Pulmonary Embolism Detection: Prospective Evaluation of Dual-Section Helical CT versus Selective Pulmonary Arteriography in 157 Patients

Qanadli, Salah D.; Hajjam, Mostafa El; Mesurolle, Benoı̂t; Barré, Olivier; Bruckert, F; Joseph, Thierry; Mignon, F; Vieillard‐Baron, Antoine; Dubourg, Olivier; Lacombe, Pascal

doi:10.1148/radiology.217.2.r00nv01447

Cited by 286 publications

(126 citation statements)

References 25 publications

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“…CTPA is especially useful to clinicians because it provides a wide range of diagnostic information other than the presence or absence of pulmonary embolism (11,25). This is a double-edged sword however, revealing an alternate cause of symptoms such as pneumonia or pleural effusion in one third of cases, while revealing incidental findings requiring diagnostic follow-up in one fourth (26).…”

Section: Discussionmentioning

confidence: 99%

Elevated d-dimer cut-off values for computed tomography pulmonary angiography—d-dimer correlates with location of embolism

et al. 2016

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Background: Acute pulmonary embolism (APE) is a potentially fatal condition, and making a timely diagnosis can be challenging. Computed tomography pulmonary angiography (CTPA) has become the modality of choice, and this contributes to the increasing load on emergency room CT scanners. Our purpose was to investigate whether an elevated d-dimer cut-off could reduce the demand for CTPA while maintaining a high sensitivity and negative predictive value (NPV). Methods:We retrospectively reviewed all patients referred for CTPA with suspicion of APE in 2012, and collected d-dimer values and CTPA results. We investigated the diagnostic performance of d-dimer using a 0.5 mg/L cut-off and an age adjusted cut-off. We also evaluated a new and elevated cut-off. Cases were categorized according to their CTPA result into: no embolism, peripheral embolism, lobar embolism and central embolism. Finally we investigated a possible correlation between d-dimer values and location of embolism.Results: We included 1,051 CTPAs, from which 216 (21%) showed pulmonary embolism. There were concomitant d-dimer analyses in 822 CTPA examinations. The current 0.5 mg/L cut-off achieved a sensitivity and NPV of 99%. The age-adjusted cut-off achieved a sensitivity and NPV of 98%, and our suggested cut-off of 0.9 mg/L achieved a sensitivity and NPV of 97%. Conclusions:We conclude that the elevated d-dimer cut-off of 0.9 mg/L achieved a high sensitivity and NPV, while reducing the number of CTPA by 27%. The correlation between d-dimer values and location of embolisms supports the suggestion of an elevated d-dimer value.

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Section: Discussionmentioning

confidence: 99%

Elevated d-dimer cut-off values for computed tomography pulmonary angiography—d-dimer correlates with location of embolism

et al. 2016

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“…Compared with single-slice CT, and for a similar degree of functional impairment, we observed a significantly higher proportion of CT angiograms devoid of respiratory (64 vs 38%) and cardiac motion artifacts (62 vs 40%) with multislice CT. Because of the well-known difficulties in assessing acute PE in patients with underlying respiratory disease, the benefit of multislice CT, which allows obtainment of a higher number of examinations interpretable down to the subsegmental pulmonary arterial bed compared with single slice CT, is emphasized. As underlined by several investigators [2,4,14,15], the limitations of single-slice CT in the detection of clots in small vessels are related mainly to lower spatial resolution and to the fact that subsegmental vessels of the upper and lower lobes frequently lie outside the limits of z-axis coverage. Consequently, the remaining indications of pulmonary angiography, namely the exclusion of subsegmental PE after a negative CT angiogram down to the segmental level, are expected to dramatically decline with the widespread availability of multislice CT scanners.…”

Section: Discussionmentioning

confidence: 99%

CT angiography of pulmonary embolism in patients with underlying respiratory disease: impact of multislice CT on image quality and negative predictive value

et al. 2002

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“…Especially, as segmental and subsegmental emboli are detected more often, when thin collimation spiral CT examinations are performed [3,6]. Basis for this methodology is a high contrast bolus within the vessel lumen.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are no larger patient series available for now. First initial data from dual-section CT suggest a depiction of (sub-) segmental emboli in approximately 90 % [3], although the clinical impact of these findings is discussed controversially [2,3]. In this context, additional functional parameters would be desirable.…”

Section: Discussionmentioning

confidence: 99%

Farbkodierte Darstellung des Lungenparenchyms bei vermuteter Lungenembolie mittels Mehrschicht-Spiral-CT

Wildberger¹,

Niethammer²,

Klotz³

et al. 2001

Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr

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Summary. Purpose: The purpose of our preliminary study was to evaluate the feasibility of a new technique for the perfusion weighted color display of the density of lung parenchyma derived from multi-slice CT (MSCT) data sets of clinical routine examinations for visualization of pulmonary embolism (PE). Materials and Methods: Imaging of patients with suspected PE was performed on a commercially available MSCT (Somatom Volume Zoom; Siemens, Forchheim, Germany) after intravenous application of 120 cc of contrast-medium using a power injector. Scan parameters were 140 kV and 100 mAs, using a thin collimation of 4 1 mm and a table speed of 7 mm (pitch: 1.75). Derived from thin collimation axial slices (slice thickness eff. 1.25 mm, reconstruction increment 0.8 mm), a new image processing technique was deployed. Based on these source images, an automated 3D-segmentation of the lungs was performed followed by threshold based extraction of major airways and vascular structures. The filtered volume data were color encoded and finally overlayed onto the original CT images. This color encoded display of parenchymal density distribution of the lungs was shown in axial, coronal and sagittal plane orientation. In four patients with excluded PE as well as in two patients with proven PE this new technique was performed. Results: In the four patients that were considered negative regarding PE on MSCT, lung densitometry showed a homogeneous distribution of color encoded densities without circumscribed decreased or increased areas, beside the usually present gravity-dependent gradient in ventro-dorsal direction. In the two patients with proven PE, low density values on perfusion weighted color maps were found distally to the occluded pulmonary arteries. Conclusions: Our initial experience indicates that lung densitometry with an optimized display of the density distribution within the lung parenchyma may provide additional information in patients with suspected or proven PE. However, a comparison with ventilation/perfusion scintigraphy and a larger number of patients are necessary for the full clinical evaluation of this new functional imaging methodology.

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Pulmonary Embolism Detection: Prospective Evaluation of Dual-Section Helical CT versus Selective Pulmonary Arteriography in 157 Patients

Abstract: Dual-section helical CT is an improvement in helical CT that offers a high sensitivity and specificity for the depiction of PE, including at the subsegmental level. Dual-section helical CT can replace pulmonary arteriography for the direct demonstration of PE in a majority of patients.

Cited by 286 publications

References 25 publications

Elevated d-dimer cut-off values for computed tomography pulmonary angiography—d-dimer correlates with location of embolism

Elevated d-dimer cut-off values for computed tomography pulmonary angiography—d-dimer correlates with location of embolism

CT angiography of pulmonary embolism in patients with underlying respiratory disease: impact of multislice CT on image quality and negative predictive value

Farbkodierte Darstellung des Lungenparenchyms bei vermuteter Lungenembolie mittels Mehrschicht-Spiral-CT

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