Diagnosing Acute Pulmonary Embolism With Computed Tomography

Devaraj, Anand; Sayer, Charlie; Sheard, Sarah; Grubnic, Sisa; Nair, Arjun; Vlahos, Ioannis

doi:10.1097/rti.0000000000000146

Cited by 27 publications

(21 citation statements)

References 15 publications

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“…contrast enhancement of the pulmonary arteries, and subjective image quality is more closely related to vessel enhancement than to noise. 9,36,41 There is a statistically significant negative correlation reported between mean/peak vessel enhancement and patient size. 41,42 Lowering the kVp can increase HU in the pulmonary arteries, making them appear brighter, because the attenuation of the beam increases as the beam energy reaches the k-edge of iodine.…”

Section: Challenges Of Imaging In Obesitymentioning

confidence: 94%

“…PE was identified in 22.6% of CTPAs in the PIOPED II study, but its incidence has been around 14-18%, and as low as 9%, in more recent studies. [35][36][37][38] The accuracy of CTPA in overweight and obese patients is generally good (Figure 1). Some studies have shown no difference in subjective image quality, diagnostic confidence, or diagnostic accuracy between obese and non-obese patients.…”

Section: Challenges Of Imaging In Obesitymentioning

confidence: 95%

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Imaging of suspected pulmonary embolism and deep venous thrombosis in obese patients

Cascio

Hon

Haramati

et al. 2018

BJR

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Obesity is a growing problem around the world, and radiology departments frequently encounter difficulties related to large patient size. Diagnosis and management of suspected venous thromboembolism, in particular deep venous thrombosis (DVT) and pulmonary embolism (PE), are challenging even in some lean patients, and can become even more complicated in the setting of obesity. Many obstacles must be overcome to obtain imaging examinations in obese patients with suspected PE and/or DVT, and to ensure that these examinations are of sufficient quality to diagnose or exclude thromboembolic disease, or to establish an alternative diagnosis. Equipment limitations and technical issues both need to be acknowledged and addressed. Table weight limits and scanner sizes that readily accommodate obese and even morbidly obese patients are not in place at many clinical sites. There are also issues with image quality, which can be substantially compromised. We discuss current understanding of the effects of patient size on imaging in general and, more specifically, on the imaging modalities used for the diagnosis and treatment of DVT and PE. Emphasis will be placed on the technical parameters and protocol nuances, including contrast dosing, which are necessary to refine and optimize images for the diagnosis of DVT and PE in obese patients, while remaining cognizant of radiation exposure. More research is necessary to develop consistent high-level evidence regarding protocols to guide radiologists, and to help them effectively utilize emerging technology.

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Section: Challenges Of Imaging In Obesitymentioning

confidence: 94%

Section: Challenges Of Imaging In Obesitymentioning

confidence: 95%

Imaging of suspected pulmonary embolism and deep venous thrombosis in obese patients

Cascio

Hon

Haramati

et al. 2018

BJR

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“…Computed tomography pulmonary angiography (CTPA) is increasingly used in the diagnosis of patients with suspected pulmonary embolism (PE) due to its high sensitivity and specificity for detecting segmental and subsegmental PE (1)(2)(3)(4)(5). However, the high radiation dose associated with the increased use of CTPA examinations has raised concerns leading to the paradigm shift of developing optimal CTPA protocols to lower radiation dose while still achieving diagnostic images.…”

Section: Introductionmentioning

confidence: 99%

Patient-specific 3D printed pulmonary artery model with simulation of peripheral pulmonary embolism for developing optimal computed tomography pulmonary angiography protocols

