Diagnostic Value of Pulmonary Artery Hypodense and Hyperdense Luminal Sign in Non-Contrast Thoracic CT Scan for Detection of Pulmonary Embolism

Izadi, Meisam; Salehnia, Nasim; Rad, Masoud Pezeshki; Reihani, Hamidreza; Shafiee, Fateme

doi:10.26502/jrci.2809050

Cited by 2 publications

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“…Similar to pulmonary emboli, this sign was most prevalent in the persistent phase of the disease. As the thrombus ages, its water content decreases, concentrating the hemoglobin and raising the CT attenuation value; this process usually requires at least 80 h to occur, explaining the low prevalence of this radiographic finding during the acute phase [ 29 , 30 , 31 ]. Hyperdense vessels persist in the chronic phase of the disease as the calcifications would not be expected to resolve.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 on Chest CT: Translating Known Microscopic Findings to Imaging Observations

D’Souza

Capaccione

Soleiman

et al. 2022

Life

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Purpose: To describe the imaging findings of COVID-19 and correlate them with their known pathology observations. Methods: This is an IRB-approved retrospective study performed at Columbia University Irving Medical Center (IRB # AAAS9652) that included symptomatic adult patients (21 years or older) who presented to our emergency room and tested positive for COVID-19 and were either admitted or discharged with at least one chest CT from 11 March 2020 through 1 July 2020. CT scans were ordered by the physicians caring for the patients; our COVID-19 care protocols did not specify the timing for chest CT scans. A scoring system was used to document the extent of pulmonary involvement. The total CT grade was the sum of the individual lobar grades and ranged from 0 (no involvement) to 16 (maximum involvement). The distribution of lung abnormalities was described as peripheral (involving the outer one-third of the lung), central (inner two-thirds of the lung), or both. Additional CT findings, including the presence of pleural fluid, atelectasis, fibrosis, cysts, and pneumothorax, were recorded. Contrast-enhanced CT scans were evaluated for the presence of a pulmonary embolism, while non-contrast chest CT scans were evaluated for hyperdense vessels. Results: 209 patients with 232 CT scans met the inclusion criteria. The average age was 61 years (range 23–97 years), and 56% of the patients were male. The average score reflecting the extent of the disease on the CT was 10.2 (out of a potential grade of 16). Further, 73% of the patients received contrast, which allowed the identification of a pulmonary embolism in 21%. Of those without contrast, 33% had hyperdense vessels, which might suggest a chronic pulmonary embolism. Further, 47% had peripheral opacities and 9% had a Hampton’s hump, and 78% of the patients had central consolidation, while 28% had round consolidations. Atelectasis was, overall, infrequent at 5%. Fibrosis was observed in 11% of those studied, with 6% having cysts and 3% pneumothorax. Conclusions: The CT manifestations of COVID-19 can be divided into findings related to endothelial and epithelial injury, as were seen on prior post-mortem reports. Endothelial injury may benefit from treatments to stabilize the endothelium. Epithelial injury is more prone to developing pulmonary fibrotic changes.

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Section: Discussionmentioning

confidence: 99%

COVID-19 on Chest CT: Translating Known Microscopic Findings to Imaging Observations

D’Souza

Capaccione

Soleiman

et al. 2022

Life

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Diagnostic Accuracy in Quantitative Evaluation of Attenuation of Pulmonary Thrombus on Noncontrast Computed Tomography Scan

Abhiram,

Masimade,

Sushaal

2023

APIK Journal of Internal Medicine

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Objectives: The objective is to assess the role of noncontrast computed tomography (NCCT) in the identification of pulmonary thromboembolism (PTE) using the difference in attenuation value between thrombus and blood pool and to establish its diagnostic accuracy. Methods: A single-center retrospective analysis was carried out for 1 year among the patients of all age groups who were referred for imaging workup with clinical suspicion of pulmonary embolism (PE). A standard protocol was followed for all the patients undergoing computed tomography pulmonary angiography (CTPA). The diagnosis of PE was based on the direct visualization of the intraluminal thrombus as complete/partial filling defect on CTPA. The average attenuation value of the thrombus on NCCT was measured retrospectively after referring to its position on the corresponding enhanced scans. The difference in attenuation of the pulmonary vessels with and without the thrombus was calculated on NCCT. The data was utilized in the generation of receiver operator characteristic curve to obtain the best cut off level for attenuation differences of the vessels and its accuracy in detecting PTE was determined. Results: Among the study population of 50 subjects, the mean age was found to be 42 years in our study with male sex (72%) having more preponderance to PTE than female sex (28%). The average blood pool range was between 20 and 60 Hounsfield unit (HU). The mean of differences in attenuation between thrombus and blood pool was 34.07 HU. The optimal cut off level for PE affection proved to be difference in attenuation of the pulmonary arteries of more than 20 HU. The sensitivity and specificity were 89.47% and 83.33%, respectively. Conclusion: In clinically suspected cases of PTE, CTPA is the most reliable diagnostic tool. However, with plain computed tomography itself, considering the difference in attenuation values, the thrombus can be identified in majority of the cases thereby reducing the exposure to radiation and contrast to the patients.

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Diagnostic Value of Pulmonary Artery Hypodense and Hyperdense Luminal Sign in Non-Contrast Thoracic CT Scan for Detection of Pulmonary Embolism

Cited by 2 publications

References 0 publications

COVID-19 on Chest CT: Translating Known Microscopic Findings to Imaging Observations

COVID-19 on Chest CT: Translating Known Microscopic Findings to Imaging Observations

Diagnostic Accuracy in Quantitative Evaluation of Attenuation of Pulmonary Thrombus on Noncontrast Computed Tomography Scan

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