Effectiveness of Automated Quantification of Pulmonary Perfused Blood Volume Using Dual-Energy CTPA for the Severity Assessment of Acute Pulmonary Embolism

Meinel, Felix G.; Graef, Anita; Bamberg, Fabian; Thieme, Sven F.; Schwarz, Florian; Sommer, Wieland H.; Neurohr, C; Kupatt, Christian; Reiser, Maximilian; Johnson, Thorsten R. C.

doi:10.1097/rli.0b013e3182879482

Cited by 47 publications

(30 citation statements)

References 42 publications

(33 reference statements)

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“…In oncological imaging, the quantification of iodine has been used for the characterization of masses and for the assessment of therapy response [22]. The quantification of pulmonary iodine content has been shown to indicate the severity of pulmonary disorders including emphysema [23] and pulmonary embolism [24]. …”

Section: Discussionmentioning

confidence: 99%

Accuracy of dual-energy computed tomography for the measurement of iodine concentration using cardiac CT protocols: validation in a phantom model

et al. 2013

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Purpose To assess the accuracy of dual-energy CT (DECT) for the quantification of iodine concentrations in a thoracic phantom across various cardiac DECT protocols and simulated patient sizes. Materials and methods Experiments were performed on first- and second-generation dual-source CT (DSCT) systems in DECT mode using various cardiac DECT protocols. An anthropomorphic thoracic phantom was equipped with tubular inserts containing known iodine concentrations (0–20 mg/mL) in the cardiac chamber and up to two fat-equivalent rings to simulate different patient sizes. DECT-derived iodine concentrations were measured using dedicated software and compared to true concentrations. General linear regression models were used to identify predictors of measurement accuracy Results Correlation between measured and true iodine concentrations (n=72) across CT systems and protocols was excellent (R=0.994–0.997, P< 0.0001). Mean measurement errors were 3.0 ± 7.0 % and −2.9 ± 3.8 % for first- and second-generation DSCT, respectively. This error increased with simulated patient size. The second-generation DSCT showed the most stable measurements across a wide range of iodine concentrations and simulated patient sizes. Conclusion Overall, DECT provides accurate measurements of iodine concentrations across cardiac CT protocols, strengthening the case for DECT-derived blood volume estimates as a surrogate of myocardial blood supply.

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Section: Discussionmentioning

confidence: 99%

Accuracy of dual-energy computed tomography for the measurement of iodine concentration using cardiac CT protocols: validation in a phantom model

et al. 2013

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“…The much shorter reading time compared with the Qanadli or Mastora obstruction score renders this technique much more suitable for the clinical workflow. The first pass iodine distribution maps generated from DE CTPA have been shown to be a valid surrogate of hypoperfusion due to acute PE, as demonstrated in several studies [36][37][38][39]. Lung parenchyma iodine perfusion maps provide a quick and reader-independent tool for the quantitative assessment of pulmonary perfusion and strongly correlate with pulmonary perfusion scintigraphy and single-photon emission computed tomography (SPECT) images (Table 1) [36,37].…”

Section: Indirect Lung Perfusion Ctpa Using Dual-energymentioning

confidence: 96%

“…Further it correlates with RV strain determined by RV/LV ratios and it inversely correlates with arterial oxygen levels [40,41,44]. Although a growing amount of data suggests a potential prognostic role for DE obtained PBV imaging in PE patients, the added value of this measurement compared with conventional CTPA measurements of RV/LV ratios is inconclusive but is subject of ongoing evaluations [38,45].…”

Section: Indirect Lung Perfusion Ctpa Using Dual-energymentioning

confidence: 97%

“…However, a limitation of these perfusion scores is its high reader variability and its more time-consuming evaluation, which limits its clinical routine use. In the past years, vendors have developed automated quantification tools for pulmonary perfusion blood volume (PBV), which have a high diagnostic accuracy while being less timeconsuming [38].…”

Section: Indirect Lung Perfusion Ctpa Using Dual-energymentioning

confidence: 99%

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Where do we stand? Functional imaging in acute and chronic pulmonary embolism with state-of-the-art CT

