Visibility and image quality of peripheral pulmonary arteries in pulmonary embolism patients using free-breathing combined with a high-threshold bolus-triggering technique in CT pulmonary angiography

Objective To investigate the visibility of peripheral pulmonary arteries by computed tomography pulmonary angiography (CTPA) and image quality using a free-breathing combined with a high-threshold bolus triggering technique and to explore the feasibility of this technique in pulmonary embolism (PE) patients who cannot hold their breath. Methods Patients with suspected PE who underwent CTPA (n=240) were randomly assigned to two groups: free-breathing (n=120) or breath-holding (n=120). Results The mean scanning time or visible pulmonary artery distal branches were not different between the groups. Mean CT main pulmonary artery (MPA) values, apical segment (S1), and posterior basal segment (S10) in the free-breathing group were higher compared with the breath-holding group. The subjective image quality score in the free-breathing group was higher compared with the breath-holding group. In the free-breathing group, no respiratory artifact was observed. In the breath-holding group, obvious respiratory artifacts were caused by severe chronic obstructive pulmonary disease (COPD), dyspnea, or other diseases that preclude patients from holding their breath. Conclusion The free-breathing mode CTPA combined with a high-threshold bolus triggering technique can provide high quality images with a lower incidence of respiratory and cardiac motion artifacts, which is especially valuable for patients who cannot hold their breath.

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Salvage of Suboptimal Enhancement of Pulmonary Artery in Pulmonary CT Angiography Studies: Rapid kVp Switch Dual Energy CT Experience

Iranian Journal of Radiology ◽

10.5812/iranjradiol.97230 ◽

2020 ◽

Vol 17 (2) ◽

Author(s):

Selen Bayraktaroglu ◽

Akın Cinkooglu ◽

Naim Ceylan ◽

Recep Savas

Keyword(s):

Pulmonary Embolism ◽

Image Quality ◽

Pulmonary Artery ◽

Imaging Modality ◽

Main Pulmonary Artery ◽

Pulmonary Arteries ◽

Dual Energy ◽

Dual Energy Ct ◽

Average Increase ◽

Noise Ratio

Background: Multidetector computed tomography (MDCT) angiography is considered as the gold standard imaging modality in the evaluation of acute pulmonary embolism. Optimum vascular enhancement is critical for MDCT studies. The suboptimal opacification in pulmonary artery could be salvaged using low-energy virtual monoenergetic images (VMI) at rapid kVp switch dual energy CT. Objectives: To explore the potential improvement in pulmonary artery opacification and to assess the change in image quality parameters in VMI using fast switch kVp dual energy CT. Patients and Methods: The CT images of 877 patients who were referred with a preliminary diagnosis of pulmonary embolism were reviewed. Sixty patients with suboptimal enhancement (< 200 Hounsfeld Unit [HU]) were involved. Standard images (140 kVp) and VMI from 40 to 120 keV were generated. Attenuation, noise, signal to noise ratio (SNR) and contrast to noise ratio (CNR) were measured in the pulmonary artery. Using VMIs, the best image was determined as the image with the main pulmonary artery opacification greater than 200 HU and image quality ≥ 3. Fifty six studies that met these criteria were considered as salvaged. At this best energy level, quantitative parameters were compared with standard images. Results: The mean attenuation of pulmonary arteries was 169.80 HU in standard images in patients with suboptimal enhancement. The attenuations of VMIs at 40, 45, 50, 55, 60, 65, and 70 keV were significantly higher than standard images (P < 0.001). Similar findings were observed with SNR and CNR. In the salvaged patients, the average increase in mean pulmonary artery attenuation was 62% (from 172.61 ± 23.4 to 280.55 ± 40.7), the average increase in SNR was 38% (from 12.1 ± 5.3 to 16.7 ± 7.1) and the average increase in CNR was 48% (9.2 ± 4.3 to 13.7 ± 6) (P < 0.001). Conclusions: Low keV VMI reconstructions significantly increase pulmonary artery attenuation, CNR and SNR compared to standard image reconstructions. Suboptimal CT studies could be salvaged using low keV VMIs.

