Pulmonary Embolism Detection with Dual-Energy CT: Experimental Study of Dual-Source CT in Rabbits

Zhang, Longjiang; Zhao, Yanping; Wu, Shengyong; Yeh, Benjamin M.; Zhou, Changsheng; Hu, Xiaobo; Hu, Qiu-Ju; Lu, Guangming

doi:10.1148/radiol.2521081682

Cited by 108 publications

(77 citation statements)

References 39 publications

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“…In some segmental arteries with non-occlusive tiny mural thrombus, the PBV image may be normal and this is the reason for false-negative results. In an experimental PE model in rabbits, Zhang et al [4] reported that the diagnostic sensitivity of PBV imaging alone in the detection of PE was 87% and had a good correlation with pathological analysis. In contrast to PBV imaging, CTA had a lower sensitivity of 67%.…”

Section: Discussionmentioning

confidence: 99%

“…The emergence of dual-source CT means that simultaneous evaluation of lung parenchyma perfusion and vascular blockage is now feasible. It has been shown to be a reliable method, with only one CT scan, in animal experiments [4] and clinical practice [5][6][7]. Besides lung parenchyma perfusion and arterial obstruction, right ventricular function is also an important tool for assessment of severity and is a predictor of mortality [8,9] in acute PE patients.…”

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confidence: 99%

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Assessment of correlation between CT angiographic clot load score, pulmonary perfusion defect score and global right ventricular function with dual-source CT for acute pulmonary embolism

Zhou¹,

Shi²,

Wang³

et al. 2012

BJR

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Objective: The purpose of this study was to prospectively investigate the correlation between CT angiographic clot load (CTACL) score, pulmonary perfusion defect (PPD) score and the global right ventricular function in the assessment of pulmonary embolism (PE) severity. Methods: 49 patients with acute PE, who underwent dual-source CT scan, were included in the study. CT angiography and perfusion imaging were performed. Data from electrocardiogram-gated coronary angiography scanning protocol were used for right ventricular function analysis. Two readers evaluated the CTACL and PPD scores using the Qanadli and Chae methods, respectively. Results: The PPD score had a strong positive correlation with the CTACL score (r50.72, p,0.001) and both scores in turn had a strong positive correlation with the right ventricular/left ventricular (RV/LV) diameter ratio (r50.60, r50.62, p,0.001). However, the PPD score had a strong negative correlation with ejection fraction (EF) (r520.63, p,0.001) while the CTACL score had a low negative correlation with EF (r520.33, p50.02). Between the RV/LV,1 group (n535) and the RV/LV .1 group (n514), the PPD score, CTACL score, pulmonary artery trunk diameter, EF and reflux of inferior vena cava were significantly different, all with p,0.001. The end-systolic volume (p50.01) was significantly different but the end-diastolic volume (p50.11) and stroke volume (p50.08) showed no statistically significant difference between the two groups. Conclusion: Therefore, considering PPD scores, CTACL scores and cardiovascular manifestations together may be helpful in the evaluation of PE severity. Pulmonary CT angiography (CTA) has been established as the first-line imaging technique for the diagnosis of pulmonary embolism (PE) in daily clinical practice [1,2]. Routine CT pulmonary angiography not only provides pulmonary arterial clot load information, but may even help to diagnose alternative causes for the patient's symptoms, such as pneumothorax, pneumonia, pulmonary oedema or pleural effusion. However, it only provides anatomical and morphological images and no information regarding perfusion function. In acute PE patients, anatomical obstruction is the most important cause of compromised physiology, and the release of vasoactive and bronchoactive agents from platelets may lead to deleterious ventilation-perfusion mismatch [3]. Therefore, assessment of both anatomical obstruction and functional perfusion is important. The emergence of dual-source CT means that simultaneous evaluation of lung parenchyma perfusion and vascular blockage is now feasible. It has been shown to be a reliable method, with only one CT scan, in animal experiments [4] and clinical practice [5][6][7]. Besides lung parenchyma perfusion and arterial obstruction, right ventricular function is also an important tool for assessment of severity and is a predictor of mortality [8,9] in acute PE patients. Several studies [10][11][12][13] have shown that the global right ventricular function can be accurately assessed with electrocardio...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Assessment of correlation between CT angiographic clot load score, pulmonary perfusion defect score and global right ventricular function with dual-source CT for acute pulmonary embolism

Zhou¹,

Shi²,

Wang³

et al. 2012

BJR

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“…Pontana et al [16] also showed that the presence of endoluminal thrombus is associated with pulmonary perfusion defects at DECT. In an experimental study by Zhang et al [22], conventional CTPA identified pulmonary emboli in only 12 and the absence of emboli in 18 pulmonary lobes, corresponding to a sensitivity and specificity of 67% and 100%. By contrast, DECT and BFI each correctly identified pulmonary emboli in 16 of 18 pulmonary lobes and reported the absence of emboli in 11 of 12 lobes, corresponding to sensitivity and specificity of 89% and 92% for detecting pulmonary emboli.…”

