scholarly journals Role of multidetector CT in predicting patient outcome in cases of pulmonary embolism: correlation between imaging findings, ICU admissions and mortality rate

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Heba Ibrahim ◽  
Samar M. El-Maadawy
Keyword(s):  
Pulmonary Embolism ◽  
Multidetector Ct ◽  
Medical Condition ◽  
Imaging Modality ◽  
Main Pulmonary Artery ◽  
Pulmonary Angiography ◽  
Septal Deviation ◽  
Hepatic Veins ◽  
Icu Admission ◽  
Contrast Reflux

Abstract Background Pulmonary embolism (PE) is a critical medical condition that requires prompt diagnosis and treatment to avoid serious morbidity and mortality risk. Multidetector CT pulmonary angiography (CTPA) is considered the first-line imaging modality for suspected acute PE. The presence of right heart strain, which supports the diagnosis, requires special attention. The aim of our retrospective study is to assess the reliability of CTPA hemodynamic indices in predicting patients’ outcome in cases of PE. Results Sixty patients were included in our study. CTPA parameters including main pulmonary artery (MPA) diameter, left ventricle (LV) diameter, right ventricle (RV)/LV ratio, and septal deviation had a clinical prognostic value for short-term 30-day mortality and ICU admission. Statistically significant relationship between MPA diameter > 29 mm, LV diameter, RV/LV ratio > 1, left-sided septal deviation and contrast reflux into the IVC/distal hepatic veins with ICU admission was observed with p values 0.031, 0.000, 0.000, 0.005 and 0.028 respectively. There was a statistically significant correlation between MPA diameter > 29 mm, LV diameter, RV/LV > 1 ratio and septal deviation with 30-day mortality with p values of < 0.001, 0.001, < 0.001 and 0.015 respectively. No significant correlation was found between 30-day mortality and contrast reflux to IVC with p value of 0.070. Conclusions CTPA measurements including MPA diameter, RV/LV ratio and septal deviation were found to be significantly correlated to ICU admission and 30-day mortality as predictors for PE severity. CT contrast reflux was found to be correlated to ICU admission; however, it was not significantly correlated to 30-day mortality.

scholarly journals Advances in the Diagnosis of Venous Thromboembolism: A Literature Review

Diagnostics ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. 365 ◽  
Author(s):  
Harish Patel ◽  
Haozhe Sun ◽  
Ali N. Hussain ◽  
Trupti Vakde
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Valsalva Maneuver ◽  
Imaging Modality ◽  
Diagnostic Algorithm ◽  
Pulmonary Angiography ◽  
Vein Thrombosis ◽  
Compression Ultrasound ◽  
Test Probability ◽  
D Dimer

The incidence of venous thromboembolism (VTE), including lower extremity deep vein thrombosis (DVT) and pulmonary embolism (PE) is increasing. The increase in suspicion for VTE has lowered the threshold for performing imaging studies to confirm diagnosis of VTE. However, only 20% of suspected cases have a confirmed diagnosis of VTE. Development of pulmonary embolism rule-out criteria (PERC) and update in pre-test probability have changed the paradigm of ruling-out patient with low index of suspicion. The D-dimer test in conjunction to the pre-test probability has been utilized in VTE diagnosis. The age appropriate D-dimer cutoff and inclusion of YEARS algorithm (signs of the DVT, hemoptysis and whether PE is the likely diagnosis) for the D-dimer cutoff have been recent updates in the evaluation of suspected PE. Multi-detector computed tomography pulmonary angiography (CTPA) and compression ultrasound (CUS) are the preferred imaging modality to diagnose PE and DVT respectively. The VTE diagnostic algorithm do differ in pregnant individuals. The prerequisite of avoiding excessive radiation has recruited planar ventilation-perfusion (V/Q) scan as preferred in pregnant patients to evaluate for PE. The modification of CUS protocol with addition of the Valsalva maneuver should be performed while evaluating DVT in pregnant individual.

scholarly journals Combined CT Pulmonary Angiography & Indirect CT Venography in Evaluation of Clinically Suspected Cases of Pulmonary Embolism- Our Experience in an Oncologic Setup

2013 ◽  
Vol 3 (1) ◽  
pp. 40-52
Author(s):  
Anuj Thankral ◽  
D Thakral ◽  
E Mohamed ◽  
EP Singh ◽  
H Lal
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Symptoms ◽  
Imaging Modality ◽  
Pulmonary Angiography ◽  
Ct Pulmonary Angiography ◽  
Ct Venography ◽  
Vein Thrombosis ◽  
Presenting Symptoms ◽  
Pulmonary Scintigraphy ◽  
Time Required