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Evaluation of the Therapeutic Effect of Pulmonary Embolism by CT Pulmonary Angiography Combined With Clinical Indexes

10.21203/rs.3.rs-672397/v2 ◽

2021 ◽

Author(s):

Meng Yuan ◽

XinYuan Cui ◽

ChunXue Yang ◽

XinYang Zhang ◽

DeLi Zhao ◽

...

Keyword(s):

Pulmonary Embolism ◽

Pulmonary Artery ◽

Heart Function ◽

Main Pulmonary Artery ◽

Pulmonary Angiography ◽

Trunk Diameter ◽

Right Heart Function ◽

Before And After ◽

Pulmonary Artery Obstruction ◽

D Dimer

Abstract Background To evaluate the value of CT pulmonary angiography (CTPA) in evaluating the therapeutic efficacy of pulmonary embolism (PE) through the study of CT pulmonary artery obstruction index (PAOI),right ventricular function parameters and some clinical indexes related to coagulation function and cardiac function injury.Materials and methods Select 30 patients with pulmonary embolism who underwent CTPA examination before and after treatment in our hospital, sort out their CTPA images before and after treatment, and obtain PAOI and right heart function parameters, including ascending aorta diameter (AAd), main pulmonary artery diameter (MPAd), ratio of main pulmonary artery diameter to ascending aorta diameter (MPAd/AAd), right pulmonary artery trunk diameter (RPAd), left pulmonary artery trunk diameter (LPAd), the ratio of the maximum short axis diameter of the right ventricle to the maximum short axis diameter of the left ventricle (RVd/LVd), and calculate the pulmonary artery obstruction index (PAOI).At the same time obtain the required clinical indicators, including serum D-dimer, N-terminal B-type natriuretic peptide precursor (NT-proBNP), cardiac troponin I (cTnI), myocardial enzyme profile (aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK)).Results MPAd, RPAd, LPAd, RVd / LVd, PAOI, D-dimer, cTnI, CK, LDH, AST had significant changes after treatment (P < 0.05), while the other parameters and indexes had no significant differences before and after treatment (P > 0.05). PAOI is positively correlated with RVd/LVd, MPAd, D-dimer. The correlation coefficient ranges from 0.281 to 0.423, among which, the correlation with D-dimer is the closest, with a correlation coefficient of 0.423. There was no significant correlation between other parameters and PAOI (P < 0.05).Conclusion CTPA is of great significance in evaluating the severity of pulmonary embolism, right heart function and therapeutic efficacy.

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Incidence and Management of Isolated Subsegmental Pulmonary Embolism.

Blood ◽

10.1182/blood.v114.22.2989.2989 ◽

2009 ◽

Vol 114 (22) ◽

pp. 2989-2989

Author(s):

Yi-Hao Shen ◽

Phil Wells ◽

Carole Dennie ◽

Marc Carrier

Keyword(s):

