[Radiological features of dual-energy CT lung perfusion imaging in patients with acute pulmonary embolism: comparison with CT pulmonary angiography].
Yan ZhangShuyang ZhangZhengyu JinHuadan XueXiaona ZhangJixiang LiangYunqing ZhangKai XuBing QiWenmin ZhaoYun Wang
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Abstract:
To explore the relationship of the perfusion defects in the dual-energy CT lung perfusion image and the filling defects in the CT pulmonary angiography (CTPA) in patients with acute pulmonary embolism.The clinical data of 22 patients with acute pulmonary embolism were retrospectively analyzed. All of them underwent contrast CT scan in two phases using dual-energy CT: the first is pulmonary artery phase, and the second was performed immediately after the first phase using dual-energy scan covered the whole lung. Perfusion defects in the lung perfusion images were compared with the filling defects in the CTPA.Complete filling defects of segmental and subsegmental pulmonary arteries mostly showed correspondence perfusion defects in the CT perfusion map, accounting for 83% and 62% respectively. However, when there were partial or central filling defects, most of them were partial perfusion defects or normal in the CT perfusion map. Three segmental perfusion defects were depicted without the visualization of endoluminal thrombi within the corresponding arteries.The perfusion defects in the CT lung perfusion image are not completely corresponding to the filling defects in the CTPA. The combination of CTPA and CT lung perfusion map will offer more information for the acute pulmonary embolism.Keywords:
Pulmonary angiography
Dual energy
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Pulmonary angiography
Dual energy
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Magnetic resonance angiography
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Objective:To study the valuation of multi-slice spiral CT in the diagnosis of pulmonary embolism.Methods:24 cases of pulmonary embolism were examined with multi-slice spiral CT pulmonary angiography,the reformation images consisted of 1.0 mm slices,with 0.7 mm reconstruction intervals and 0.75 mm slices,with 0.5 mm reconstruction intervals,VRT,MIP and MPR were adopted as post-processing techniques of CT pulmonary angiography,and then images were compared.Results:In 24 cases of PE,76 branches of pulmonary embolism were identified,including 6 aortopulmonay arteries,36 lobar arteries,27 segmental pulmonary arteries and 7 subsegmental pulmonary arteries,PE showed that was no a significant difference between images of 1.0 mm slices and 0.75 mm slices reformation.Conclusion:Multi-slice spiral CT pulmonary angiography proves to be highly sensitivity and strongly specificity for the diagnosis of pulmonary embolism,CTPA is safety,immediate,noninvasive,it shoud be the first choice for the detection of PE.
Pulmonary angiography
Spiral computed tomography
Pulmonary vasculature
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Objective: To investigate the value of diagnosis of pulmonary embolism by co-registration SPECT/CT image fusion.Methods:78 patients who were suspected pulmonary embolism were studied,man 26,female 52,28 to 80 years old.78 patients underwent 99mTc-MAA Lung perfusion image including eight-direction static imaging and SPECT/CT image fusion without changing the position of the patients.The emission image with X-ray map was reconstruct by OSEM.Results: Among 78 patients,40 were diagnosed pulmonary embolism by SPECT/CT.The sensitivity and specificity were 90%(36/40) and 84.2%(32/38),fake masculine and fake negative were 15.8%(6/38) and 10%(4/40).The exact rate of SPECT/CT image fusion was 87.2%(68/78)and was similar to that of pulmonary perfusion/ventilation imaging in literature reports.Conclusion: Pulmonary perfusion SPECT/CT image fusion can get both information of pulmonary perfusion and transparency in one study.The method had distinct advantages in diagnosing pulmonary embolism.
Spect imaging
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Objective To assess the clinical value of dual source CT dual energy lung perfusion imaging in the diagnosis of suspected pulmonary embolism(PE). Methods 25 patients with suspected PE received contrast enhanced dual source CT scanning with dual energy mode. The dedicated software of Dual Energy was used for image post-processing. The number and location of PE in dual energy perfusion imaging(DEPI) and CT pulmonary angiography(CTPA) were recorded respectively. Sensitivity and specificity were measured comparing to CTPA as a standard of reference. The relationship between range of lung perfusion abnormality in DEPI and cardiovascular measurements was analyzed. Result 21 lobes, 47 segmental and 37 sub-segmental were involved with pulmonary embolism. The 95.2%, 89.4% and 89.2% agreement between DEPI and CTPA were showed in the levels of lung and partial lung respectively. Complete filling defects of segmental and subsegmental pulmonary arteries mostly showed correspondence perfusion defects in the CT perfusion map. However, when there were partial filling defects, most of them were partial perfusion defects. A few of them were normal in the CT perfusion map. Otherwise, segmental perfusion defects were depicted without the visualization of endo-luminal thrombi in some patients. Conclusions DEPI may reveal abnormal perfusion resulted by PE. The combination of CTPA and DEPI will offer more information for diagnosis of the acute pulmonary embolism.
