scholarly journals Dual energy spectral CT imaging of pulmonary embolism with Mycoplasma pneumoniae pneumonia in children

2020 ◽  
Author(s):  
Lixin Yang ◽  
Jihang Sun ◽  
Jiangying Li ◽  
Tong Yu ◽  
Bei Wang ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Mycoplasma Pneumoniae ◽  
Iodine Concentration ◽  
Pulmonary Angiography ◽  
Dual Energy ◽  
Normal Lung ◽  
Spectral Ct ◽  
Significant Difference ◽  
Perfusion Defects ◽  
Mycoplasma Pneumoniae Pneumonia

Abstract Background: Pulmonary embolism (PE) associated with Mycoplasma pneumoniae pneumonia (MPP) in children has already attracted more attention. We aimed to evaluate the application of dual-energy spectral CT in diagnosing PE in children with MPP.Methods: Eight-three children with MPP and highly suspected PE, underwent CT pulmonary angiography (CTPA) with spectral imaging mode. Noise, clot-to-artery contrast-to-noise ratio, image quality and diagnosis confidence were calculated and assessed on nine monochromatic image sets (40 to 80keV). CTPA images were observed for the presence, localization, and embolic degrees of PE. Emboli were divided between intra and extra-consolidation. For extra-consolidation clots, iodine concentration (IC) of perfusion defects and normal lung, perfusion defects of 4 children before and after the treatment were measured and compared. For intra-consolidation clots, IC of consolidation areas with clots and consolidation areas without clot were measured and compared.Results: The optimal energy level for detecting PE in children was 55 keV. 116 clots (29 extra consolidations) were found in 25 children, IC of defect regions associated with PE was 0.69±0.28mg/mL (extra-consolidations) and 0.90±0.23mg/mL (intra-consolidations), both significantly lower than the 2.76±0.45mg/mL in normal lungs and 10.25±1.76mg/mL in consolidations without clots (P<0.001). Significant difference was found in the presence or absence of perfusion defects between occlusive clots and nonocclusive clots(P<0.001). IC of the perfusion defects significantly increased after treatment (P<0.001).Conclusions: In spectral CTPA 55 keV images optimize PE detection for children. and MD images quantify pulmonary blood flow of PE, and may help to detect small clots and quantify embolic degrees.

scholarly journals Analysis of the iodine distribution map in patients with diagnosis of pulmonary embolism: Initial results

2021 ◽  
Vol 7 (1) ◽  
pp. 21-33
Author(s):  
Cecilia Muñoz ◽  
Anghelo Silencio ◽  
Isna Larico
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Lung Parenchyma ◽  
Dual Energy ◽  
Normal Lung ◽  
Distribution Map ◽  
Dual Energy Computed Tomography ◽  
Perfusion Defects ◽  
Iodine Map ◽  
Iodine Maps

Objectives: Analysing the iodine map distribution in patients with pulmonary embolism diagnosis by Dual Energy Computed Tomography. Materials and methods: Twenty-four images of pulmonary angiotomography by dual energy computed tomography were used to determinate the presence of pulmonary thrombi and identify the perfusion defects (PDs) in the Iodine Maps. Moreover, the iodine density (mg/ml) were measured in normal lung parenchyma and lung parenchyma with PDs areas. The documentary analysis was used thought the data collection sheet and the Likert scale questionnaire. The statistic software SPSS v.25 was used. Results: Thirty-four thrombi were found (21 occlusive and 13 partials occlusive) at monochromatic images. Forty-one perfusion defects (PD) were found at Iodine Maps, these have multiple origins: pulmonary thrombi (69.23%), artifacts (17.95%) and other alterations (12.82%). Furthermore, two new thrombi (5.56%) were identified, both were occlusive and segmental level. Mean Iodine density showed statistically significant differences among normal lung parenchyma (1.65 ± 0.66 mg/ml; [0.77-2.79 mg/ ml]) and parenchyma with PD areas (0.51 ± 0.26 mg/ml; [0.12-1.02 mg/ml])(p=0.000). Mean iodine density also had statistically significant differences between parenchyma with occlusive PD and partial occlusive PD (p=0.000). Iodine Map diagnostic quality was excellent (54.17%), good (33.33%), moderate (12.50%). Conclusion: The Iodine distribution Map offers a benefit greater than 5% in the diagnosis of pulmonary embolism by Dual-Energy Computed Tomography.  