Pulmonary Embolism ◽

Pulmonary Artery ◽

Clinical Management ◽

High Probability ◽

Conflicts Of Interest ◽

Anticoagulation Therapy ◽

Pulmonary Arteries ◽

Filling Defect ◽

Pulmonary Angiography ◽

Acute Pe

Abstract Abstract 2989 Poster Board II-965 Introduction: The use of computed tomographic pulmonary angiography (CTPA) in patients with suspected pulmonary embolism (PE) has improved the visualization of subsegmental pulmonary arteries. However, the clinical significance of subsegmental PE is unclear. In the PIOPED Study, PE limited to subsegmental pulmonary arteries was most prevalent among patients with low-probability ventilation/perfusion (V/Q) scans. Patients with non-diagnostic (low or intermediate) V/Q scans can be safely managed without anticoagulation. The incidence and clinical management of subsegmental PE remains uncertain. Objective: To evaluate the incidence and clinical management of subsegmental PE in patients with suspected acute PE. Methods: This is a retrospective cohort study of consecutive patients with suspected acute PE undergoing CTPA at the Ottawa Hospital from Jan 1, 2007 to Dec 31, 2008. Subsegmental PE was defined as one or more pulmonary artery filling defects located in the subsegmental level, with no filling defects visualized at more proximal pulmonary artery levels. All patients were followed for a minimum of 6 months after the index PE. Results: A total of 78 (10.4%, 95% CI: 8.4 to 12.8%) cases of subsegmental PE were identified out of 748 cases of PE diagnosed by CTPA. Forty-three (77%) of these had a single isolated subsegmental filling defect. Data could be extracted in 56 (72%) of the 78 cases. Among these 56 patients, 18 (32%) had unprovoked PE. Further investigations were performed in 50 patients (Ultrasonography (U/S) of legs (n=38), U/S and V/Q scan (n=11) or V/Q scan alone (n=1)). Deep vein thrombosis was detected in 12 patients and two patients had a high probability V/Q scan. Forty-eight (86%) patients were anticoagulated. All patients with concurrent DVT or high probability V/Q scan were started on anticoagulation therapy. Two patients experienced a major bleeding episode after anticoagulation. Out of the 8 patients left untreated, there were no recurrent VTE. Conclusion: Isolated subsegmental PE represents approximately 10% of all acute PE diagnosed by CTPA. Patients with subsegmental PE diagnosed on CTPA are more commonly receiving anticoagulation than not. Further studies are needed to establish the risk benefit ratio of anticoagulation therapy in patients with subsegmental PE diagnosed on CTPA. Disclosures: No relevant conflicts of interest to declare.

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Clinical significance of peculiarities of the lesions of the vascular bed associated with pulmonary thromboembolism

Clinical Medicine (Russian Journal) ◽

10.18821/0023-2149-2017-95-5-394-397 ◽

2017 ◽

Vol 95 (5) ◽

pp. 394-397

Author(s):

M. A. Bachurina ◽

V. V. Mazur ◽

E. S. Mazur

Keyword(s):

Pulmonary Embolism ◽

High Risk ◽

Pulmonary Artery ◽

Main Pulmonary Artery ◽

Clinical Manifestations ◽

Pulmonary Angiography ◽

Community Acquired Pneumonia ◽

Low Risk ◽

Risk Patients ◽

Vascular Obstruction

Aim. To study effect of the level of vascular obstruction on the clinical manifestations of pulmonary embolism (PE). Material and methods. 63 patients with PE were included in this study. PE was verified by multidetector computed tomography (MSCT) with pulmonary angiography. 43 patients with high-risk PE survived the first week of the disease. In the remaining 20 patients with community-acquired pneumonia PE was diagnosed using MSCT pulmonary angiography in the first week of illness. Results. Obstruction of the trunk of the pulmonary artery or its lobar branches was detected in 34 (79.1%) patients with a high risk of PE and in only 2 (10%) ones with low-risk PE (p <0,001). The development of pneumonia complicated the course of the disease in 14 (32.6%) patients with a high risk of pulmonary embolism. The clots in the segmental branches of the pulmonary artery were identified in 9 (64.3%) patients with pneumonia. In high-risk patients with PE without pneumonia the lesion of segmental branches was detected only in 1 (3.4%) case (p <0,001). In patients with pneumonia at low risk of PE, the obstruction segmental branches was detected in 17 (85%) cases. Conclusion. The development of obstructive shock in PE is associated with a trunk embolism and/or the main pulmonary artery branches embolism. Infarction pneumonia is associated with the lesions of segmental branches of the pulmonary artery.

