Dual-energy CT performance in acute pulmonary embolism: a meta-analysis

Monti, Caterina Beatrice; Zanardo, Moreno; Cozzi, Andrea; Schiaffino, Simone; Spagnolo, Pietro; Secchi, Francesco; Cecco, Carlo N. De; Sardanelli, Francesco

doi:10.1007/s00330-020-07633-8

Cited by 23 publications

(20 citation statements)

References 38 publications

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“…A sufficiently high contrast opacification of the pulmonary arteries is a prerequisite of CTPA to allow for a safe diagnosis or exclusion of pulmonary embolism [ 12 , 25 ]. To reach an adequate contrast in the pulmonary arteries, several factors, including the contrast media administration protocol and the CT scanning technique as well as patient-related factors, have to be taken into account [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Computed tomography pulmonary angiography (CTPA), owing to its high sensitivity and specificity as well as wide availability, represents the imaging modality of choice for the diagnosis or exclusion of pulmonary embolism [ 5 , 11 , 12 ]. The scan initiation of CTPA is usually performed with the bolus tracking technique which enables an individualized optimization of the scan start in relation to the contrast arrival in the pulmonary artery circulation [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis of acute heart failure in CT pulmonary angiography: feasibility and accuracy

et al. 2022

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Objectives To evaluate the feasibility and accuracy of diagnosing acute heart failure (HF) with CT pulmonary angiography (CTPA) in emergency department patients. Methods In this retrospective single-center study, we evaluated 150 emergency department patients (mean age 65 ± 17 years) undergoing CTPA with a fixed scan (100 kVp) and contrast media protocol (60 mL, 4 mL/s) who had no pulmonary embolism (PE). Patients were subdivided into training cohort (n = 100) and test cohort (n = 50). Three independent, blinded readers measured the attenuation in the right ventricle (RV) and left ventricle (LV) on axial images. The ratio (HUratio) and difference (HUdiff) between RV and LV attenuation were calculated. Diagnosis of acute HF was made on the basis of clinical, laboratory, and echocardiography data. Optimal thresholds, sensitivity, and specificity were calculated using the area under the curve (AUC) from receiver operating characteristics analysis. Results Fifty-nine of the 150 patients (40%) were diagnosed with acute HF. Attenuation measurements showed an almost perfect interobserver agreement (intraclass correlation coefficient: 0.986, 95%CI: 0.980–0.991). NT-pro BNP exhibited moderate correlations with HUratio (r = 0.50, p < 0.001) and HUdiff (r = 0.50, p < 0.001). In the training cohort, HUratio (AUC: 0.89, 95%CI: 0.82–0.95) and HUdiff (AUC: 0.88, 95%CI: 0.81–0.95) showed a very good performance to diagnose HF. Optimal cutoff values were 1.42 for HUratio (sensitivity 93%; specificity 75%) and 113 for HUdiff (sensitivity 93%; specificity 73%). Applying these thresholds to the test cohort yielded a sensitivity of 89% and 89% and a specificity of 69% and 63% for HUratio and HUdiff, respectively. Conclusion In emergency department patients undergoing CTPA and showing no PE, both HUratio and HUdiff have a high sensitivity for diagnosing acute HF. Key Points • Heart failure is a common differential diagnosis in patients undergoing CT pulmonary angiography. • In emergency department patients undergoing CT pulmonary angiography and showing no pulmonary embolism, attenuation differences of the left and right ventricle have a high sensitivity for diagnosing acute heart failure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnosis of acute heart failure in CT pulmonary angiography: feasibility and accuracy

et al. 2022

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“…Several studies showed a positive correlation between perfusion defects, signs of RVD, and PA obstruction [52][53][54]. On the other hand, according to Monti et al, DECT did not yield additional diagnostic benefits in the detection of patients with APE compared to single CT energy [55].…”

Section: Dual Energy Ctmentioning

confidence: 94%

Acute Pulmonary Embolism: Prognostic Role of Computed Tomography Pulmonary Angiography (CTPA)

et al. 2022

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Computed Tomography Pulmonary Angiography (CTPA) is considered the gold standard diagnostic technique in patients with suspected acute pulmonary embolism in emergency departments. Several studies have been conducted on the predictive value of CTPA on the outcomes of pulmonary embolism (PE). The purpose of this article is to provide an updated review of the literature reporting imaging parameters and quantitative CT scores to predict the severity of PE.

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“…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 ].…”

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 performance in acute pulmonary embolism: a meta-analysis

Cited by 23 publications

References 38 publications

Diagnosis of acute heart failure in CT pulmonary angiography: feasibility and accuracy

Diagnosis of acute heart failure in CT pulmonary angiography: feasibility and accuracy

Acute Pulmonary Embolism: Prognostic Role of Computed Tomography Pulmonary Angiography (CTPA)

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

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