Dual-Energy CT for Pulmonary Embolism: Current and Evolving Clinical Applications

Hong, Yoo Jin; Shim, Jina; Lee, Sang Min; Im, Dong Jin; Hur, Jin

doi:10.3348/kjr.2020.1512

Cited by 25 publications

(23 citation statements)

References 89 publications

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“…Dual-energy CT (DECT) is a promising tool providing both anatomical information and material properties. An iodine map from DECT shows added value over CTPA in the diagnosis of PE [1]. In CT with suboptimal enhancement, monoenergetic image reconstruction can improve the diagnostic accuracy of PE by increasing vascular attenuation and the contrast-to-noise ratio [2].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Pulmonary Embolism in Unenhanced Dual Energy CT Using an Electron Density Image

Bae

Jeon

2021

Diagnostics

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Dual-energy computed tomography (CT) is a promising tool, providing both anatomical information and material properties. Using spectral information such as iodine mapping and virtual monoenergetic reconstruction, dual-energy CT showed added value over pulmonary CT angiography in the diagnosis of pulmonary embolism. However, the role of non-contrast-enhanced dual energy CT in pulmonary embolism has never been reported. Here, we report a case of acute pulmonary embolism detected on an electron density image from an unenhanced dual-energy CT using a dual-layer detector system.

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Section: Introductionmentioning

confidence: 99%

Diagnosis of Pulmonary Embolism in Unenhanced Dual Energy CT Using an Electron Density Image

Bae

Jeon

2021

Diagnostics

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“…The introduction of dual-energy CT (DECT) has allowed radiologists to generate functional images as well as traditional anatomic images. 11 12 With the recent advent of the DECT technique, the ability to obtain color-coded iodine perfusion map of the lung may allow us to evaluate perfusion changes in the lungs and further supports the role of pulmonary CTPA ( Figs. 3 and 4 ).…”

Section: Imaging Of Acute and Chronic Pe And Deep Vein Thrombosis (Dvt)mentioning

confidence: 90%

“… 13 14 15 16 Hong et al 11 pieced together the diagnostic values of DECT for the detection of acute and chronic PE and the results are as follows: sensitivity and specificity for acute PE range from 60% to 90% and 88% to 99%, respectively, for acute PE; and those for chronic PE range from 96% to 100% and 76% to 96%, respectively, for chronic PE, when using SPECT or scintigraphy as a reference standard. It is also interesting that in terms of radiation dose, according to the same summary from Hong et al, 11 DECT does not add radiation dose, when compared with conventional CT. It has been reported in prior study that DECT is associated with higher radiation exposure than single-energy CT. 17 …”

Section: Imaging Of Acute and Chronic Pe And Deep Vein Thrombosis (Dvt)mentioning

confidence: 99%

Acute Pulmonary Embolism and Chronic Thromboembolic Pulmonary Hypertension: Clinical and Serial CT Pulmonary Angiographic Features

Nam

Cho

et al. 2022

J Korean Med Sci

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In acute pulmonary embolism (PE), circulatory failure and systemic hypotension are important clinically for predicting poor prognosis. While pulmonary artery (PA) clot loads can be an indicator of the severity of current episode of PE or treatment effectiveness, they may not be used directly as an indicator of right ventricular (RV) failure or patient death. In other words, pulmonary vascular resistance or patient prognosis may not be determined only with mechanical obstruction of PAs and their branches by intravascular clot loads on computed tomography pulmonary angiography (CTPA), but determined also with vasoactive amines, reflex PA vasoconstriction, and systemic arterial hypoxemia occurring during acute PE. Large RV diameter with RV/left ventricle (LV) ratio > 1.0 and/or the presence of occlusive clot and pulmonary infarction on initial CTPA, and clinically determined high baseline PA pressure and RV dysfunction are independent predictors of oncoming chronic thromboembolic pulmonary hypertension (CTEPH). In this pictorial review, authors aimed to demonstrate clinical and serial CTPA features in patients with acute massive and submassive PE and to disclose acute CTPA and clinical features that are related to the prediction of oncoming CTEPH.

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Section: Introductionmentioning

confidence: 99%

“…Pulmonary embolism (PE) is defined as an occlusion of the pulmonary arteries by thromboembolic material [ 1 , 2 , 3 , 4 , 5 , 6 ]. It is a potentially life-threatening condition which frequently results in death [ 1 , 2 , 3 , 4 , 5 , 6 ]. PE contributes to one of the most common in-hospital complications, causing widespread morbidity and mortality [ 1 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of Photon Counting Detector CT Derived Virtual Monoenergetic Images on the Diagnosis of Pulmonary Embolism

et al. 2022

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Purpose: To assess the impact of virtual-monoenergetic-image (VMI) energies on the diagnosis of pulmonary embolism (PE) in photon-counting-detector computed-tomography (PCD-CT). Methods: Eighty patients (median age 60.4 years) with suspected PE were retrospectively included. Scans were performed on PCD-CT in the multi-energy mode at 120 kV. VMIs from 40–70 keV in 10 keV intervals were reconstructed. CT-attenuation was measured in the pulmonary trunk and the main branches of the pulmonary artery. Signal-to-noise (SNR) ratio was calculated. Two radiologists evaluated subjective-image-quality (noise, vessel-attenuation and sharpness; five-point-Likert-scale, non-diagnostic–excellent), the presence of hardening artefacts and presence/visibility of PE. Results: Signal was highest at the lowest evaluated VMI (40 keV; 1053.50 HU); image noise was lowest at the highest VMI (70 keV; 15.60 HU). Highest SNR was achieved at the lowest VMI (p < 0.05). Inter-reader-agreement for subjective analysis was fair to excellent (k = 0.373–1.000; p < 0.001). Scores for vessel-attenuation and sharpness were highest at 40 keV (both:5, range 4/3–5; k = 1.000); scores for image-noise were highest at 70 keV (4, range 3–5). The highest number of hardening artifacts were reported at 40 keV (n = 22; 28%). PE-visualization was rated best at 50 keV (4.7; range 4–5) and decreased with increasing VMI-energy (r = −0.558; p < 0.001). Conclusions: While SNR was best at 40 keV, subjective PE visibility was rated highest at 50 keV, potentially owing to the lower image noise and hardening artefacts.

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Dual-Energy CT for Pulmonary Embolism: Current and Evolving Clinical Applications

Cited by 25 publications

References 89 publications

Diagnosis of Pulmonary Embolism in Unenhanced Dual Energy CT Using an Electron Density Image

Diagnosis of Pulmonary Embolism in Unenhanced Dual Energy CT Using an Electron Density Image

Acute Pulmonary Embolism and Chronic Thromboembolic Pulmonary Hypertension: Clinical and Serial CT Pulmonary Angiographic Features

Impact of Photon Counting Detector CT Derived Virtual Monoenergetic Images on the Diagnosis of Pulmonary Embolism

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