Computed tomography of acute pulmonary embolism: state-of-the-art

Abstract

Multidetector computed tomography (CT) plays an important role in the detection, risk stratification and prognosis evaluation of acute pulmonary embolism. This review will discuss the technical improvements for imaging peripheral pulmonary arteries, the methods of assessing pulmonary embolism severity based on CT findings, a multidetector CT technique for pulmonary embolism detection, and lastly, how to avoid overutilization of CT pulmonary angiography and overdiagnosis of pulmonary embolism. Key Points • We describe clinical prediction rules and D-dimers for pulmonary embolism evaluation. • Overutilization of CT pulmonary angiography and overdiagnosis of pulmonary embolism should be avoided. • We discuss technical improvements for imaging peripheral pulmonary arteries. • Pulmonary embolism severity can be assessed based on CT findings. • We discuss multidetector CT techniques for pulmonary embolism detection.

Computed tomography pulmonary angiography for acute pulmonary embolism: prediction of adverse outcomes and 90-day mortality in a single test

“…The azygos vein diameter was higher in the OTHERS group (10 mm [8][9][10][11]), with a p-value of 0.028. The OTHERS group had more subsegmental artery involvement (52 [71%]) than the adverse outcome (5 [31%]), death within 30 days (4 [40%]), and death within 30-90 days (1 [20%]) groups (p = 0.003).…”

“…Because PE may cause death after right ventricular failure and circulatory collapse, right ventricle (RV) dysfunction should be detected rapidly to identify patients who might benefit from fibrinolytic therapy [1]. Recently, computed tomography has enabled noninvasive PE diagnosis [10,11]. Every year, many patients undergo pulmonary computed tomography (CT) angiography and receive ionising radiation; therefore, it would be prudent to investigate as many CT findings as possible to identify…”

Detection of pulmonary embolism with free-breathing dynamic contrast-enhanced MRI

“…With free-breathing DCE MRI we were able to detect perfusion defects caused by PE in very good agreement with contrast-enhanced CTPA, which is regarded as the gold standard for the diagnosis of PE. 2 Of the 16 patient lungs, 15 were affected by PE, as demonstrated by CTPA. In patient #6, both readers did not locate a perfusion defect in the left lung; however, in CTPA an obstruction was detected.…”

Vascular CT and MRI: a practical guide to imaging protocols

“…Acute pulmonary embolism (PE) is the third most common acute cardiovascular disorder after myocardial infarction and stroke [ 130 ]. CT pulmonary angiography (CTPA) is the non-invasive reference standard for PE diagnosis and risk stratification, identifying adverse prognostic indicators such as right ventricular dilatation, interventricular septal bowing and a high embolus burden [ 131 ]. DECT, in particular iodine map reconstructions, have been shown to improve the accuracy of pulmonary emboli detection on CT, by demonstrating areas hypoperfused lung [ 43 , 44 ].…”