Section: Detection Of Pementioning

confidence: 99%

Dual-energy computed tomography in pulmonary embolism

Wu²,

Bm³

et al. 2010

BJR

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ABSTRACT. The introduction of modern dual-energy CT (DECT) scanners has enabled contrast material to be distinguished at imaging without the need for a separate unenhanced scan. Images of pulmonary parenchymal contrast enhancement obtained using DECT improve the detection of defects, augmenting our ability to detect pulmonary emboli; however, with these advances new pitfalls are also introduced. In this pictorial review, we present the technique, clinical applications and causes and remedies of false results of dual-energy pulmonary parenchymal enhancement defects in pulmonary embolism.

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“…[1][2][3] Pulmonary embolism is a common cause of pulmonary IRI (PIRI), and the incidence of pulmonary embolism is increasing 4,5 with a mortality rate of up to 30%. 6 With timely identification and treatment of pulmonary embolism, mortality rates can be reduced to ,10%.…”

mentioning

confidence: 99%

Lung ischaemia–reperfusion injury in a canine model: dual-energy CT findings with pathophysiological correlation

Lü

Xu²,

Zhang³

et al. 2014

BJR

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both contributed equally to this article.Objective: To evaluate dual-energy CT (DECT) findings of pulmonary ischaemic-reperfusion injury (PIRI) and its pathophysiological correlation in the canine model. Methods: A PIRI model was established in 11 canines, utilizing closed pectoral balloon occlusion. Two control canines were also included. For the PIRI model, the left pulmonary artery was occluded with a balloon, which was deflated and removed after 2 h. DECT was performed before, during occlusion and at 2, 3 and 4 h thereafter and was utilized to construct pulmonary perfusion maps. Immediately after the CT scan at the fourth hour post reperfusion, the canines were sacrificed, and lung specimens were harvested for pathological analysis. CT findings, pulmonary artery pressure and blood gas results were then analysed. Results: Data at every time point were available for 10 animals (experimental group, n 5 8; control group, n 5 2).Quantitative measurements from DECT pulmonary perfusion maps found iodine attenuation values of the left lung to be the lowest at 2 h post embolization and the highest at 1 h post reperfusion. In the contralateral lung, perfusion values also peaked at 1 h post reperfusion. Continuous hypoxia and acid-based disorders were observed during PIRI, and comprehensive analysis showed physiological changes to be worst at 3 h post reperfusion. Conclusion: DECT pulmonary perfusion mapping demonstrated pulmonary perfusion of the bilateral lungs to be the greatest at 1 h post reperfusion. These CT findings corresponded with pathophysiological changes. Advances in knowledge: DECT pulmonary perfusion mapping can be used to evaluate lung ischaemiareperfusion injury.Ischaemia-reperfusion injury (IRI) occurs under a variety of clinical conditions, including lung and/or cardiac transplantation, cardiopulmonary bypass, pulmonary resection, re-expansion pulmonary oedema, shock, cardiopulmonary resuscitation and pulmonary embolism.1-3 Pulmonary embolism is a common cause of pulmonary IRI (PIRI), and the incidence of pulmonary embolism is increasing 4,5 with a mortality rate of up to 30%. 6 With timely identification and treatment of pulmonary embolism, mortality rates can be reduced to ,10%.7 However, reperfusion after treatment for lung ischaemia can also cause serious complications, such as haemorrhage and pulmonary oedema.8 Therefore, it is important to understand both the pathophysiological and imaging appearances of pulmonary IRI. Lung transplantation is also a common cause for PIRI following pulmonary arterial occlusion. Currently, the incidence of PIRI following transplantation is estimated at up to 25%. Post transplantation, PIRI can lead to insufficiency of the primary lung graft, delayed graft function, acute or chronic rejection (e.g. pulmonary oedema and acute respiratory failure), and increased early post-operative mortality and graft failure. 9,10 CT is currently the predominant modality for the imaging assessment of thoracic disorders, including PIRI. Dual-energy CT (DECT) allows simultaneous ac...

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Pulmonary Embolism Detection with Dual-Energy CT: Experimental Study of Dual-Source CT in Rabbits

Abstract: Dual-source CT can depict normal and abnormal blood perfusion distribution in a rabbit's lung. Abnormal pulmonary blood distribution, as shown at dual-source CT, improves detection of acute PE in rabbits.

Cited by 108 publications

References 39 publications

Assessment of correlation between CT angiographic clot load score, pulmonary perfusion defect score and global right ventricular function with dual-source CT for acute pulmonary embolism

Assessment of correlation between CT angiographic clot load score, pulmonary perfusion defect score and global right ventricular function with dual-source CT for acute pulmonary embolism

Dual-energy computed tomography in pulmonary embolism

Lung ischaemia–reperfusion injury in a canine model: dual-energy CT findings with pathophysiological correlation

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