Impact of CT perfusion imaging on the assessment of peripheral chronic pulmonary thromboembolism: clinical experience in 62 patients

Faivre, Julien Le; Duhamel, Alain; Khung, Suonita; Faivre, J; Lamblin, Nicolas; Rémy, Jacques; Rémy‐Jardin, Martine

doi:10.1007/s00330-016-4262-1

Cited by 32 publications

(18 citation statements)

References 34 publications

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“…198 DECT imaging generates maps of regional iodine density in the lung parenchyma as a surrogate for perfusion. This may further improve the evaluation of suspected CTEPH by better demonstrating regions of decreased or absent blood flow 199 and has been shown to have excellent agreement with SPECT. 200 Although the availability of this technology is relatively limited, iodine mapping using CTPA with an unenhanced pre-scan is an emerging technique, which generates a lung perfusion map.…”

Section: Section 2: Imaging Adults With Pulmonary Hypertensionmentioning

confidence: 90%

Section: Section 3 Imaging Pathway For Suspected Pulmonary Hypertensimentioning

confidence: 99%

“…CT lung subtraction iodine mapping (CT-LISM) or DECT in addition to directly visualizing abnormalities in the pulmonary arterial tree also allows construction of perfusion lung maps, preventing the need for other forms of perfusion lung imaging to exclude CTEPH. 81,86,199,245 Supplementary investigations including tests to assess for conditions associated with PAH such as connective tissue disease and HIV infection should be considered. 1,194 Review and integration of imaging investigations with other tests and assessment for respiratory disease.…”

Section: Ct Pulmonary Angiographymentioning

confidence: 99%

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Statement on imaging and pulmonary hypertension from the Pulmonary Vascular Research Institute (PVRI)

Kiely¹,

Levin²,

et al. 2019

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Pulmonary hypertension (PH) is highly heterogeneous and despite treatment advances it remains a life-shortening condition. There have been significant advances in imaging technologies, but despite evidence of their potential clinical utility, practice remains variable, dependent in part on imaging availability and expertise. This statement summarizes current and emerging imaging modalities and their potential role in the diagnosis and assessment of suspected PH. It also includes a review of commonly encountered clinical and radiological scenarios, and imaging and modeling-based biomarkers. An expert panel was formed including clinicians, radiologists, imaging scientists, and computational modelers. Section editors generated a series of summary statements based on a review of the literature and professional experience and, following consensus review, a diagnostic algorithm and 55 statements were agreed. The diagnostic algorithm and summary statements emphasize the key role and added value of imaging in the diagnosis and assessment of PH and highlight areas requiring further research.

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Section: Section 2: Imaging Adults With Pulmonary Hypertensionmentioning

confidence: 90%

Section: Section 3 Imaging Pathway For Suspected Pulmonary Hypertensimentioning

confidence: 99%

Section: Ct Pulmonary Angiographymentioning

confidence: 99%

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Statement on imaging and pulmonary hypertension from the Pulmonary Vascular Research Institute (PVRI)

Kiely¹,

Levin²,

et al. 2019

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“…In the clinical context of PH, most attention has been directed toward the description of DECT perfusion changes in CTEPH. [64][65][66] The patterns of DECT perfusion changes have a high level of concordant findings with V/Q scintigraphy in the Figure 22 -Examples of neovascularization and lobular ground-glass opacities in a patient with (A) heritable pulmonary arterial hypertension (PAH) with patchy and ill defined centrilobular nodules, thought to be due to cholesterol granulomas within small vessels. Also notable on this image is the presence of neovascularization with serpiginous peripheralpulmonary collaterals (black arrow).…”

Section: Single-energy Ct Scanmentioning

confidence: 92%

Imaging of Pulmonary Hypertension

Altschul

Rémy‐Jardin

Machnicki

et al. 2019

Chest

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Pulmonary hypertension (PH) is an end result of a diverse array of complex clinical conditions that invoke hemodynamic and pathophysiological changes in the pulmonary vasculature. Many patients' symptoms begin with dyspnea on exertion for which screening tests such as chest roentgenograms and more definitive noninvasive tests such as CT scans are ordered initially. It is imperative that clinicians are cognizant of subtle clues on these imaging modalities that alert them to the possibility of PH. These clues may serve as a stepping stone towards more advanced noninvasive (echocardiogram) and invasive (right heart catheterization) testing. On the CT scan, the signs are classified into mediastinal and lung parenchymal abnormalities. In addition to suspecting the diagnosis of PH, this paper provides a pictorial essay to guide health care professionals in identifying the etiology of PH. This paper also provides concrete definitions, wherever possible, of what constitutes abnormalities in PH, such as dilated pulmonary arteries, pruning of vessels, and increased thickness of free wall of the right ventricle. The sensitivities and specificities of each sign are enumerated. The common radiographic and clinical features of many different etiologies of PH are tabulated for the convenience of the readers. Some newer imaging modalities such as dual-energy CT of the chest that hold promise for the future are also described.

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“…95 Blood volume detected using this approach has also been shown to be related to right heart strain in patients with PE 93 and improve the detection of pulmonary embolus, particularly in the peripheral lung. 96,97 DECT has also shown significant promise in the study of Chronic thromboembolic pulmonary hypertension 3998 as well as in distinguishing tumor embolism from thromboembolism. 99 …”

Section: Dual Energy Computed Tomographymentioning

confidence: 99%

Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism

Rahaghi

Minhas

Heresi

2018

Clinics in Chest Medicine

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Imaging continues to be the modality of choice for the diagnosis of venous thromboembolic disease, particularly when incorporated into diagnostic algorithms. Improvement in imaging techniques as well as new imaging modalities and processing methods have improved diagnostic accuracy and additionally are being leveraged in prognostication and decision making for choice of intervention. In this article, we review the role of imaging in diagnosis and prognostication of venous thromboembolism. We also discuss emerging imaging approaches that may in the near future find clinical usefulness in improving diagnosis and prognostication as well as differentiating disease phenotypes.

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Impact of CT perfusion imaging on the assessment of peripheral chronic pulmonary thromboembolism: clinical experience in 62 patients

Abstract: • Dual-energy computed tomography generates standard diagnostic imaging and lung perfusion analysis. • Depiction of CPE on central arteries relies on standard diagnostic imaging. • Detection of peripheral CPE is improved by perfusion imaging.

Cited by 32 publications

References 34 publications

Statement on imaging and pulmonary hypertension from the Pulmonary Vascular Research Institute (PVRI)

Statement on imaging and pulmonary hypertension from the Pulmonary Vascular Research Institute (PVRI)

Imaging of Pulmonary Hypertension

Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism

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