Unenhanced multidetector computed tomography findings in acute central pulmonary embolism

Abstract

Background Computed tomography pulmonary angiography (CTPA) is the gold standard for the diagnosis of pulmonary embolism (PE). However, contrast is contraindicated in some patients. The purpose of this study was to determine the diagnostic accuracy of unenhanced multidetector CT (MDCT) for diagnosis of central PE using CTPA as the gold standard. Methods The records of patients with suspected PE seen between 2010 and 2013 were retrospectively reviewed. Inclusion criteria were an acute, central PE confirmed by CTPA and non-enhanced MDCT before contrast injection. Patients with a PE ruled out by CTPA served as a control group. MDCT findings studied were high-attenuation emboli in pulmonary artery (PA), main PA dilatation > 33.2 mm, and peripheral wedge-shaped consolidation. Receiver operating characteristic (ROC) analysis was used to determine the sensitivity and specificity of unenhanced MDCT to detect PE. Wells score of all patients were calculated using data extracted from medical records prior to imaging analysis. Results Thirty-two patients with a PE confirmed by CTPA and 32 with a PE ruled out by CTPA were included. Among the three main MDCT findings, high-attenuation emboli in the PA showed best diagnostic performance (Sensitivity 72.9%; Specificity 100%), followed by main PA dilatation > 33.2 mm (sensitivity 46.9%; specificity 90.6%), and peripheral wedge-shaped consolidation (sensitivity 43.8%; specificity 78.1%). Given any one or more positive findings on unenhanced MDCT, the sensitivity was 96.9% and specificity was 71.9% for a diagnosis of PE in patients. The area under the curve (AUC) of a composite measure of unenhanced MDCT findings (0.909) was significantly higher than that of the Wells score (0.688), indicating unenhanced MDCT was reliable for detecting PE than Wells score. Conclusions Unenhanced MDCT is an alternative for the diagnosis of acute central PE when CTPA is not available.

Diagnostic accuracy of X-ray versus CT in COVID-19: a propensity-matched database study

“…Sensitivities of non-contrast CT for diagnosis of PE have been reported at 96.9% and specificity at 71.9%. 33 34 …”

<p>The Predictive Value of microRNA-134 and microRNA-1233 for the Early Diagnosis of Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Acute Pulmonary Embolism</p>

“…Therefore, it is still urgent to develop reliable and simple biomarkers for APE diagnosis. 19,33 The vital characteristics of an ideal biomarker are its reproducible measurability and its high specificity and sensitivity for the clinicopathological outcome of diseases. 34,35 Peripheral venous blood samples are the preferred source for the detection of biomarkers of disease, and most established biomarkers evaluated by this method have shown consistent and repeatable results.…”

“…Moreover, the use of CTPA also has the problem of radiation exposure. [18][19][20] In addition, in clinical practice, many doctors overuse CTPA in order to reduce missed diagnosis, resulting in waste of medical supplies and excessive medical costs. Therefore, it is necessary to explore non-invasive, simple and reliable new biomarkers for the diagnosis of AECOPD complicated by APE.…”

Monitored Reconstruction: Computed Tomography as an Anytime Algorithm

“…To check the hypothesis H2, which is necessary to apply the stopping rules (14), (15), and (16), derived in subsection II-E, we need to confirm that the -distances between consecutive partial reconstruction results decrease as the number of acquired projections increases. The plotted distances between the consecutive reconstruction results for all objects are presented in Figure 6, the corresponding distance values are presented in Table 4.…”

“…Along with the development of techniques and protocols for the study of stationary objects, another actively developed direction is the study of dynamic objects, or the socalled 4D-tomography [14]. 4D reconstruction techniques in a medical field allows studying the organs which are in continuous motion, such as lungs [15], [16] and heart [17]- [19]. Industrial applications of 4D tomography include monitoring of the development of porous networks [20], cracking damage [21], local fluid flow [22], and more [23].…”