Dual energy
Pulmonary angiography
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On value of the dual source CT dual energy perfusion imaging for the diagnosis of pulmonary embolism
Objective To study the diagnostic value of dual source CT dual energy perfusion imaging( DEPI) for pulmonary embolism. Methods A retrospective analysis of clinical data was conducted in 95 patients with a clinical diagnosis of pulmonary embolism suspected who were admitted in Nanshan hospital from March 2010 to February 2014. All of them underwent dual energy imaging. The images were evaluated with lung PBV software on the workstation,then CT pulmonary angiography( CTPA),DEPI and fusion image were obtained. The number and location of PE in DEP I and CTPA were recorded and analyzed. The sensitivity,specificity,positive predictive value( PPV) and negative predictive value( NPV) of DEPI images for the diagnosis of PE were calculated. Results To lung as evaluation unit,the DEPI detection perfusion defect or sparse 47,CTPA checked out the corresponding vascular embodiment 50,the coincidence rate is94. 0%,Pulmonary segments as evaluation unit,the DEPI detected 145 lung segment have perfusion defects or reduction,and the CTPA detected 156 embolus coincidence rate was 93. 0%. Pulmonary subsegment as evaluation unit,DEPI detected 81 lung subsegment have perfusion defects or reduction,and the CTPA detected 103 embolus coincidence rate was 79. 0%. The sensitivity,specificity,PPV and NPV of DEPI for the diagnosis of PE was 94. 0%,83. 0%,94. 0%,89. 0%,the K value was 0. 82. Conclusion the dual source CT dual energy perfusion imaging can sensitively display pulmonary embolism caused by perfusion defects or sparse,make up for the CTPA show distal pulmonary embolus deficiency,and can also provide functional and anatomical information,improve the accuracy of diagnosis of pulmonary embolism.
Pulmonary angiography
Embolus
Dual energy
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Objective To evaluate the value of 16-slice spiral CT pulmonary angiography in detecting peripheral pulmonary embolismin canine models. Methods The peripheral pulmonary embolism animal modes were made in 9 dogs by introducing gelatin sponge of2～4 mm in diameter and 1 cm at length into pulmonary arteries through a catheter under DSA,MSCTPA examination was performed 10 dayslatter, the original images were reconstructed at the console workstation. The image findings were compared with that of pathologicaldissections.Results The program of pulmonary embolism models in 9 cases was finished and pulmonary infarction were found in four dogs,52 pulmonary arteries including 2 lode arteries , 18 segmental arteries and 32 subsegmental arteries were involved to be found on MSCTPA,while 55 pulmonary arteries including 2 lode arteries,18 segmental arteries and 35 subsegmental arteries were involved in pathologicaldissections .The accuracy of 16-slice spiral CT pulmonary angiography in diagnosis of peripheral pulmonary embolism and subsegmental pulmonary embolism was 94.34% and 91.43%,respectively, the positive predictive value was 94.12% in latter.Conclusion 16-slice spiral CT is a feasible method in diagnosing pulmonary embolism.
Spiral computed tomography
Pulmonary Infarction
Pulmonary angiography
Coronary arteries
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Objective To evaluate the value of the sixteen slice spiral CT and pulmonary perfusion/ventilation imaging in diagnosis of pulmonary embolism.Methods Imaging data (spiral CT scanning plus enhanced scanning and pulmonary perfusion/ventilation imaging) in 32 cases diagnosed as pulmonary embolism were retrospectively compared and analyzed.Results The detecting rate of spiral CT enhanced scanning was 90.6%.Pulmonary segments involved in 43.2%, while the detecting rate of the pulmonary perfusion and ventilation imaging was 84.4% and the involved rate of pulmonary embolism was 36.8% ,respectively.Conclusion Spiral CT enhanced scanning is a perfect method for observing direct sign of pulmonary embolism, especially combined with pulmonary perfusion/ventilation imaging.
Ventilation perfusion mismatch
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Neuroradiology
Multislice
Bronchial artery
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Machbarkeitsstudie zur Dual-Energy-CT-Angiografie (CTA) der Lunge bei Patienten mit Verdacht auf Lungenembolie. 24 Patienten mit Verdacht auf Lungenembolie wurden mit einer Dual-Energy-CTA (A-System: 140 kV/ 65 mAsref, B-System: 80 kV/ 190 mAsref) an einem Dual-Source-CT untersucht. Mittels einer speziellen Dual-Energy-Software wurden Voxel, die sowohl Luft und Jod enthielten, in farbkodierten Perfusionskarten visualisiert. Auf den Perfusionskarten wurden Perfusionsdefekte als mit einer Lungenembolie vereinbar oder nicht vereinbar durch 2 geblindete Radiologen klassifiziert. Die Bildqualität der Perfusionskarten wurde anhand einer 5-Punkte-Skala bewertet (1: exzellent, 5: ungenügend). Als Goldstandard für die Diagnose einer Lungenembolie diente die Auswertung der CTA durch einen dritten unabhängigen Radiologen. In allen Patienten mit Lungenembolie (n = 4) wurden mit einer Lungenembolie vereinbare Perfusionsdefekte in den von der Lungenembolie betroffenen Lungenabschnitten identifiziert. In den Patienten ohne Lungenembolie wurde von keinem der Auswerter als mit einer Lungenembolie vereinbare Perfusionsdefekte identifiziert. Daher betrug für beide Auswerter die patientenbasierte Sensitivität und Spezifität für die Diagnose einer Lungenembolie 100 %. Segmentbasiert betrug die Sensitivität und Spezifität zwischen 60 – 66,7 % und 99,5 – 99,8 %. Die Übereinstimmung zwischen beiden Auswertern war gut (k = 0,81). Perfusionsdefekte, die nicht als mit einer Lungenembolie vereinbar klassifiziert wurden, wurden am häufigsten durch Streifenartefakte durch dichtes Kontrastmittel in den großen thorakalen Gefäßen hervorgerufen. Der mediane Score der Bildqualität der Perfusionskarten betrug 2. Zusammenfassend erlaubt die Dual-energy-CTA der Lunge die Visualisierung von durch eine Lungenembolie hervorgerufenen Perfusionsdefekten. Zur Reduzierung von Artefakten durch dichtes Kontrastmittel ist eine Optimierung des Injektionsprotokolls erforderlich.
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