Pulmonary Embolism: Optimization of Small Pulmonary Artery Visualization at Multi–Detector Row CT

Patel, Smita; Kazerooni, Ella A.; Cascade, Philip N.

doi:10.1148/radiol.2272011139

Cited by 256 publications

(124 citation statements)

References 43 publications

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“…The introduction of CTPA has made it possible to image the pulmonary arterial tree faster with submillimetrecollimation, thereby improving the overall quality and increasing the sensitivity for isolated subsegmental PE (14)(15). However, the interpretation of CTPA is mainly focussed on the presence or published absence of embolism and a rough estimation of its severity (massive, extensive or isolated).…”

Section: Discussionmentioning

confidence: 99%

Correlation of alveolar–arterial gradient with Computed Tomography Pulmonary Artery Obstruction index in acute Pulmonary Embolism

Karakayali¹,

Yılmaz²,

Ertok

et al. 2016

Cumhuriyet Medical Journal

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SUMMARY Objective:The purpose of our study was to investigate the relationship between the pulmonary artery obstruction index (PAOI) assessed with helical computed tomography (CT) and impairment in blood gases in patients with acute pulmonary embolism (PE). Method: This retrospective study design was carried out in the Tertiary Training and Research Hospital Emergency Clinic over a 6-month period with patients in whom PE was detected. The Alveolar-arterial (A-a) oxygen gradient for oxygen was calculated according to the formula 150 -1.25 (PaCO2 -PaO2), and the PAOI for each patient was measured with the Qanadli score at the mediastinal window using chest CT angiography (CTA). Results: There were 113 patients included in the study; their mean age was 61.40 (±16.082) years and 51.4% of the patients were female. The mean Alveolar-arterial (A-a) oxygen gradient value was 65.13(±18.78) in massive embolism group. The mean PAOI was determined as 34.027 (min:7.5, max:83.7). The relationship between the radiologically measured PAOI and the Alveolararterial (A-a) oxygen gradient were compared, and an increase in the index was detected as the Alveolar-arterial (A-a) oxygen gradient level increased; this difference was found to be statistically significant (r=0.400; p<0.001).Conclusions: This retrospective observational study found a weak but positive correlation between the PAOI and the Alveolar-arterial (A-a) oxygen gradient. Our study showed that consideration of the Alveolar-arterial (A-a) oxygen gradient increases the sensitivity of blood gas analysis in documented pulmonary embolism.All data showed that the Alveolar-arterial (A-a) oxygen gradient values may be clinically beneficial, as such testing is easy to perform and cost-effective.Moreover, it can be performed at the bedside to detect which patients should be treated with thrombolytics.

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Section: Discussionmentioning

confidence: 99%

Correlation of alveolar–arterial gradient with Computed Tomography Pulmonary Artery Obstruction index in acute Pulmonary Embolism

Karakayali¹,

Yılmaz²,

Ertok

et al. 2016

Cumhuriyet Medical Journal

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“…При этом адекватно визуализируются ЛА, по крайней мере до сегментарного уровня [131][132][133]. В исследовании PIOPED II установлена 83% ная чув ствительность и 96% ная специфичность МДКТ (пре имущественно для 4 детекторных томографов) [134].…”

Section: кт ангиография лаunclassified

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014).The Task Force of the European Society of Cardiology for diagnosis and management of pulmonary embolism

Редакционная¹

2015

Pulʹmonologiâ (Mosk.)

