Diagnostic Value of Sixteen Slice SCT and Pulmonary Perfusion/ventilation Imaging in Pulmonary Embolism
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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.Keywords:
Ventilation perfusion mismatch
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Objective To evaluate the clinical application of spiral CT pulmonary angiography(SCTPA) in the diagnosis of pulmonary embolism(PE) and its limitation.Methods 52 cases of PE were analyzed.SCTPA were performed in all cases with slice thickness 3 mm,pitch 1.5~2.0,scanning time 0.8 s,reconstruction thickness 1mm.The reconstructions of SCTPA included MIP,MPR and SSD.Results 2898 pulmonary arteries in 52 cases were observed.The direct manifestations of PE were showed in 927 pulmonary arteries(32.0%) by SCTPA,in which superior segmental and inferior segmental of pulmonary arteries were involved respectively.The indirect manifestations of PE were showed by plain scan in 113 cases.Conclusion SCTPA is a high effective and noninvasive method in the diagnosis of PE especially for the PE of superior segmental.
Pulmonary angiography
Spiral computed tomography
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Objective:To study the Multi-slice Helical CT detection methods in the pulmonary embolism.Methods:15 suspected patients with pulmonary embolism were performed with dual-phase enhanced CT scan and all the data were reconstructed by MPR,VR,CPR and MIP in the workstop.Results:All cases were acquired content imaging,and 34 branches of pulmonary embolism were identified in 15 cases: right pulmonary arteries in 6 cases(17.6%),left pulmonary arteries in 7 cases(20.6%),lobar arteries in 12 cases(35.3%),segmental arteries in 8 cases(23.5%),subsegmental artery in 1 case(2.9%).Conclusion:MSCT and CTA are the effective immediate,and safe methods for the diagnosis of pulmonary embolism.
Helical computed tomography
Main Pulmonary Artery
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To comprehensively assess thoracic anatomy and pulmonary microcirculation in pulmonary embolism by using computed tomographic (CT) angiography of the pulmonary arteries combined with functional CT imaging of blood flow.Twenty-two patients suspected of having acute pulmonary embolism underwent contrast material-enhanced thin-section electron-beam CT angiography of the pulmonary arteries. In addition, in each patient, a dynamic multisection blood flow CT study was performed on a 7.6-cm lung volume with electrocardiographic gating. Pulmonary blood flow was calculated, and perfusion parameters were visualized on color-coded maps. The color-coded maps and CT angiograms were independently evaluated, segment by segment, by two readers for perfusion deficits and the presence of clots, respectively. The results were compared.Mean pulmonary blood flow was 0.63 mL/min/mL in the occluded segments versus 2.27 mL/min/mL in the nonoccluded segments (P: =.001). The sensitivity and specificity of perfusion maps for the presence of segmental pulmonary embolism compared with those of CT angiography were 75.4% and 82.3%, respectively, with positive and negative predictive values of 79.6% and 84.7%, respectively. The false-negative findings were caused mainly by partial occlusion of vessels. In eight patients, a substantial alternative or additional pathologic entity was diagnosed.By combining CT angiography and dynamic CT imaging, a comprehensive and noninvasive diagnosis of thoracic structure and function is feasible with a single modality.
Pulmonary angiography
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Value of Dual-energy Lung Perfusion Imaging Using a Dual-source CT System for the Pulmonary Embolism
To investigate the diagnostic value of dual-energy lung perfusion imaging (DEPI) using a dual-source CT system for the pulmonary embolism (PE).50 patients in high acute PE prevalence were enrolled to accept the DEPI (lung perfusion image and CTA image of pulmonary artery acquired through the Dual Energy software) and emergent DSA angiography (golden diagnostic criterion).Patients using CT had significantly reduced examination duration and dosage of contrast agent than those using DSA examination, (P < 0.05). In total, 260 pulmonary arteries and 1020 pulmonary segments were examined through CTA, in which embolisms were identified in 50 lobes of lung, 108 pulmonary segments and 82 sub-segments. Reduction or lack of perfusion was identified through DEPI in 48 lobes of lung (concordance rate of 96.0%), 103 pulmonary segments (concordance rate of 95.4%) and 78 subsegments (concordance rate of 95.1%). The comparison of embolism quantity and morphological characteristics of pulmonary artery between CTA images and DEPI images showed no statistically significant difference.Better application value can be achieved in the diagnosis of pulmonary embolism by dual-energy lung perfusion imaging using a dual-source CT system.
Pulmonary angiography
Concordance
Dual energy
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Objective To evaluate the role of single-slice spiral CT pulmonary angiography in diagnosis of pulmonary embolism(PE).Methods Thin collimation single-slice spiral CT pulmonary angiography(CTPA) was preformed in 31 patients suspected of PE. The raw data were used to perform the reconstruction with lmm section thickness. The axial images of 3mm,1mm section thickness were compared. Results Direct signs in- cluding filling defects, mural thrombus and complete occlusion and indirect signs, such as pulmonary artery hy- pertension, were detected using CTPA.1mm effective thickness images demonstrated more abnormalities in segmental and subsegmental pulmonary arteries, compared with 3 mm effective thickness images(P0.05). Conclusion Single-slice spiral CT is a fast and valid technique for the diagnosis of PE.