scholarly journals Dual-energy CT angiography reveals high prevalence of perfusion defects unrelated to pulmonary embolism in COVID-19 lesions

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Alice Le Berre ◽  
Tom Boeken ◽  
Caroline Caramella ◽  
Daniel Afonso ◽  
Caroline Nhy ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Suspected Pulmonary Embolism ◽  
Computed Tomography Pulmonary Angiography ◽  
High Prevalence ◽  
Perfusion Defects ◽  
Oxygen Requirements ◽  
D Dimer

Abstract Background Lung perfusion defects (PDs) have been described in COVID-19 using dual-energy computed tomography pulmonary angiography (DE-CTPA). We assessed the prevalence and characteristics of PDs in COVID-19 patients with suspected pulmonary embolism (PE) and negative CTPA. Methods This retrospective study included COVID-19 and non-COVID-19 pneumonia groups of patients with DE-CTPA negative for PE. Two radiologists rated the presence of PD within the lung opacities and analyzed the type of lung opacities and PD pattern (i.e. homogeneous or heterogeneous). The clinical, biological, radiological characteristics including time from first symptoms and admission to DE-CTPA, oxygen requirements, CRP, D-dimer levels, duration of hospital admission and death were compared within the COVID-19 group between patients with (PD +) or without PD (PD-). Results 67 COVID-19 and 79 non-COVID-19 patients were included. PDs were more frequent in the COVID-19 than in the non-COVID-19 group (59.7% and 26.6% respectively, p < 0.001). Patterns of PDs were different, with COVID-19 patients exhibiting heterogenous PDs (38/40, 95%) whereas non-COVID-19 patients showed mostly homogeneous perfusion defects (7/21 heterogeneous PDs, 33%), p < 0.001. In COVID-19 patients, most consolidations (9/10, 90%) exhibited PDs while less than a third of consolidations (19/67, 28%) had PDs in non-COVID-19 patients. D-dimer, oxygen levels and outcome were similar between COVID-19 PD + and PD- patients; however, time between admission and DE-CTPA was longer in PD + patients (median [IQR], 1 [0–7] and 0 [0–2]; p = 0.045). Conclusion Unlike in bacterial pneumonia, heterogeneous PDs within lung opacities are a frequent feature of COVID-19 pneumonia in PE-suspected patients.

Effect of Aerosol Inhalation of Budesonide Suspension on Clinical Efficacy, Remission Time of Asthma and Disappearance Time of Rales in Children with Mycoplasma Pneumoniae Pneumonia

2021 ◽  
Vol 7 (5) ◽  
pp. 3057-3062
Author(s):  
TingTing Zheng ◽  
XiNi Liu ◽  
Xuechun Chen
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Clinical Efficacy ◽  
Oral Treatment ◽  
Control Group ◽  
Study Group ◽  
Aerosol Inhalation ◽  
Significant Difference ◽  
Disappearance Time ◽  
And Control ◽  
Mycoplasma Pneumoniae Pneumonia

To investigate the effect of aerosol inhalation of budesonide suspension on clinical efficacy, remission time of asthma and disappearance time of rales in children with mycoplasma pneumoniae pneumonia. Methods: 100 cases of mycoplasma pneumoniae pneumonia in our hospital from February 2019 to February 2021 were randomly divided into study group (n = 50) and control group (n = 50). The control group was given azithromycin intravenous drip followed by oral treatment, and the study group was given aerosol inhalation of budesonide suspension on the basis of the control group. Results: Compared with the control group, disappearance time of rales in the study group, remission time of cough, remission time of asthma and time of hospitalization in the study group were relatively short (P<0.05), and the efficacy in the study group was relatively high (P<0.05). There was no significant difference in the incidence of nausea, vomiting, abdominal pain, diarrhea and hoarseness between the two groups (P>0.05). The improvement of FVCS FEV1 and PEF and other indexes was relatively high in the study group by comparing with the control group (P<0.05). Conclusion: Aerosol inhalation of budesonide suspension in children with mycoplasma pneumoniae pneumonia can effectively enhance the therapeutic effect, promote the improvement of lung function, and reduce the disappearance time of rales and remission time of asthma, so it can be popularized.