The study was aimed at evaluating role of CT Pulmonary Angiography (CTPA) and Indirect CT venography (ICTV) in clinically suspected pulmonary embolism (PE) in oncology setup.17/31 (54.9%) patients were diagnosed with PE with or without deep vein thrombosis. DVT was diagnosed in 12(38.7%). 1 patient had DVT in absence of PE while 13/31 (41.9%) patients were diagnosed not to have PE or DVT. Clinical symptoms or pre-test probability determined by Well’s criteria and other laboratory investigations were not found predictive of PE. CTPA diagnosed PE with greater ease, shorter time required with no dependence on clinical pretest probability unlike pulmonary scintigraphy. In cases with CTPA negative for PE, CT described additional findings possibly explaining patient’s presenting symptoms unlike negative pulmonary scintigraphy. In cases where PE was excluded, CTV identified DVT (if present) in the same sitting, obviating separate venous Doppler. A single investigation with ability to deal with complete spectrum of DVT and PE makes CTPA & ICTV ‘one stop shop’ imaging modality for PE and DVT. Nepalese Journal of Radiology / Vol.3 / No.1 / Issue 4 / Jan-June, 2013 / 40-52 DOI: http://dx.doi.org/10.3126/njr.v3i1.8795

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

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.

scholarly journals Rate of Nondiagnostic Computerized Tomography Pulmonary Angiograms (CTPAs) Performed for the Diagnosis of Pulmonary Embolism in Pregnant and Immediately Postpartum Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Sarah Hogan ◽  
Jillian Greene ◽  
Jeffery Flemming
Keyword(s):  
Pulmonary Embolism ◽  
Breast Tissue ◽  
Main Pulmonary Artery ◽  
Pulmonary Angiography ◽  
Eastern Health ◽  
X Rays ◽  
Diagnostic Quality ◽  
Normal Chest ◽  
Line Imaging

Objective. To evaluate the nondiagnostic rate of computed tomography pulmonary angiography (CTPA) in pregnant and postpartum patients with suspected pulmonary embolism (PE) to determine whether CTPA or ventilation-perfusion (VQ) scan should be considered first line imaging in this patient population considering their equivalent accuracy and the greater radiation exposure to proliferating breast tissue of CTPA. Methods. All pregnant/postpartum female patients between 18 and 50 years of age who had CTPA within the Eastern Health Authority between November 2012 and November 2016 were included. Each scan was evaluated for nondiagnosis based on two criteria: contrast density in the main pulmonary artery, and respiratory motion artefact. If either of these criteria were not met, the scan was labelled as nondiagnostic. Results. The nondiagnostic rate overall was 43% (n=83). This is similar to current literature values for rates of CTPA nondiagnosis, and comparable to the reported diagnostic quality of the reporting radiologist. This is much greater compared to rates of ventilation/perfusion nondiagnosis in comparable populations. Even in patients with normal chest radiographs, which represents the main patient group where VQ may be considered as an alternative, the nondiagnostic rate of CT is much higher. Conclusion. This is the first study to attempt to identify an objective method of determining nondiagnosis in pregnant and postpartum patients undergoing a CTPA. Our results strengthen the argument that alternative imaging should be considered when investigating for PE in this population in order to protect the proliferating breast tissue, and VQ scan should be considered especially in patients with normal chest X-rays.

The diagnosis and management of pulmonary embolism

2020 ◽  
Vol 29 (1) ◽  
pp. 22-26 ◽  
Author(s):  
Emma Toplis ◽  
Gerri Mortimore
Keyword(s):  
Pulmonary Embolism ◽  
Imaging Modality ◽  
Pulmonary Angiography ◽  
Arterial System ◽  
Bleeding Events ◽  
Clinical Probability ◽  
Wells Score ◽  
Pulmonary Arterial ◽  
The Uk ◽  
Specific Symptoms

Pulmonary embolism (PE) is a condition characterised by an obstruction of the pulmonary arterial system by one or more emboli. Advanced clinical practitioners are often faced with ruling out a diagnosis of PE in patients with non-specific symptoms such as dyspnoea and pleuritic chest pain, which can be fairly mild and therefore a diagnosis of PE easily missed. PEs can be a challenge to diagnose, especially in elderly people, since it can be difficult to differentiate their symptoms from other less serious illnesses. Widely used scoring tools are helpful to calculate a patient's probability of having a PE. The Wells score is the most widely used pre-test clinical probability indicator of PE used in the UK, which scores the patient's probability of having a PE based on their risk factors. The D-dimer test is a relatively simple investigation to rule out venous thromboembolism (VTE) but can be raised for various reasons other than PE. Computed tomography pulmonary angiography (CTPA) is regarded as the gold standard imaging modality for investigation of acute PE but ventilation-perfusion (VQ) scans can be used as an alternative imaging technique for diagnosing PE in those where CTPA is contraindicated. Thrombolysis is underused in clinical practice due to the fear of adverse bleeding events. Patients without a massive or sub-massive PE are treated with anticoagulant therapy, usually commencing with subcutaneous low-molecular-weight heparin and switching over to a direct oral anticoagulant (DOAC). There has been a shift away from treatment with warfarin for the prevention and treatment of VTE over the past decade.

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

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.

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

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.

scholarly journals 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

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052093932
Author(s):  
Daliang Liu ◽  
Xiansheng Cai ◽  
Xiaoshuang Che ◽  
Yong Ma ◽  
Yucun Fu ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Image Quality ◽  
Pulmonary Artery ◽  
Main Pulmonary Artery ◽  
Pulmonary Arteries ◽  
Free Breathing ◽  
Pulmonary Angiography ◽  
Motion Artifacts ◽  
Breath Holding ◽  
High Threshold

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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