Pulmonary angiography
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Objective To explore the application value of multi slice spiral CT angiography in evaluating pulmonary artery embolism.Methods Data of 11 patients with pulmonary artery embolism were retrospectively analyzed,the contrast-enhanced SCT scans of the pulmonary arteries were performed.MPR,MIP and VR were performed simultaneously.Results The CT value of enhanced pulmonary artery was obviously higher than the thrombus,the position and morphology of embolus in pulmonary artery were clearly displayed in cross section CT pictures with MPR,CPR,MIP and VR.Conclusion Multi slice CT angiography can clearly show the position and morphology of embolus in pulmonary artery,which has obvious technique advantage and higher value in the diagnosis of pulmonary artery embolism.
Embolus
Main Pulmonary Artery
Pulmonary angiography
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Purpose:To evaluate the clinical value of Multi - slice spiral computer tomography pulmonary angiography(MSCTPA)in diagnosis of pulmonary embolism(PE).Methods:Multi-slice spiral CT pulmonary angiography was performed in 196 patients who were suspected of PE from April 2007 to December 2008.The images of these patients were analyzed.Results:The display rate of 1-5 level pulmonary arteries were 100.00%,100.00%,100.00%,99.67%and 98.00%.In the PE group,there was statistical significance in the display rate of the 5 level pulmonary arteries between 16 - slice and 64- slice spiral CT(P0.05).In the N - PE group,there was no statistical significance in the display rate of the 5 level pulmonary artery between 16 - slice and 64 - slice spiral CT(P0.05);there was no statistical significance in the display rate of the 5 level pulmonary artery between PE and Non-PE(P0.05) when 16 - slice spiral CT was used;there was no statistical significance in the display rate of the 5 level pulmonary artery between PE and Non - PE(P0.05) when 64 - slice spiral CT was used.The direct sign of pulmonary embolism was filling defect in different degree,the indirect signs including pulmonary hypertension,lung infraction and pleural effusion,the incidence rate of which were 50.62%, 33.33%and 41.97%respectively.Conclusion:MSCTPA was a reliable and convenience examination for diagnosis of pulmonary embolism.
Pulmonary angiography
Spiral computed tomography
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Objective To assess the value of clinical application of spiral CT pulmonary angiography(SCTPA). Methods 82 patients underwent spiral CT pulmonary angiography using Simens Somatom Plus 4 CT scanner with 3 mm slice thickness pitch 1.5, 1.2 mm reconstruction interval and 3-4 ml/s contrast medium injection rate.The study included 30 normal subjects, 40 central pulmonary carcinoma with signs of central pulmonary artery(CPA) infiltration, 5 pulmonary artery aplasia, 4 pulmonary arteriovenous malformation, 3 after pulmonary artery sleeve resection plasty. 32 cases were proved by surgery pathology or DSA. Results SCTPA could clearly show central and peripheral pulmonary vessels and differentiate central pulmonary artery and vein in all 30 cases of normal group. SCTPA demonstrated narrowing, displacement and malformation of pulmonary vessels in 46 cases, as well as the relationship between pulmonary vessel and mass in 28 cases. Conclusion SCTPA is useful in evaluating diseases of pulmonary vessels, it can partly replace DSA.
Pulmonary angiography
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Objective To assess the clinical value of monochromatic and iodine- based material decomposition images by spectral CT imaging for diagnosing pulmonary embolism and perfusion defect. Methods Fifty- six patients with clinically suspected pulmonary embolism and with filling defects in the lobar pulmonary and segmental pulmonary arteries underwent CT angiography with spectral CT imaging mode by GE Discovery CT750HD scanner. Results In 56 patients,a total of 302 filling defects in the pulmonary arteries were detected,65 in the lobar pulmonary arteries and 237 in the segmental pulmonary arteries. 203 perfusion defects were detected based on the iodine images. There was no significant difference in the display rate between filling defects in the segmental pulmonary arteries and perfusion defects on the iodine- based lung perfusion images. The average iodine concentrations were 2. 21 ± 0. 50 mg·mL- 1 in the normal lung parenchyma and 0. 74 ± 0. 44 mg·mL- 1in perfusion defects and there was significant difference( P 0. 05). Conclusion There is good correlation between pulmonary embolism detected with the monochromatic CTA images and perfusion defect assessed with the iodine- base material decomposition images. Spectral CT may provide a reliable diagnose evidence in the evaluation of pulmonary embolism and associated functional changes in lung parenchyma.
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Objective To study the value of dual-slice spiral CT angiography for pulmonary embolism(PE).Methods Twelve patients with PE were scanned by dual-slice spiral CT (GE Hispeed NX/I scanner). Scan started with a delay time of 15s after injection of 100ml of nonionic contrast medium by automatic injector with flow rate 3.0-4.0ml/s and 20s of total scanning time. Data was transferred to and performed post-process in a Sun workstation (ADW 4.0). Results 97 pulmonary arteries (51%) were involved including 40% pulmonary artery trunk, main pulmonary and 61% interlobular arteries and segment arteries. Direct sign of PE were intraluminal-filling defects including partial, mural, total filling defects and railway-track sign. Indirect signs of PE were mosaic sign (lung window), focus of pulmonary infarction, decrease of pulmonary blood supply and enlargement of right ventricle. Conclusion Spiral CT angiography is a noninvasive and effective method for detecting PE. It can play a significant role in clinical diagnosis of PE.
Pulmonary Infarction
Pulmonary angiography
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