Pulmonary arteries and lung parenchyma in chronic pulmonary embolism: preoperative and postoperative CT findings.

Schwickert, Heidi C.; Schweden, F; Schild, Hans H.; Piepenburg, R.; C, Düber; Kauczor, Hans Ulrich; Renner, Christopher; Iversen, Stein; Thelen, M.

doi:10.1148/radiology.191.2.8153305

Cited by 125 publications

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“…Similarly, Schwickert et al analyzed the CT findings in 75 patients diagnosed with CTEPH and found mosaic perfusion in 77% (34). However, the mosaic perfusion pattern can also be found in patients with PH due to other causes (31)(32)(33)(34)(35)(36)(37), and up to 12% of patients with idiopathic pulmonary arterial hypertension will have mosaic perfusion on CTPA (35).…”

Section: Mosaic Attenuation Patternmentioning

confidence: 97%

“…A report was considered as suggestive of chronic thromboembolic pulmonary disease if it stated visualization of the thrombus, calcified thrombus, recanalization, sudden change in vessel caliber, strictures, poststenotic dilatation, webs, or perfusion abnormality (30)(31)(32)(33)(34). The presence of mosaic perfusion, defined as areas of increased and decreased attenuation and vascularity without evidence of destruction or displacement of pulmonary vessels, was also noted.…”

Section: Multidetector Ctpamentioning

confidence: 99%

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Ventilation-Perfusion Scintigraphy Is More Sensitive than Multidetector CTPA in Detecting Chronic Thromboembolic Pulmonary Disease as a Treatable Cause of Pulmonary Hypertension

Tunariu¹,

Gibbs²,

Win³

et al. 2007

Journal of Nuclear Medicine

503

249

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Pulmonary hypertension (PH) is a progressive disease with a poor prognosis. Identifying chronic thromboembolic pulmonary disease as a cause of PH has major clinical implications as these patients could be potentially offered a surgical cure. Ventilationperfusion (V/Q) scintigraphy has a high sensitivity to detect embolic disease but its value has been challenged with the emergence of multidetector CT pulmonary angiography (CTPA). We compared the value of V/Q scintigraphy with CTPA in detecting chronic thromboembolic pulmonary disease. Methods: We retrospectively reviewed the results of V/Q scintigraphy and CTPA performed on patients who had been referred to the Pulmonary Hypertension Service at Hammersmith Hospital between 2000 and 2005. A total of 227 patients (85 males, 142 females; age range, 18-81 y; mean age, 42 y) had all tests done at Hammersmith Hospital and were included in the study. Interpretation of scans was according to the modified PIOPED (Prospective Investigation of Pulmonary Embolism Diagnosis) criteria. CTPA was considered as suggestive of chronic thromboembolic pulmonary disease if it showed visualization of the thrombus or webs, recanalization, perfusion abnormalities, stenosis, or strictures. Standard pulmonary angiography was performed via femoral approach. In 90% of the cases, CTPA and V/Q scintigraphy were performed within 10 d. Results: Seventy-eight patients (group A) had a final diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) and 149 (group B) had non-CTEPH etiology. Among group A, V/Q scintigraphy was reported as high probability in 75 patients, intermediate probability in 1 patient, and low probability in 2 patients. CTPA was positive in 40 patients and negative in 38 patients. Among group B, V/Q scintigraphy was reported as low probability in 134, intermediate probability in 7, and high probability in 8 patients. CTPA was negative in 148 patients and false-positive in 1 patient. Statistical analysis showed V/Q scintigraphy to have a sensitivity of 96%-97.4% and a specificity of 90%-95%. CTPA showed a sensitivity of 51% and a specificity of 99%. Conclusion: Our results demonstrate that V/Q scintigraphy has a higher sensitivity than CTPA in detecting CTEPH as a potential curable cause of PH.