Aldosari¹,

Jansen²,

Sun³

2019

Quant. Imaging Med. Surg

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Background: Computed tomography pulmonary angiography (CTPA) is the preferred imaging modality for diagnosis of patients with suspected pulmonary embolism (PE). Radiation dose associated with CTPA has been significantly reduced due to the use of dose-reduction strategies, however, investigation of low-dose CTPA with use of different kVp and pitch values has not been systematically studied. The aim of this study was to utilize a 3D printed pulmonary model with simulation of small thrombus in the pulmonary arteries for development of optimal CTPA protocols. Methods: Animal blood clots were inserted into the pulmonary arteries to simulate peripheral embolism based on a realistic 3D printed pulmonary artery model. The 3D printed model was scanned with 192-slice 3 rd generation dual-source CT with 1 mm slice thickness and 0.5 mm reconstruction interval. All images were reconstructed with advanced modelled iterative reconstruction (IR) at a strength level of 3. CTPA scanning parameters were as follows: 70, 80, 100 and 120 kVp, 0.9, 2.2 and 3.2 pitch values. Quantitative assessment of image quality was determined by measuring signal-to-noise ratio (SNR) in both main pulmonary arteries, while qualitative analysis of images was scored by two experienced radiologists (score of 1 indicates poor visualization of thrombus with no confidence, and score of 5 excellent visualization of thrombus with high confidence) to determine the image quality in relation to different scanning protocols for detection of thrombus in the pulmonary arteries. Results: No significant differences were found in SNR measurements among all CTPA protocols (P>0.05), regardless of kVp or pitch values used, although SNR was higher with 120 kVp and 0.9 and 2.2 pitch protocols than that in other protocols. The thrombi were detected in all images, with 70 kVp and 3.2 pitch protocol scored the lowest with a score of 3 by two observers, and images with other protocols were scored 4 or 5. Lowering kVp from 120 to 70 with use of high-pitch 2.2 or 3.2 protocol resulted in up to 80% dose reduction without significantly affecting image quality. Conclusions: Low-dose CT pulmonary angiography protocols comprising 70 kVp and high pitch 2.2 or 3.2 allow for detection of peripheral PE with significant reduction in radiation dose while images are still considered diagnostic.

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“…In another CT study, it was also documented that coronary atherosclerosis was not uncommon in asymptomatic SSc patients [58] . Finally, CT scan is the technique of choice for assessment of pulmonary embolism and pulmonary hypertension secondary due to recurrent pulmonary emboli [59] .…”

Section: Single-photon Emission Computed Tomographymentioning

confidence: 99%

“How many times must a man look up before he can really see the sky?” Rheumatic cardiovascular disease in the era of multimodality imaging

Mavrogeni

Markousis‐Mavrogenis

Heutemann

et al. 2015

WJM

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Cardiovascular involvement in rheumatic diseases (RD) is the result of various pathophysiologic mechanisms including inflammation, accelerated atherosclerosis, myocardial ischemia, due to micro-or macro-vascular lesions and fibrosis. Noninvasive cardiovascular imaging, including echocardiography, nuclear techniques, cardiovascular computed tomography and cardiovascular magnetic resonance, represents the main diagnostic tool for early, non-invasive diagnosis of heart disease in RD. However, in the era of multimodality imaging and financial crisis there is an imperative need for rational use of imaging techniques in order to obtain the maximum benefit at the lowest possible cost for the health insurance system. The oligo-asymptomatic cardiovascular presentation and the high cardiovascular mortality of RD necessitate a reliable and reproducible diagnostic approach to catch early cardiovascular involvement. Echocardiography remains the routine cornerstone of cardiovascular evaluation. However, a normal echocardiogram can not always exclude cardiac involvement and/or identify heart disease acuity and pathophysiology. Therefore, cardiovascular magnetic resonance is a necessary adjunct complementary to echocardiography, especially in new onset heart failure and when there are conflicting data from clinical, electrocardiographic and echocardiographic evaluation of RD patients.

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Diagnosing Acute Pulmonary Embolism With Computed Tomography

Cited by 27 publications

References 15 publications

Imaging of suspected pulmonary embolism and deep venous thrombosis in obese patients

Imaging of suspected pulmonary embolism and deep venous thrombosis in obese patients

Patient-specific 3D printed pulmonary artery model with simulation of peripheral pulmonary embolism for developing optimal computed tomography pulmonary angiography protocols

“How many times must a man look up before he can really see the sky?” Rheumatic cardiovascular disease in the era of multimodality imaging

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