Clinical value of dual energy spectral CT imaging in diagnosing pulmonary embolism and perfusion defect
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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.Cite
Pulmonary angiography
Dual energy
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Dual-Energy CT for the Assessment of Contrast Material Distribution in the Pulmonary ParenchymaSven F. Thieme1, Thorsten R. C. Johnson1, Christopher Lee2, Justin McWilliams3, Christoph R. Becker1, Maximilian F. Reiser1 and Konstantin Nikolaou1Audio Available | Share
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Parenchyma
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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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The purpose of this article is to systematically investigate focal iodine defects found in patients without other CT evidence for pulmonary embolism on color-coded iodine perfusion maps of dual-energy pulmonary CT angiography scans.Forty-three patients (mean age, 56.9 years; range, 29-88 years) who underwent pulmonary CT angiography using dual-energy CT from November 2007 to February 2008 but who had no pulmonary embolism were included in our study. Dark orange- or black-colored areas on color-coded iodine perfusion maps were interpreted as focal iodine defects. Two radiologists recorded the presence, location, and characteristics of the focal iodine defects in consensus and evaluated the examinations with regard to the causes of the focal iodine defects.Focal iodine defects were found in 41 patients (95%). The most commonly involved segments were the anterior segment of the right upper lobe (33/38, 86.8%), the apical segment of the right upper lobe (32/38, 84.2%), the medial segment of the right middle lobe (32/38, 84.2%), the apicoposterior segment of the left upper lobe (35/42, 83.3%), the superior and inferior lingular segments of the left upper lobe (23/42, 54.8%), and the medial-basal segment of the right lower lobe (11/32, 34.4%). Beam-hardening artifacts caused by contrast material in the superior vena cava accounted for nearly all defects in the apices of both upper lobes. Cardiac motion was the most common cause of defects in right middle lobe and left upper lobe lingular segments, and diaphragmatic motion was the most common cause in the lung bases.Knowledge of the focal iodine defects not related to pulmonary embolism leads to more accurate interpretation of dual-energy pulmonary CT angiography scans.
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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.
Pulmonary angiography
Dual energy
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Objective To investigate the diagnostic value of multi-slice CT angiography(MSCTA) with different reconstruction intervals in diagnosis of pulmonary embolism. Materials and Methods 36 patients with pulmonary embolism underwent MSCTA and the transverse images were reconstructed with 10%、50%、70% overlapping followed by MPR respectively.The manifestation ratio of pulmonary embolus in transverse and MPR images with different reconstruction intervals were compared. Results 298 pulmonary arteries were involved among 36 pulmonary embolism patients.Three different types of transverse and the coresponding MPR images had the same result for detecting the embolism of primary pulmonary artery and lobar arteries.For detecting the embolism of segmental arteries,the images with 50% and 70% overlapping were much better than images with 10% overlapping,and no significant difference was observed between images with 50% and 70% overlapping. Conclusion The transverse images with 50% overlapping can improve the manifestation ratio of segmental arteries embolism compared with images with 10% overlapping,and there is no need to increase the reconstruction interval to 70%.
Pulmonary angiography
PULMONARY EMBOLUS
Embolus
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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 discuss the diagnostic value of spiral CT pulmonary angiography in the diagnosis of pulmonary embolism(PE).Methods:12 patients with PE were performed spiral CT volume scanning.Three dimensional and multiplanar images of pulmonary artery were obtained after post procession in the work station.Results:Among 196 branches of pulmonary arteries in 12 patients,PE was found in 46.4%.Embolism located in main pulmonary artery,left or right pulmonary artery,lobar arteries and segmental arteries.On multiplanar images,it showed intraluminal filling defect or no contrast medium in distant pulmonary arteries.On the pulmonary angiography images,it showed filling defect or cutting off sign in main pulmonary arteries;similar changes were observed in the lobar or segmental branches.Conclusion:SCTA images could obtain more diagnostic imformation by observing PE from different directions.SCTA is a reliable method in diagnosis of PE above the level of lobar or segmental artery.
Pulmonary angiography
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