State-of-the-art pulmonary arterial imaging – Part 1

Int J Cardiovasc Imaging

et al. 2020

Self Cite

The manuscript discusses the application of CT pulmonary angiography, ventilation-perfusion scan, and magnetic resonance angiography to detect acute pulmonary embolism and to plan endovascular therapy. CT pulmonary angiography offers high accuracy, speed of acquisition, and widespread availability when applied to acute pulmonary embolism detection. This imaging modality also aids the planning of endovascular therapy by visualizing the number and distribution of emboli, determining ideal intra-procedural catheter position for treatment, and signs of right heart strain. Ventilation-perfusion scan and magnetic resonance angiography with and without contrast enhancement can also aid in the detection and pre-procedural planning of endovascular therapy in patients who are not candidates for CT pulmonary angiography.

Section: Clinical Evaluation Of Suspected Acute Pementioning

confidence: 99%

Acute pulmonary embolism multimodality imaging prior to endovascular therapy

Sin

McLennan

Int J Cardiovasc Imaging

et al. 2020

Self Cite

“…In hemodynamically stable patients, scoring systems such as the Wells score, simplified Wells score or revised Geneva score are applied to determine the pre-test probability for PTE allowing categorization into low, intermediate or high probability (▶ Table 1) [2,4,20]. For patients with low probability of PTE, the absence of all pulmonary embolism rule-out criteria (PERC) effectively excludes PTE with high sensitivity and a very low false-negative rate (▶ Table 2) [2,21].…”

Section: Clinical Evaluation and Diagnostic Algorithmmentioning

confidence: 99%

“…The performance of the D-dimer test in the elderly can be improved by using age-adjusted cut-offs [22]. Patients with a positive D-dimer test or high probability of PTE undergo CTPA as the imaging modality of choice to confirm or exclude PTE [4,20,23]. D-dimer may be nonspecifically elevated in oncologic, hospitalized and pregnant patients.…”

Section: Clinical Evaluation and Diagnostic Algorithmmentioning

confidence: 99%

“…Direct findings of acute PTE by CTPA or MRA comprise filling defects within pulmonary arteries often surrounded with a rim of contrast resulting in the "polo mint sign" in the plane perpendicular to the vessel course or the "railway sign" in the plane along the vessel course (▶ Fig. 3) [20,23]. A clear advantage of CTPA compared to MRA is the signal of the embolus itself which shows softtissue density on CT as opposed to no signal on MRA sequences with a short echo time.…”

Section: Imaging Findingsmentioning

confidence: 99%

“…Emboli in acute PTE tend to form acute angles with the vessel wall and are frequently located at vessel bifurcations (▶ Fig. 3) [20]. They can also be entirely occlusive and lead to an enlargement of the affected vessel while the arteries distal to the embolus can have a smaller caliber as perfusion is impaired.…”

Section: Imaging Findingsmentioning

confidence: 99%

See 2 more Smart Citations

Acute Pulmonary Embolism: Imaging Techniques, Findings, Endovascular Treatment and Differential Diagnoses

Palm

Rajiah

et al. 2019

Fortschr Röntgenstr

Self Cite

Background Acute thrombotic pulmonary embolism (PE) is a common and potentially fatal event with imaging playing a pivotal role in the diagnosis and management of these patients. Method This review discusses imaging techniques, diagnostic algorithms, imaging findings and endovascular treatment of acute thrombotic PE, and illustrates important differential diagnoses relating to the spectrum of acute non-thrombotic PE and non-embolic pulmonary artery disease. The review emphasizes information relevant for everyday radiological practice and highlights recent advances that can be readily applied in the clinical routine. Results/Conclusion Computed tomography pulmonary angiography (CTPA) is the current reference standard for the diagnosis of acute PE. Ventilation and perfusion (VQ) scanning or – in centers with adequate expertise – magnetic resonance imaging (MRI) is indicated in pregnant or young patients and patients with contraindications to iodinated contrast. Invasive angiography is reserved for patients with intended endovascular treatment. Artifacts, acute non-thrombotic PE, chronic PE and non-embolic pulmonary artery diseases should always be considered as differential diagnoses. Key points: Citation Format

Advanced imaging in pulmonary hypertension: emerging techniques and applications

Int J Cardiovasc Imaging

Melzig

Derlin

et al. 2018

Pulmonary hypertension (PH) is a pathophysiological disorder defined by an increase in pulmonary arterial pressure which can occur in multiple clinical conditions. Irrespective of etiology, PH entails a negative impact on exercise capacity and quality of life, and is associated with high mortality particularly in pulmonary arterial hypertension. Noninvasive imaging techniques play an important role in suggesting the presence of PH, providing noninvasive pulmonary pressure measurements, classifying the group of PH, identifying a possibly underlying disease, providing prognostic information and assessing response to treatment. While echocardiography, computed tomography (CT) and ventilation/perfusion scans are an integral part of routine work-up of patients with suspected PH according to current guidelines and across centers, innovative new techniques and applications in the field of PH such as 3D echocardiography, dual-energy CT, 4D flow magnetic resonance imaging (MRI), T1 and extracellular volume fraction mapping, non-contrast-enhanced MRI sequences for perfusion and ventilation assessment, and molecular-targeted positron emission tomography are emerging. This review discusses advanced and emerging imaging techniques in diagnosis, prognostic evaluation and follow-up of patients with PH.