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Section: Mosaic Attenuation Patternmentioning

confidence: 97%

Section: Multidetector Ctpamentioning

confidence: 99%

Ventilation-Perfusion Scintigraphy Is More Sensitive than Multidetector CTPA in Detecting Chronic Thromboembolic Pulmonary Disease as a Treatable Cause of Pulmonary Hypertension

Tunariu¹,

Gibbs²,

Win³

et al. 2007

Journal of Nuclear Medicine

503

249

View full text Add to dashboard Cite

show abstract

“…Eccentrically located, potentially calcified masses within the pulmonary arteries, contiguous to the vessel wall, abrupt cut-off of lobar or segmental arteries, and irregularities of the vessel diameter are considered findings suggestive of chronic PE ( fig. 4) [18].…”

Section: Image Interpretationmentioning

confidence: 99%

Spiral computed tomography of pulmonary embolism

Herold¹

2002

European Respiratory Journal

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Spiral computed tomography of pulmonary embolism. C.J. Herold. #ERS Journals Ltd 2002. ABSTRACT: Within the last several years, spiral computed tomography angiography (SCTA) of the pulmonary arteries has emerged as a noninvasive angiographic modality for the evaluation of patients with suspected pulmonary embolism (PE). SCTA is based on continuous computed tomography (CT) data acquisition during patient transport through the rotating X-ray tube and detector system, where scanning is performed in the time period in which the injected contrast material passes through the pulmonary arteries. Single detector spiral CT has a sensitivity of y85-90% and a specificity between 88-95%. Sensitivity and specificity are very likely to increase with the use of multidetector spiral CT scanners that allow scanning of large lung volumes with a scan collimation as narrow as 1 mm.Currently, SCTA is most commonly used as a primary imaging method in patients with suspected PE, and as a second-line method in cases with inconclusive ventilation/ perfusion scintigraphy results. SCTA has proven to be cost-effective, especially in combination with ultrasound of the lower extremities.Limitations of the method include a decreased sensitivity for the detection of small isolated clots in the peripheral pulmonary arterial bed, and a potentially reduced image quality in patients with coexistent cardiopulmonary disorders.Despite these limitations, several studies have now documented that, in patients with suspected pulmonary embolism, it is safe to withhold anticoagulation therapy if a spiral computed tomography exam of the pulmonary arteries is negative and no lower extremity venous thrombosis is present. In the future, multislice computed tomography scanning of the pulmonary arteries with multiplanar reformation and one-stop shopping, i.e. scanning of the pulmonary arteries and the lower extremity veins in a single session, will further enhance the role of computed tomography angiography in the examination of patients with suspected pulmonary embolism. Pulmonary embolism (PE) is often encountered both in the hospital setting and in private clinical practice. Because untreated PE is associated with a greatly increased mortality risk, accurate diagnosis of PE is of critical importance [1,2]. However, because clinical findings, laboratory tests, and signs and symptoms at physical examination are often nonspecific, imaging methods are a significant part of the diagnostic evaluation of patients with suspected PE.Since PE is not an isolated disorder but, rather, a symptom of the entire venous thromboembolism complex, imaging studies of the lower extremities and the pelvis, the most common source of pulmonary emboli, are a fundamental requirement for the diagnostic work-up of patients with suspected PE. Various imaging modalities have been attempted in this evaluation process within the last few decades. For many years, ventilation/perfusion (V/Q) scintigraphy has served as the noninvasive procedure of choice for the assessment of patients with susp...

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“…4,5 Anticoagulation with warfarin was considered the treatment of choice in our patient due to her extensive cardiac history. Her symptoms have largely resolved and she is now mobile.…”

Section: Discussionmentioning

confidence: 99%

Cauda equina syndrome versus saddle embolism

Shaw

Anwar²,

Targett³

et al. 2008

Ann R Coll Surg Engl

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We discuss a case of saddle embolism with a clinical presentation similar to cauda equina syndrome in a 79-year-old woman with a history of ischaemic heart disease. Saddle embolus is very rare but one of an array of visceral causes for back and leg pain. This case highlights diagnostic difficulties, particularly in patients with multiple disorders. A high index of suspicion for vascular conditions must be exercised in cases of arterial dysfunction presenting with back pain.

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Pulmonary arteries and lung parenchyma in chronic pulmonary embolism: preoperative and postoperative CT findings.

Abstract: CT enables demonstration of pulmonary thromboembolism with criteria pertaining to pulmonary arteries and to lung parenchyma and enables assessment of technical operatibility and confirmation of surgical success.

Cited by 125 publications

References 0 publications

Ventilation-Perfusion Scintigraphy Is More Sensitive than Multidetector CTPA in Detecting Chronic Thromboembolic Pulmonary Disease as a Treatable Cause of Pulmonary Hypertension

Ventilation-Perfusion Scintigraphy Is More Sensitive than Multidetector CTPA in Detecting Chronic Thromboembolic Pulmonary Disease as a Treatable Cause of Pulmonary Hypertension

Spiral computed tomography of pulmonary embolism

Cauda equina syndrome versus saddle embolism

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