scholarly journals Gender-related differences in clinical presentation, electrocardiography signs, laboratory markers and outcome in patients with acute pulmonary embolism

2016 ◽  
Vol 73 (9) ◽  
pp. 844-849 ◽  
Author(s):  
Slobodan Obradovic ◽  
Boris Dzudovic ◽  
Sinisa Rusovic ◽  
Vesna Subota ◽  
Dragana Obradovic
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Clinical Presentation ◽  
Univariate Analysis ◽  
Pulmonary Angiography ◽  
Laboratory Findings ◽  
Laboratory Markers ◽  
Significant Difference ◽  
Echocardiographic Examination ◽  
Gender Specific Differences

Background/Aim. Acute pulmonary embolism (PE) is a potentially life threating event, but there are scarce data about genderrelated differences in this condition. The aim of this study was to identify gender-specific differences in clinical presentation, the diagnosis and outcome between male and female patients with PE. Methods. We analysed the data of 144 consecutive patients with PE (50% women) and compared female and male patients regarding clinical presentation, electrocardiography (ECG) signs, basic laboratory markers and six-month outcome. All the patients confirmed PE by visualized thrombus on the multidetector computed tomography with pulmonary angiography (MDCTPA), ECG and echocardiographic examination at admission. Results. Compared to the men, the women were older and a larger proportion of them was in the third tertile of age (66.0% vs 34.0%, p = 0.008). In univariate analysis the men more often had hemoptysis [OR (95% CI) 3.75 (1.16-12.11)], chest pain [OR (95% CI) 3.31 (1.57-7.00)] febrile state [OR (95% CI) 2.41 (1.12-5.22)] and pneumonia at PE presentation [OR (95% CI) 3.40 (1.25-9.22)] and less likely had heart decompensation early in the course of the disease [OR (95%CI) 0.48 (0.24-0.97)]. In the multivariate analysis a significant difference in the rate of pneumonia and acute heart failure between genders disappeared due to strong influence of age. There was no significant difference in the occurrence of typical ECG signs for PE between the genders. Women had higher level of admission glycaemia [7.7 mmol/L (5.5-8.2 mmol/L) vs 6.9 mmol/L (6.3-9.6 mmol/L), p = 0.006] and total number of leukocytes [10.5 x 109/L (8.8-12.7 x 109/L vs 8.7 x 109/L (7.0-11.6 x 109/L)), p = 0.007]. There was a trend toward higher plasma level of brain natriuretic peptide in women compared to men 127.1 pg/mL (55.0-484.0 pg/mL), p = 0.092] vs [90.3 pg/mL (39.2-308.5 pg/mL). The main 6-month outcomes, death and major bleeding, had similar frequencies in both sexes. Conclusion. There are several important differences between men and women in the clinical presentation of PE and basic laboratory findings which can influence the diagnosis and treatment of PE.

Quantitative lobar pulmonary perfusion assessment on dual-energy CT pulmonary angiography: applications in pulmonary embolism

2020 ◽  
Vol 30 (5) ◽  
pp. 2535-2542 ◽  
Author(s):  
Ramandeep Singh ◽  
Ryan Zipan Nie ◽  
Fatemeh Homayounieh ◽  
Bernhard Schmidt ◽  
Thomas Flohr ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Pulmonary Perfusion ◽  
Ct Pulmonary Angiography ◽  
Perfusion Assessment

scholarly journals Dual-energy Spectral CT Quantitative Parameters for the Differentiation of Glioma Recurrence from Treatment-Related Changes: A Preliminary Study

