Michiels JJ, Schroyens W, De Backer W, van der Planken M, Hoogsteden H, Pattynama PM. Assessment of the radiographic images and pulmonary vascular casts. Diagnosis of pulmonary embolism with spiral CT as a second procedure following scintigraphy. 1. In comparison to pulmonary angiography it is less invasive, less expensive, and its use may be more acceptable to physicians (7). Clin Med (Lond). Trad HS, Boasquevisque GS, Giacometti TR, Trad CY, Zoghbi Neto OS, Trad CS. IEEE Trans Med Imaging. Computed tomography pulmonary angiography (CTPA) is used for diagnosis. The negative predictive value of CTPA is 93% to 96%. Clinically, detection of pulmonary emboli is a common and important diagnostic problem (1); correct diagnosis leads to appropriate therapy, but false-positive and false-negative results are associated with significant risk for the patient. John Wiley, New York. The positive predictive values for Readers 1 and 2, for each modality, are shown in Table 2. Notably, 3 of 11 patients with PE had upper extremity sources. Using spiral CT we correctly identified 117 of 135 patients with PE, and 106 of 117 patients without PE. 2003 Jul;13(7):1501-7. doi: 10.1007/s00330-002-1709-3. Pulmonary embolism: prospective comparison of spiral CT with ventilation–perfusion scintigraphy. Pulmonary embolism (PE) was clinically described in the early 1800s, and von Virchow first described the connection between venous thrombosis and PE. https://doi.org/10.1164/ajrccm.161.3.9904067. A 6.3-Fr Grollman angiographic catheter was also advanced into the main pulmonary artery using a catheter guide wire (Seldinger technique). A 14-French (Fr) polyethylene catheter was introduced into the left external jugular vein for later injection of the emboli. We conclude that spiral CT is comparable to angiography for detection of pulmonary emboli. Spiral computed tomographic (CT) angiography of the pulmonary circulation has emerged recently as a potential useful diagnostic method for the evaluation of the pulmonary circulation. Eighty-four of the 86 emboli injected (98%) were recovered in the lung casts. Contrast-enhanced spiral CT. Images were obtained while pigs were in the supine position. Although our results show that spiral CT is comparable to pulmonary angiography for the detection of pulmonary emboli in this porcine model, a number of caveats concerning experimental design should be considered before the results are applied clinically. Comparison with pulmonary angiography. In this paper, the technique, the findings and the role of spiral CT angiography in diagnosis of pulmonary embolism are discussed. No radiation remains in a patient's body after a CT examination. The utility of spiral CT in clinically suspected pulmonary embolism. CT1: as for CT3, except, preparation delay of 12 ± 2 s. Lungs were scanned from the level of the main pulmonary artery to 2 cm cephalad to the posterior costophrenic angle, using a field of view of 24 cm. We studied 16 anesthetized, juvenile pigs and injected colored methacrylate beads (3.8 mm, small; 4.2 mm, large) via the jugular vein. Contrast-enhanced spiral computed tomography (spiral CT) is a promising new technique for the diagnosis of pulmonary embolism. Pulmonary embolism: validation of spiral CT angiography in 149 patients. The total number of false positive and false negatives for the two readers for each imaging modality is shown in Table 3. CT angiography of the heart is a useful way of detecting blocked coronary arteries. A polyethylene catheter (3 mm interior diameter) was inserted into the left carotid artery for measurement of systemic arterial blood pressure. The current standard of care for members with suspected pulmonary embolism is a spiral CT scan, also called a CTA, CT PA (computed tomography pulmonary angiography), MDCT (multidector CT) or helical CT scan. The spiral CT scans were reviewed at mediastinal and lung window settings on a workstation using a track ball to improve visualization of the branching pattern of the pulmonary vasculature. Complications and validity of pulmonary angiography in acute pulmonary embolism. Figure 1: CT pulmonary angiography shows multiple pulmonary emboli in a 63-year-old male with chest pain for 7 days. E-mail: American Journal of Respiratory and Critical Care Medicine. The ventilator was turned off at end-inspiration and spiral CT scans were obtained (∼ 45 s). This potential problem will be minimized with the advent of multidetector CT which will shorten the acquisition time. Epub 2015 Dec 29. Fleiss, J. L. 1981. Spiral CT angiography for suspected pulmonary embolism: a cost-effectiveness analysis: van Erkel A R, van Rossum A B, Bloem J L, Klevit J, Pattynama P M Record Status. We conclude that spiral CT is comparable to angiography for detection of pulmonary emboli. The patients underwent close surveillance for PE, yielding a higher incidence than expected, confirmed by using both spiral CT and pulmonary angiography in all cases. The patients underwent close surveillance for PE, yielding a higher incidence than expected, confirmed by using both spiral CT and pulmonary angiography in all cases. This site uses cookies. 