Parenchymal and Pleural Findings in Patients with and Patients without Acute Pulmonary Embolism Detected at Spiral CT

Shah, Ami A.; Davis, Stephanie; Gamsu, G; Intriere, Lisa

doi:10.1148/radiology.211.1.r99ap03147

Cited by 142 publications

(106 citation statements)

References 24 publications

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“…The advantages of CTA-rapid and widely available examinations, the ability to perform lower-extremity venous imaging concurrently if needed, the high proportion of definitive diagnostic results, and the ability of CT to provide additional diagnostic information (30,31) that may be of clinical importance-secure a place for CTA as a first-line diagnostic imaging modality in appropriately selected patients. However, the advantages of perfusion scintigraphy-lower cost, much lower radiation dose, avoidance of iodinated contrast material, and technical simplicity-can now be considered together with a contemporary characterization of the diagnostic accuracy of the test in a predominantly outpatient population.…”

Section: Discussionmentioning

confidence: 99%

Sensitivity and Specificity of Perfusion Scintigraphy Combined with Chest Radiography for Acute Pulmonary Embolism in PIOPED II

Sostman¹,

Miniati²,

Gottschalk³

et al. 2008

J Nucl Med

168

131

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Section: Discussionmentioning

confidence: 99%

Sensitivity and Specificity of Perfusion Scintigraphy Combined with Chest Radiography for Acute Pulmonary Embolism in PIOPED II

Sostman¹,

Miniati²,

Gottschalk³

et al. 2008

J Nucl Med

168

131

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“…Linear (plate-like) atelectasis is also seen with increased frequency on CT in patients with acute PTE. Other findings, such as areas of decreased attenuation and pleural effusion, are not helpful in distinguishing patients with and without acute PTE (9,10) . A number of technical, anatomical, and patient related pitfalls may lead to misinterpretation of the CT images.…”

Section: Interpretation Of Imagesmentioning

confidence: 99%

“…Diagnosis of acute PTE requires assessment of both the vascular and parenchymal findings. Assessment of the lung windows is important not only to identify the pulmonary arteries by their proximity to the bronchi, but also to assess for the presence of ancillary signs that may be helpful in suggesting the presence of pulmonary embolism (9,10) . The most helpful ancillary sign is the presence of a non-enhancing pleural-based wedge-shaped pulmonary opacity (Fig.…”

Section: Interpretation Of Imagesmentioning

confidence: 99%

Diagnóstico por imagem do tromboembolismo pulmonar agudo

Silva¹,

Müller²

2004

J. bras. pneumol.

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The diagnosis of acute pulmonary thromboembolism is based on clinical probability, use of D-dimer (when available) and imaging. The main imaging modalities used in the diagnosis are ventilation-perfusion (V/Q), pulmonary angiography, and computed tomography (CT). In the last decade several studies have demonstrated that spiral CT has a high sensitivity and specificity in the diagnosis of acute pulmonary thromboembolism. The evaluation of the pulmonary arteries has further improved with the recent introduction of multidetector spiral CT scanners. Several groups of investigators have suggested that contrast enhanced spiral should replace scintigraphy in the assessment of patients whose symptoms are suggestive of acute PE. This article discusses the role of the various imaging modalities in the diagnosis of acute pulmonary thromboembolism with emphasis on spiral CT.

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“…In one study, CTPA identified pleural or parenchymal abnormalities that explained indeterminate defects on V/Q scans in 57% of patients; 11 in other studies, alternative intrathoracic findings were identified in 11% to 85% of patients undergoing CTPA; 6,8,9,13,32,47-51 these additional findings were nonspecific, occurring both in patients with and without PE. 52 Although other such intrathoracic abnormalities may not imply a need for further evaluation, their identification may affect patient management.…”

Section: Ct Pulmonary Angiographymentioning

confidence: 99%

Role of Computed Tomography and Magnetic Resonance Imaging for Deep Venous Thrombosis and Pulmonary Embolism

2004

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Abstract-During the 1990s, computed tomography (CT) and magnetic resonance (MR) imaging underwent extensive technological advancement and expanded clinical use in patients with venous thromboembolic disease, particularly with regard to evaluation of the pulmonary vasculature. In many institutions, helical (spiral) CT pulmonary angiography has become the initial imaging study of choice to evaluate patients with suspected pulmonary embolism, supplanting ventilation/perfusion scintigraphy. In addition, CT venography of the pelvis and lower extremities is often incorporated into the CT angiography protocol to identify or exclude concurrent deep venous thrombosis. MR pulmonary angiography and MR venography are second-line diagnostic tools because of their higher cost, limited availability, and other logistical constraints. As the technology improves and becomes more widely available, MR imaging may play a greater role in the evaluation of patients with venous thromboembolic disease. Key Words: thrombosis Ⅲ pulmonary heart disease Ⅲ imaging Ⅲ MRI D uring the 1990s, technological advances in computed tomography (CT) and magnetic resonance (MR) imaging made these techniques applicable to the diagnosis of venous thromboembolic disease, particularly for the pulmonary vasculature in patients with suspected pulmonary embolism (PE). At the opening of the third millennium, in many institutions, helical (spiral) CT pulmonary angiography (CTPA) has become the initial imaging study of choice for evaluating patients with suspected PE, supplanting ventilation/perfusion (V/Q) scintigraphy by reducing indeterminate examinations. 1-4 CT venography (CTV) of the pelvic and lower extremity veins after CTPA of the pulmonary arteries has been advocated by some as an adjunct to helical CT for detection of concurrent deep venous thrombosis (DVT) using a single imaging technique for detection of venous thromboembolic disease.Although MR imaging produces high tissue contrast without ionizing radiation, currently, this technique is less popular than CT for evaluation of acute venous thromboembolism (VTE) because of technical limitations, higher costs, limited availability, and other logistical considerations. As technology improves, however, MR pulmonary angiography (MRPA) and MR venography (MRV) may play a greater role in the evaluation of patients with venous thromboembolic disease.This article reviews applications of CT and MR imaging in the clinical evaluation of patients with suspected venous thromboembolic disease. CT Pulmonary AngiographyCTPA has gained acceptance as a first-line imaging study in cases of suspected acute PE, replacing traditional V/Q scintigraphy at many institutions. In general, V/Q scanning is reserved for patients in whom motion artifact or poor right heart function limit the quality of CT examination and those with contraindications to intravenous radiographic contrast.After contrast administration, CTPA provides visualization of the pulmonary arterial system in the axial plane, and multiplanar and three-dimensional...

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Parenchymal and Pleural Findings in Patients with and Patients without Acute Pulmonary Embolism Detected at Spiral CT

Abstract: Parenchymal and pleural findings at CT are of limited value for differentiating patients with PE from those without PE.

Cited by 142 publications

References 24 publications

Sensitivity and Specificity of Perfusion Scintigraphy Combined with Chest Radiography for Acute Pulmonary Embolism in PIOPED II

Sensitivity and Specificity of Perfusion Scintigraphy Combined with Chest Radiography for Acute Pulmonary Embolism in PIOPED II

Diagnóstico por imagem do tromboembolismo pulmonar agudo

Role of Computed Tomography and Magnetic Resonance Imaging for Deep Venous Thrombosis and Pulmonary Embolism

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