

Dimitrov

Insko

Rizi

et al. 2005

Magnetic Resonance Imaging

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Purpose:To address the problem of inadequate signal-tonoise ratio (SNR) encountered in lung perfusion magnetic resonance imaging (MRI) by developing an indirect detection based on the strong hyperpolarized (HP) gas signal. Materials and Methods:Our model is based on detecting the effects of gadolinium (Gd) flowing through lung capillaries by recording the phase of the nearby alveolar HP gas. In a HP gas 3 He phantom we imaged gas phases before and after removing tubes containing paramagnetic solution away from the phantom. We also imaged HP gas phases in pig lungs before and after injection of Gd. Finally, parenchymal spin phase in excised lungs was measured as a function of Gd concentration. Results:In the phantom, the differential phase map displayed a pattern characteristic of a susceptibility-induced dipole field, showing the possibility of an indirect detection. In vivo, the differential phase map showed homogeneous appearance, as expected for uniform perfusion in healthy lungs. Ex vivo, the parenchymal spin phases were shown to depend linearly on Gd concentration. Conclusion:Our method should allow indirect perfusion (Q) and direct ventilation (V) to be assessed simultaneously, thus allowing for diagnosis of V/Q mismatches. The linear dependency of parenchymal spin phase vs. Gd concentration may allow for quantification of lung perfusion.

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Complications and validity of pulmonary angiography in acute pulmonary embolism.

Cited by 644 publications

References 21 publications

D-Dimer testing: the role of the clinical laboratory in the diagnosis of pulmonary embolism

D-Dimer testing: the role of the clinical laboratory in the diagnosis of pulmonary embolism

Incremental prognostic value of troponin I and echocardiography in patients with acute pulmonary embolism

Indirect detection of lung perfusion using susceptibility‐based hyperpolarized gas imaging

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