1A , 1B , 1C , 1D , and 1E ). These emboli were in the upper lobes above the level of the main pulmonary artery. Diagnosis of acute pulmonary embolism: time for a new approach [Editorial]. The negative predictive value of a normal spiral CT study is high, compares very favorably with catheter pulmonary angiography, 61 and approaches 98%, regardless of whether underlying lung disease is present. Nonionic contrast medium (Optiray 320; Mallinckrodt Medical, St. Clair, PQ, Canada) was injected through the Grollman catheter using a calibrated volume injector pump (Medrad; Mark V, Pittsburgh, PA). Spiral CT scanning allows simultaneous imaging of anomalous vessels and lung parenchyma in a single examination and is particularly useful in the diagnosis and assessment of pulmonary sequestration. This site needs JavaScript to work properly. If the methacrylate emboli did not completely interrupt blood flow through the vessels in which they lodged then they might be easier to identify using CT rather than angiography. If appropriate equipment is available (multidetector CT), then CT pulmonary angiogram is safe to be used as … The sensitivity of each technique, as interpreted by each reader, for emboli of different sizes, was calculated by the proportion of true-positive identifications. By comparison, spiral CT is much less invasive, is associated with fewer complications, is less expensive, and is quicker (2-4). Hoffmann U, Moselewski F, Cury RC, et al. Epub 2002 Nov 19. van Rossum AB, Pattynama PM, Ton ER, Treurniet FE, Arndt JW, van Eck B, Kieft GJ.  |  Spiral CT Angiography for Acute PE: Where Do We Stand? Multi-detector row spiral CT pulmonary angiography: comparison with single-detector row spiral CT. Raptopoulos V(1), Boiselle PM. 2–4 CTPA is a standard procedure that obtains a CT volume while intravenously injected iodinated contrast media (CM) opacifies the pulmonary arteries. Pulmonary angiography. Iodinated contrast medium is administered as a … National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. PURPOSE: To evaluate the accuracy of spiral computed tomography (CT) in the noninvasive diagnosis of pulmonary embolism (PE). POSITIVE PREDICTIVE VALUES (%) FOR DETECTION  OF PULMONARY EMBOLI, Table 3. Please enable it to take advantage of the complete set of features! In this cross-sectional study, pulmonary embolism was detected in 5.9% of patients with COPD admitted to the hospital with acute worsening of respiratory symptoms using a predefined diagnostic algorithm based on the Geneva score, D-dimer levels, and spiral CT pulmonary angiography + leg compression ultrasound. 1988. There are two principal approaches for performing a CTPA of high diagnostic quality: Images were reviewed on a workstation at mediastinal settings (window 350 Hounsfield units [HU], level 35 HU) and lung settings (window 1,500 HU, level −750 HU). (D) Embolus 1 is easily seen on spiral CT (1-mm collimation). The results of this study illustrate the difficulty of assessing a new diagnostic technique when the accepted gold standard is less than perfect. By continuing to browse The interobserver correlations for diagnosis of subsegmental PE with multidetector spiral CT exceed the reproducibility of selective pulmonary angiography. This is because when using CT the diagnosis is based on the identification of the actual embolic material whereas when using angiography the presence of a distal perfusion defect also aids in the identification of emboli. The accuracy of the readers' diagnoses for the three imaging modalities (angiography, CT3, and CT1) was verified. Spiral CT scans were technically suboptimal in three patients. Comparison of the mean sensitivity of the three imaging modalities (Table 1, Figure 1) showed that there was no difference between CT3, CT1, and angiography (p = 0.42). SCTA is based on continuous computed tomography (CT) data acquisition during patient transport through the rotating X‐ray tube and detector system, where … TOTAL NUMBER OF FALSE POSITIVES AND NEGATIVES IDENTIFIED BY THE TWO READERS*. A CT coronary angiogram also enables radiologists to examine blood vessel walls, which the catheterization procedure does not. Spiral computed tomography versus pulmonary angiography in the diagnosis of acute massive pulmonary embolism. Remy-Jardin M, Remy J, Wattinne L, Giraud F. Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the single-breath-hold technique--comparison with pulmonary angiography. CT angiography may also cost less than catheter angiography. Using fluoroscopy, the Swan-Ganz catheter was advanced into the main pulmonary artery for measurement of pulmonary arterial pressure. Findings from both studies were positive in 39 patients. Table 1. PEEP was maintained until the cast had completely hardened (approximately 4 h) and the lungs were then carefully removed from the chest. Materials and methods: A prospective study was performed in 75 patients who were evaluated with spiral CT and pulmonary angiography of each lung to detect central PE; 25 of the patients also underwent ventilation-perfusion (V-P) scanning. Pigs were killed and the pulmonary arterial tree was cast using methacrylate. The ventilator was turned off at end-inspiration and pulmonary angiograms were obtained at a rate of 3 to 7.5 frames per second. CT demonstrated central PE in two patients with normal V-P scans. Similarly, angiography detected 12 false-positive interpretations of pulmonary emboli that were (correctly) not diagnosed by CT3 and 12 that were (correctly) not diagnosed by CT1.  |  2C —Acute pulmonary embolism (PE) in 78-year-old woman (same patient as shown in Figs. NLM Baile EM, King GG, Müller NL, D'yachkova Y, Coche EE, Paré PD, Mayo JR. Spiral computed tomography is comparable to angiography for the diagnosis of pulmonary embolism. Radiol Bras. A nuclear medicine utilizing a gamma camera, V/Q imaging involves injecting both a radioactive tracer and having the patient inhale radioactive gas. Multi-detector row spiral CT pulmonary angiography: comparison with single-detector row spiral CT. Raptopoulos V(1), Boiselle PM. The protocol used for obtaining spiral CT images is similar to the one that is currently used for the clinical diagnosis of pulmonary embolism in our institution. Goodman, L. R., J. J. Curtin, M. W. Mewissen, W. D. Foley, R. J. Lipchik, M. R. Crain, K. B. 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