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РезюмеВ данных Клинических рекомендациях суммированы все современные доказательства по диагностике и лечению тромбоэмболии легочной артерии (ТЭЛА). В отличие от предыдущей версии рекомендаций, в данном документе представлены упрощенные варианты клинических прогностических шкал, подробно рассмотрена стратификация риска летального исхода, включая промежуточные степени риска, представлены новые подходы к АКТ, в т. ч. системному тромболизису и катетерным методам лечения, терапии антагонистом витамина К, определено место новых пероральных антикоагулянтов в терапии ТЭЛА. Ключевые слова: рекомендации, тромбоэмболия легочной артерии, венозный тромбоз, шок, гипотензия, торакалгия, одышка, сердеч ная недостаточность, диагностика, антикоагулянты, тромболизис. SummaryThese clinical recommendations summarized currently available evidence on diagnosis and management of patients with pulmonary embolism. When compared to previous version of recommendations, this document has introduced simplified clinical prognostic scales and a new risk stratifi cation system including intermediate risk. Novel approach to anticoagulant therapy have been also reviewed including systemic thrombolysis, catheter directed treatment, vitamin K antagonists and new oral anticoagulants. Key words: recommendations, pulmonary embolism, venous thromboembolism, shock, hypotension, chest pain, dyspnea, heart failure, diagnosis, anticoagulants, thrombolysis.Тромбоэмболия легочной артерии: клинические рекомендации Европейского общества кардиологов (2014) 526Пульмонология. 2015; 25 (5): 525-552 возникавших в ходе работы над Рекомендациями, надлежало информировать ЕОК и вносить соответ ствующие поправки. Финансирование Рабочей груп пы проводилось за счет средств ЕОК полностью, без участия представителей медицинской промышлен ности.Комитетом ЕОК по Практическим рекомендаци ям проведены наблюдение за процессом подготовки новых Клинических рекомендаций и его координа ция. Члены Комитета также несли ответственность за утверждение новых Клинических рекомендаций. Клинические рекомендации ЕОК активно проана лизированы Комитетом по Практическим рекомен дациям и внешними экспертами. После соответст вующих поправок Рекомендации были одобрены всеми экспертами Рабочей группы. Окончательный документ был утвержден Комитетом по Практичес ким рекомендациям для публикации в журнале European Heart Journal.Задача написания Клинических рекомендаций ЕОК заключается не только в объединении результа тов исследований последних лет, но также и в разра ботке образовательных методик и программ внедре ния Рекомендаций в практическое здравоохранение.Для практического использования Рекоменда ций готовится их краткая («карманная») версия, а также слайды, буклеты с ключевыми положения ми, листовки для неспециалистов и электронная версия для смартфонов и других гаджетов (сокра щенные варианты); с полным текст Рекомендаций опубликован на сайте ЕОК и находится в свободном доступе. Национальным обществам рекомендуется утверждать, переводить на национальные языки и внедрять Клинические рекоме...

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“…Moreover, the modality used to make this diagnosis has changed substantially over the years, transitioning from the invasive pulmonary angiogram [3] to the ventilation/perfusion (V/Q) scan. More recently, as enhanced technology has improved the sensitivity of new generations of contrast CT scans (from single-detector row CT scans to spiral CT scans to multidetector row spiral CT [MDCT]), MDCT scans have become the standard of care for diagnosing suspected PE [14,17], because they allow for better visualization of small emboli in subsegmental branches of the pulmonary arteries [11,15].…”

Section: Introductionmentioning

confidence: 99%

Overdiagnosis of Pulmonary Embolism: Evaluation of a Hypoxia Algorithm Designed to Avoid This Catastrophic Problem

Winters

Solarz

Jacovides

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background We observed a substantial increase in the incidence of pulmonary embolism (PE) after total joint arthroplasty (TJA) when multidetector computerized tomography (MDCT) replaced ventilation-perfusion (V/Q) scans as the diagnostic modality of choice. We questioned whether this resulted from the detection of clinically unimportant PE with the more sensitive MDCT and in 2007 instituted a hypoxia protocol to enhance the detection of PE. Questions/purposes We determined whether this new hypoxia protocol increased the specificity of our workups for suspected clinically important PE in the immediate postoperative period without affecting patient morbidity and mortality. Patients and Methods We compared the frequency of MDCT, V/Q scan and total investigations, incidence of PE, and overall mortality rates in the 3 years prior

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Pulmonary Embolism: Optimization of Small Pulmonary Artery Visualization at Multi–Detector Row CT

Abstract: Multi-detector row CT at 1.25-mm collimation significantly improves visualization of segmental and subsegmental arteries and interobserver agreement in detection of pulmonary embolism.

Cited by 256 publications

References 43 publications

Correlation of alveolar–arterial gradient with Computed Tomography Pulmonary Artery Obstruction index in acute Pulmonary Embolism

Correlation of alveolar–arterial gradient with Computed Tomography Pulmonary Artery Obstruction index in acute Pulmonary Embolism

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014).The Task Force of the European Society of Cardiology for diagnosis and management of pulmonary embolism

Overdiagnosis of Pulmonary Embolism: Evaluation of a Hypoxia Algorithm Designed to Avoid This Catastrophic Problem

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