Pulmonary embolism: diagnosis with spiral CT and ventilation-perfusion scanning--correlation with pulmonary angiographic results or clinical outcome.

Garg, Kavita D.; Welsh, Carolyn H.; Feyerabend, A J; Subber, S W; Russ, Paul; Johnston, Robert J.; Durham, Joleno; Lynch, DA

doi:10.1148/radiology.208.1.9646814

Cited by 212 publications

(90 citation statements)

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“…Compared with single-slice CT, and for a similar degree of functional impairment, we observed a significantly higher proportion of CT angiograms devoid of respiratory (64 vs 38%) and cardiac motion artifacts (62 vs 40%) with multislice CT. Because of the well-known difficulties in assessing acute PE in patients with underlying respiratory disease, the benefit of multislice CT, which allows obtainment of a higher number of examinations interpretable down to the subsegmental pulmonary arterial bed compared with single slice CT, is emphasized. As underlined by several investigators [2,4,14,15], the limitations of single-slice CT in the detection of clots in small vessels are related mainly to lower spatial resolution and to the fact that subsegmental vessels of the upper and lower lobes frequently lie outside the limits of z-axis coverage. Consequently, the remaining indications of pulmonary angiography, namely the exclusion of subsegmental PE after a negative CT angiogram down to the segmental level, are expected to dramatically decline with the widespread availability of multislice CT scanners.…”

Section: Discussionmentioning

confidence: 99%

CT angiography of pulmonary embolism in patients with underlying respiratory disease: impact of multislice CT on image quality and negative predictive value

et al. 2002

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Section: Discussionmentioning

confidence: 99%

CT angiography of pulmonary embolism in patients with underlying respiratory disease: impact of multislice CT on image quality and negative predictive value

et al. 2002

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“…Although pulmonary ventilation (1, 2) and perfusion (3,4) can be examined by a variety of imaging techniques, currently no methods exist to image alveolar-capillary gas transfer. Yet certain pulmonary pathologies such as inflammation, fibrosis, and edema may initially have a predominant effect on the gas exchange process but not on ventilation or perfusion.…”

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confidence: 99%

Imaging alveolar–capillary gas transfer using hyperpolarized ¹²⁹ Xe MRI

Driehuys

Cofer

Pollaro

et al. 2006

Proc. Natl. Acad. Sci. U.S.A.

218

236

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Effective pulmonary gas exchange relies on the free diffusion of gases across the thin tissue barrier separating airspace from the capillary red blood cells (RBCs). Pulmonary pathologies, such as inflammation, fibrosis, and edema, which cause an increased blood-gas barrier thickness, impair the efficiency of this exchange. However, definitive assessment of such gas-exchange abnormalities is challenging, because no methods currently exist to directly image the gas transfer process. Here we exploit the solubility and chemical shift of 129 Xe, the magnetic resonance signal of which has been enhanced by 10 5 with hyperpolarization, to differentially image its transfer from the airspaces into the tissue barrier spaces and RBCs in the gas exchange regions of the lung. Based on a simple diffusion model, we estimate that this MR imaging method for measuring 129 Xe alveolar-capillary transfer is sensitive to changes in blood-gas barrier thickness of Ϸ5 m. We validate the successful separation of tissue barrier and RBC images and show the utility of this method in a rat model of pulmonary fibrosis where 129 Xe replenishment of the RBCs is severely impaired in regions of lung injury.diffusing capacity ͉ fibrosis ͉ gas exchange ͉ blood-gas barrier

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“…29 Revised criteria for the interpretation of ventilation-perfusion examinations 30,31 and novel technologies in nuclear medicine such as SPECT 32 can decrease the proportion of indeterminate scintigraphic studies but cannot offset the limitations inherent to a functional imaging test. 33 Different from other imaging tests, ventilation-perfusion scintigraphy is an indirect test for PE based on assessment of pulmonary perfusion. This differs from imaging modalities that allow direct visualization (Figure 1) of PE and other thoracic pathology.…”

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confidence: 99%

Spiral Computed Tomography for Acute Pulmonary Embolism

2004

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There is still considerable debate about the optimal diagnostic imaging modality for acute pulmonary embolism. If imaging is deemed necessary from an initial clinical evaluation such as D-dimer testing, options include nuclear medicine scanning, catheter pulmonary angiography, and spiral CT. In many institutions, spiral CT is becoming established as the first-line imaging test in daily clinical practice. With spiral CT, thrombus is directly visualized, and both mediastinal and parenchymal structures are evaluated, which may provide important alternative or additional diagnoses. However, limitations for the accurate diagnosis of small peripheral emboli, with a reported miss rate of up to 30% with single-slice spiral CT so far, have prevented the unanimous embrace of spiral CT as the new standard of reference for imaging pulmonary embolism. The clinical significance of the detection and treatment of isolated peripheral pulmonary emboli is uncertain. Evidence is accumulating that it is safe practice to withhold anticoagulation in patients with suspected pulmonary embolism on the basis of a negative spiral CT study. Remaining concerns about the accuracy of spiral CT for pulmonary embolism detection may be overcome by the introduction of multidetector-row spiral CT. This widely available technology has improved visualization of peripheral pulmonary arteries and detection of small emboli. The most recent generation of multidetector-row spiral CT scanners appears to outperform competing imaging modalities for the accurate detection of central and peripheral pulmonary embolism. In this review, we assess the current role and future potential of CT in the diagnostic algorithm of acute pulmonary embolism.

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Pulmonary embolism: diagnosis with spiral CT and ventilation-perfusion scanning--correlation with pulmonary angiographic results or clinical outcome.

Abstract: Spiral CT has greater accuracy and specificity than V-P scanning in patients with an unresolved diagnosis and may be useful as the primary screening technique for PE.

Cited by 212 publications

References 0 publications

CT angiography of pulmonary embolism in patients with underlying respiratory disease: impact of multislice CT on image quality and negative predictive value

CT angiography of pulmonary embolism in patients with underlying respiratory disease: impact of multislice CT on image quality and negative predictive value

Imaging alveolar–capillary gas transfer using hyperpolarized ¹²⁹ Xe MRI

Spiral Computed Tomography for Acute Pulmonary Embolism

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Pulmonary embolism: diagnosis with spiral CT and ventilation-perfusion scanning--correlation with pulmonary angiographic results or clinical outcome.

Abstract: Spiral CT has greater accuracy and specificity than V-P scanning in patients with an unresolved diagnosis and may be useful as the primary screening technique for PE.

Cited by 212 publications

References 0 publications

CT angiography of pulmonary embolism in patients with underlying respiratory disease: impact of multislice CT on image quality and negative predictive value

CT angiography of pulmonary embolism in patients with underlying respiratory disease: impact of multislice CT on image quality and negative predictive value

Imaging alveolar–capillary gas transfer using hyperpolarized 129 Xe MRI

Spiral Computed Tomography for Acute Pulmonary Embolism

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Imaging alveolar–capillary gas transfer using hyperpolarized ¹²⁹ Xe MRI