2019 ◽  
Author(s):  
Yanchun Lv ◽  
Jian Zhou ◽  
Xiaofei Lv ◽  
Li Tian ◽  
Haoqiang He ◽  
...  
Keyword(s):  
Atomic Number ◽  
Predictive Value ◽  
Effective Atomic Number ◽  
Roc Curves ◽  
Iodine Concentration ◽  
Dual Energy ◽  
Spectral Ct ◽  
Quantitative Parameters ◽  
Glioma Recurrence ◽  
Venous Phase

Abstract Background: Differentiating glioma recurrence from treatment-related changes can be challenging on conventional imaging. We evaluated the use of dual-energy spectral computed tomographic (CT) quantitative parameters for this differentiation. Methods: Twenty-eight patients were examined by dual-energy spectral imaging CT. The slope of the spectral Hounsfield unit curve (λ HU ), effective atomic number (Z eff ), normalized effective atomic number (Z eff-N ), iodine concentration (IC), and normalized iodine concentration (IC N ) in the post-treatment enhanced areas were calculated. Pathological results or clinicoradiologic follow-up of ≥2 months were used for final diagnosis. Nonparametric and t -tests were used to compare quantitative parameters between glioma recurrence and treatment-related changes. Positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated; sensitivity and specificity were calculated using receiver operating characteristic (ROC) curves. ROC curves were generated using predictive probabilities to evaluate the diagnostic value. Results: There were no significant differences in quantitative parameters based on examination of pre-contrast λ HU , Z eff , Z eff-N , IC, IC N and venous phase IC N ( P >0.05). Venous phase λ HU , Z eff , Z eff-N , and IC in glioma recurrence were higher than in treatment-related changes ( P <0.001). The optimal venous phase threshold was 1.03, 7.75, 1.04, and 2.85 mg/cm 3 , achieving 66.7%, 91.7%, 83.3%, and 91.7% sensitivity; 100.0%, 77.8%, 88.9%, and 77.8% specificity; 100.0%, 73.3%, 83.3%, and 73.3% PPV; 81.8%, 93.3%, 88.9%, and 93.3% NPV; and 86.7%, 83.3%, 86.7%, and 83.3% accuracy, respectively. The areas under the curve (AUC) were 0.912, 0.912, 0.931, and 0.910 in glioma recurrence and treatment-related changes, respectively. Conclusions: Dual-energy spectral CT imaging may provide quantitative values to aid in differentiation of glioma recurrence from treatment-related changes.

Streptokinase and Urokinase in the Treatment of Pulmonary Thromboemboli

1976 ◽  
Vol 35 (01) ◽  
pp. 057-069 ◽  
Author(s):  
William R Bell
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Phase I ◽  
Phase Ii ◽  
Clinical History ◽  
Pulmonary Angiography ◽  
Lung Perfusion ◽  
Bleeding Complications ◽  
Significant Difference ◽  
Cardiopulmonary Hemodynamics

SummaryIn Phase I of this study of 160 patients with pulmonary embolism, it was demonstrated that 12 hours of urokinase accelerated the resolution of pulmonary thromboemboli compared to heparin alone. Phase II compared 12 hours of urokinase, 24 hours of urokinase and 24 hours of streptokinase in 167 patients. All patients had a clinical history and angiographic diagnosis of pulmonary embolism. Patients were randomly allocated to treatment. All physicians making patient observations were unaware of drug assignment.Resolution of the thromboembolism 24–30 hours after therapy had been instituted was determined by pulmonary angiography, lung perfusion scans and cardiopulmonary hemodynamics. Twenty-four hours of urokinase did not demonstrate greater clot resolution than 12 hours of urokinase. Twenty-four hours of urokinase resulted in greater improvement than streptokinase in lung perfusion scans, but not in angiograms. In patients with massive embolism, this difference was statistically significant. Hemodynamic differences varied.Bleeding complications and morbidity due to allergic reactions with streptokinase and urokinase were minimal. There was no statistically significant difference in mortality in the three treatment groups.From the Phase I and Phase II data it is reasonable to conclude that all three regimens of thrombolytic therapy are more effective than heparin alone in accelerating resolution of pulmonary emboli. Thrombolytic therapy offers the clinician an alternative to pulmonary embolectomy.

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