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Simultaneous bilateral contrast injection in computed tomography pulmonary angiography

Acta Radiologica ◽

10.1258/ar.2011.110244 ◽

2012 ◽

Vol 53 (1) ◽

pp. 69-75 ◽

Cited By ~ 3

Author(s):

Stefan Bulla ◽

Gregor Pache ◽

Thorsten Bley ◽

Mathias Langer ◽

Philipp Blanke

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Image Quality ◽

Pulmonary Artery ◽

Contrast Media ◽

Pulmonary Angiography ◽

Computed Tomography Pulmonary Angiography ◽

Fixed Amount ◽

Institutional Review ◽

Group A

Background Computed tomography pulmonary angiography (CTPA) has evolved as the gold standard for diagnosing pulmonary embolism. However, subsegmental arteries are often not assessed to do insufficient attenuation. Purpose To evaluate the influence of simultaneous bilateral versus unilateral injection of a fixed amount of contrast media on pulmonary artery opacification and image quality in CTPA. Material and Methods In this institutional review board-approved prospective study, 180 patients (91 women, mean age 61.9 ± 16.5 years) referred for CTPA (100 kV) due to suspected pulmonary embolism were randomized in groups of 45 patients each, with either unilateral (A:4 mL/s; B:6 mL/s) or bilateral (C: 6 mL/s; D: 8 mL/s) (Y-shaped line) injection of 50 mL contrast media. Attenuation was assessed including the subsegmental arteries (4th order). Image quality was evaluated by two readers in consensus using a three-point grading scale (3 = excellent image quality, no artifacts, 1 = non-diagnostic). Results Mean pulmonary artery attenuation was significantly higher with bilateral injection (1st to 3rd order: A: 303.6 ± 8.8HU; B: 371.1 ± 11.0HU vs. C: 443.2 ± 24.1HU; D: 562.3 ± 15.3HU, P < 0.001). Evaluation of subsegmental arteries was feasible for all patients in groups B–D, but only in 36/45 (80%) patients in group A. Subsegmental attenuation was significantly higher with bilateral injection (A: 284.7 ± 12.1HU; B: 367.4 ± 12.1HU vs. C: 494.2 ± 21.5HU; D: 562.3 ± 26.7HU, P < 0.001). Image quality was diagnostic for all patients but best for group C (A: 2.15 ± 0.4; B: 2.14 ± 0.5; C: 2.92 ± 0.3, and D: 2.51 ± 0.5). Conclusion Using the same amount of contrast media, bilateral injection yields higher pulmonary artery attenuation and better image quality than unilateral injection. This technique may improve subsegmental pulmonary artery assessment.

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Evaluation of the Therapeutic Effect of Pulmonary Embolism by CT Pulmonary Angiography Combined With Clinical Indexes

10.21203/rs.3.rs-672397/v1 ◽

2021 ◽

Author(s):

Meng Yuan ◽

XinYuan Cui ◽

ChunXue Yang ◽

XinYang Zhang ◽

DeLi Zhao ◽

...

Keyword(s):

Pulmonary Embolism ◽

Pulmonary Artery ◽

Heart Function ◽

Main Pulmonary Artery ◽

Pulmonary Angiography ◽

Trunk Diameter ◽

Right Heart Function ◽

Before And After ◽

Pulmonary Artery Obstruction ◽

D Dimer

Abstract BackgroundTo evaluate the value of CT pulmonary angiography (CTPA) in evaluating the therapeutic efficacy of pulmonary embolism (PE) through the study of CT pulmonary artery obstruction index (PAOI), right ventricular function parameters and some clinical indexes related to coagulation function and cardiac function injury.Materials and methodsSelect 30 patients with pulmonary embolism who underwent CTPA examination before and after treatment in our hospital, sort out their CTPA images before and after treatment, and obtain PAOI and right heart function parameters, including ascending aorta diameter (AAd), main pulmonary artery diameter (MPAd), ratio of main pulmonary artery diameter to ascending aorta diameter (MPAd/AAd), right pulmonary artery trunk diameter (RPAd), left pulmonary artery trunk diameter (LPAd), the ratio of the maximum short axis diameter of the right ventricle to the maximum short axis diameter of the left ventricle (RVd/LVd), and calculate the pulmonary artery obstruction index (PAOI).At the same time obtain the required clinical indicators, including serum D-dimer, N-terminal B-type natriuretic peptide precursor (NT-proBNP), cardiac troponin I (cTnI), myocardial enzyme profile (aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK)).ResultsMPAd, RPAd,LPAd,RVd / LVd, PAOI, D-dimer, cTnI, CK, LDH, AST had significant changes after treatment (P < 0.05), while the other parameters and indexes had no significant differences before and after treatment (P > 0.05). PAOI is positively correlated with RVd/LVd, MPAd, D-dimer. The correlation coefficient ranges from 0.281 to 0.423, among which, the correlation with D-dimer is the closest, with a correlation coefficient of 0.423. There was no significant correlation between other parameters and PAOI (P < 0.05).ConclusionCTPA is of great significance in evaluating the severity of pulmonary embolism, right heart function and therapeutic efficacy.