Meyer

Haubenreisser

Sudarski

et al. 2015

European Journal of Radiology

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“…This analysis quantifies lung PBV by measuring the pulmonary parenchymal enhancement in relation to the contrast enhancement in a reference vessel. 3 The pulmonary trunk was defined as a reference vessel, and a standardized 0.5-cm 2 region of interest (ROI) was placed within the pulmonary trunk. Lung PBV was automatically calculated as (mean pulmonary parenchymal enhancement in HU/mean enhancement in the pulmonary trunk in HU)/calibration factor 0.15 ( Figure 1).…”

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Dual-energy CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion

Thieme¹,

Meinel²,

Graef³

et al. 2014

BJR

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CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion. Br J Radiol 2014;87:20140079. FULL PAPER Dual-energy CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion S F THIEME, F G MEINEL, A GRAEF, A D HELCK, M F REISER and T RC JOHNSON Results: No significant difference of PBV but significant differences of mean PA and LA enhancement and individual enhancement differences (PA 2 LA) were found between the populations. PA 2 LA was higher in patients with elevated BNP and proBNP and was positively correlated with these values. Receiver operating characteristic analysis revealed a moderate discriminatory power of the PA 2 LA difference for the presence of cardiac biomarker elevations. Conclusion: PBV in DE-CTPA is not altered in patients with signs of congestive heart failure. However, differences in enhancement values in the pre-and postpulmonary vessels were found in comparison with the control population. Advances in knowledge: Altered pulmonary vascular haemodynamics in pulmonary venous congestion are not reflected in dual-energy-derived PBV maps. In the diagnosis of left heart failure in patients with chest pain and dyspnoea, density measurements in the pulmonary artery and in the left atrium in CTPA images may be a helpful diagnostic tool.In the diagnostic algorithms for patients with acute dyspnoea, CT pulmonary angiography (CTPA) plays a major role, specifically in cases when pulmonary embolism (PE) is suspected. Whenever no PE can be detected, radiologists face the challenge to detect alternative pathological thoracic findings. An undiagnosed acute or chronic left heart failure with pulmonary congestion can be an alternative cause of acute dyspnoea. Although there are some direct and indirect CT criteria that suggest the diagnosis of congestive heart failure with pulmonary venous hypertension (e.g. dilated pulmonary veins with a blurry appearance of the vessel walls, thickening of the interlobular septal lines, ground-glass opacities/alveolar oedema, pleural effusions and an enlargement of the left atrium and/or ventricle), the diagnosis of left heart failure on the basis of CT findings is often equivocal and rather rater dependent. For suspected left heart failure, chest radiography represents the primary diagnostic tool rather than CT. Still, if CTPA is performed in chest pain workup, an improved, more objective diagnosis of congestive heart failure would be desirable. Dual-energy CTPA (DE-CTPA) can quantify the iodinerelated pulmonary beam absorption and thus allow an automated, reader-independent, software-based quantification of the pulmonary content of iodinated contrast material [termed "perfused blood volume" (PBV)].1 Based on the assumption that an impaired left heart function leads to variances in the pulmonary blood content and in the dynamics of the pulmonary passage of the contrast bolus, we tried to find out if ...

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Effectiveness of Automated Quantification of Pulmonary Perfused Blood Volume Using Dual-Energy CTPA for the Severity Assessment of Acute Pulmonary Embolism

Abstract: Dual-energy computed tomography pulmonary angiography can be used for an immediate, reader-independent estimation of global pulmonary PBV in acute PE, which inversely correlates with thrombus load, laboratory parameters of PE severity, and the necessity for ICU admission.

Cited by 47 publications

References 42 publications

Accuracy of dual-energy computed tomography for the measurement of iodine concentration using cardiac CT protocols: validation in a phantom model

Accuracy of dual-energy computed tomography for the measurement of iodine concentration using cardiac CT protocols: validation in a phantom model

Where do we stand? Functional imaging in acute and chronic pulmonary embolism with state-of-the-art CT

Dual-energy CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion

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