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A Systematic Review of Double Low-dose CT Pulmonary Angiography in Pulmonary Embolism

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405614666180813120619 ◽

2019 ◽

Vol 15 (5) ◽

pp. 453-460 ◽

Cited By ~ 1

Author(s):

Sultan Aldosari ◽

Zhonghua Sun

Keyword(s):

Systematic Review ◽

Pulmonary Embolism ◽

Image Quality ◽

Radiation Dose ◽

Contrast Medium ◽

Low Dose ◽

Pulmonary Angiography ◽

Ct Pulmonary Angiography ◽

Low Contrast ◽

Low Contrast Medium

Background: The aim of this study is to perform a systematic review of the feasibility and clinical application of double low-dose CT pulmonary angiography (CTPA) in the diagnosis of patients with suspected pulmonary embolism. Discussion: A total of 13 studies were found to meet selection criteria reporting both low radiation dose (70 or 80 kVp versus 100 or 120 kVp) and low contrast medium dose CTPA protocols. Lowdose CTPA resulted in radiation dose reduction from 29.6% to 87.5% in 12 studies (range: 0.4 to 23.5 mSv), while in one study, radiation dose was increased in the dual-energy CT group when compared to the standard 120 kVp group. CTPA with use of low contrast medium volume (range: 20 to 75 ml) was compared to standard CTPA (range: 50 to 101 ml) in 12 studies with reduction between 25 and 67%, while in the remaining study, low iodine concentration was used with 23% dose reduction achieved. Quantitative assessment of image quality (in terms of signal-to-noise ratio and contrast-to-noise ratio) showed that low-dose CTPA was associated with higher, lower and no change in image quality in 3, 3 and 6 studies, respectively when compared to the standard CTPA protocol. The subjective assessment indicated similar image quality in 11 studies between low-dose and standard CTPA groups, and improved image quality in 1 study with low-dose CTPA. Conclusion: This review shows that double low-dose CTPA is feasible in the diagnosis of pulmonary embolism with significant reductions in both radiation and contrast medium doses, without compromising diagnostic image quality.

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Pulmonary atresia with a ventricular septal defect and left pulmonary artery discontinuity: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02750-4 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Hyun-Hwa Cha ◽

Hae Min Kim ◽

Won Joon Seong

Keyword(s):

Pulmonary Artery ◽

Subclavian Artery ◽

Septal Defect ◽

Left Subclavian Artery ◽

Ductus Arteriosus ◽

Main Pulmonary Artery ◽

Pulmonary Arteries ◽

Pulmonary Atresia ◽

Left Pulmonary Artery ◽

Right Pulmonary Artery

Abstract Background Unilateral pulmonary artery discontinuity is a rare malformation that is associated with other intracardiac abnormalities. Cases accompanied by other cardiac abnormalities are often missed on prenatal echocardiography. The prenatal diagnosis of isolated unilateral pulmonary artery discontinuity can also be delayed. However, undiagnosed this malformation would have an effect on further prognosis. We report our case of a prenatal diagnosis of pulmonary atresia with ventricular septal defect and left pulmonary artery discontinuity. Case presentation A 33-year-old Asian woman visited our institution at 24 weeks of gestation because of suspected fetal congenital heart disease. Fetal echocardiography revealed a small atretic main pulmonary artery giving rise to the right pulmonary artery without bifurcation and the left pulmonary artery arising from the ductus arteriosus originating from the left subclavian artery. The neonate was delivered by cesarean section at 376/7 weeks of gestation. Postnatal echocardiography and multidetector computed tomography showed a right aortic arch, with the small right pulmonary artery originating from the atretic main pulmonary artery and the left pulmonary artery originating from the left subclavian artery. Patency of the ductus arteriosus from the left subclavian artery was maintained with prostaglandin E1. Right ventricular outflow tract reconstruction and pulmonary angioplasty with Gore-Tex graft patch was performed 25th day after birth. Unfortunately, the neonate died because of right heart failure 8 days postoperation. Conclusion There is a possibility that both pulmonary arteries do not arise from the same great artery (main pulmonary artery or common arterial trunk). Therefore, clinicians should check the origin of both pulmonary arteries.

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A visualized pulmonary arterial thrombus by using a new echocardiographic view in an intermediate-risk a cute pulmonary embolism patient: a case report

10.21203/rs.2.19164/v1 ◽

2019 ◽

Author(s):

Guanyu Mu ◽

Feixue Li ◽

Xiaolin Chen ◽

Bo Zhao ◽

Guangping Li ◽

...

Keyword(s):

Blood Pressure ◽

Pulmonary Embolism ◽

Pulmonary Artery ◽

Acute Pulmonary Embolism ◽

Clinical Signs ◽

Signs And Symptoms ◽

Pulmonary Angiography ◽

Normal Blood ◽

Intermediate Risk ◽

Normal Blood Pressure

Abstract BackgroundAcute pulmonary embolism (APE) is a life-threatening disease with nonspecific clinical signs and symptoms. Rapid and accurate diagnosis is crucial for the clinical management of patients with acute pulmonary embolism. A new recommended echocardiography view may be of further help in the diagnosis, evaluate the change of the thrombosis and treatment effect.Case presentationWe report a case of a 74-year-old man with a 12-day history of decreased exercise capacity and dyspnoea. The patient was diagnosed intermediate-risk APE as several pulmonary emboli in pulmonary artery were seen in multidetector computed tomographic pulmonary angiography with normal blood pressure and echocardiographic right ventricular overload. And we found a pulmonary artery clot in the right pulmonary artery through transthoracic echocardiography. After 11-days anticoagulation, the patient underwent a reassessment, showed decrease in RV diameter and pulmonary artery thrombus. ConclusionThis case highlights the significant role that echocardiography played in a patient who presented pulmonary embolism with a stable hemodynamic situation and normal blood pressure. The new echocardiographic view could provide correct diagnoses by identifying the clot size and location visually. Knowledge of the echocardiography results of APE would aid the diagnosis.

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Rehabilitation of pulmonary arteries: hybrid treatment in the unilateral absence of the pulmonary artery.

10.22541/au.161314215.58819168/v1 ◽

2021 ◽

Author(s):

Jorge Cervantes-Salazar ◽

Jose García-Montes ◽

Henry Peralta-Santos ◽

Diego Ortega-Zhindón ◽

Juan Calderón-Colmenero

Keyword(s):

Pulmonary Artery ◽

Respiratory Infections ◽

Ductus Arteriosus ◽

Main Pulmonary Artery ◽

Pulmonary Arteries ◽

Surgical Reconstruction ◽

Hybrid Strategy ◽

Right Pulmonary Artery ◽

History Of ◽

Bilateral Ductus Arteriosus

We present two patients with history of recurrent respiratory infections, fatigue and sweating. They were diagnosed with absence of connection between the main pulmonary artery (MPA) and right pulmonary artery (RPA) and bilateral ductus arteriosus, with the RPA originating from the ductus arteriosus. Treatment was approached with a hybrid strategy: percutaneous intraluminal angioplasty with a right intraductal stent and device closure of the left ductus arteriosus and followed by surgical reconstruction with interposition of a graft from RPA to MPA. Both patients had a favorable outcome.

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