The value of 64-detector row computed tomography for the exclusion of pulmonary embolism

Pesavento, Raffaele; Conti, Giorgio; Minotto, Isabella; Filippi, Lucia; Mongiat, Maurizio; Faveri, D. De; Maurizi, Francesca; Valle, Fabio Dalla; Piovella, Chiara; Pagnan, Antonio; Prandoni, Paolo

doi:10.1160/th10-10-0638

Cited by 16 publications

(3 citation statements)

References 40 publications

(42 reference statements)

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“…These are most often due to patient movement or poor bolus enhancement [14–16]. Additionally, continuous improvement of the contrast agent injection protocols has to be achieved due to the shorter scan times.…”

Section: Scanning Protocolsmentioning

confidence: 99%

SPECT/CT and pulmonary embolism

Mortensen

Gutte

2013

Eur J Nucl Med Mol Imaging

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Acute pulmonary embolism (PE) is diagnosed either by ventilation/perfusion (V/P) scintigraphy or pulmonary CT angiography (CTPA). In recent years both techniques have improved. Many nuclear medicine centres have adopted the single photon emission CT (SPECT) technique as opposed to the planar technique for diagnosing PE. SPECT has been shown to have fewer indeterminate results and a higher diagnostic value. The latest improvement is the combination of a low-dose CT scan with a V/P SPECT scan in a hybrid tomograph. In a study comparing CTPA, planar scintigraphy and SPECT alone, SPECT/CT had the best diagnostic accuracy for PE. In addition, recent developments in the CTPA technique have made it possible to image the pulmonary arteries of the lungs in one breath-hold. This development is based on the change from a single-detector to multidetector CT technology with an increase in volume coverage per rotation and faster rotation. Furthermore, the dual energy CT technique is a promising modality that can provide functional imaging in combination with anatomical information. Newer high-end CT scanners and SPECT systems are able to visualize smaller subsegmental emboli. However, consensus is lacking regarding the clinical impact and treatment. In the present review, SPECT and SPECT in combination with low-dose CT, CTPA and dual energy CT are discussed in the context of diagnosing PE.

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Section: Scanning Protocolsmentioning

confidence: 99%

SPECT/CT and pulmonary embolism

Mortensen

Gutte

2013

Eur J Nucl Med Mol Imaging

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“…The implementation of multi-detector CTPA in clinical practice have improved the visualization of peripheral vessels, leading to a higher sensitivity of PE diagnosis and higher rate of subsegmental PE detection (2 to 3 mm in diameter) ( 9 ). While the rate of the subsegmental PE diagnosis is increasing with advancements of multi-detector CT ( 10 ), the true incidence of subsegmental PE remains unclear. The increase in the incidence of PE could also be the overdiagnosis or misdiagnosis by the CPTA as compared to the ventilation-perfusion (V/Q) scan that usually underdiagnoses subsegmental PEs ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Validation of an automated technique for quantification of pulmonary perfusion territories using computed tomography angiography

Zhao¹,

Malkasian²,

Hubbard³

et al. 2023

Quant Imaging Med Surg

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Background: Computed tomography pulmonary angiography (CTPA) is the primary modality for the detection and diagnosis of pulmonary embolism (PE) while the stratification of PE severity remains challenging using angiography. Hence, an automated minimum-cost path (MCP) technique was validated to quantify the subtended lung tissue distal to emboli using CTPA.Methods: A Swan-Ganz catheter was placed in the pulmonary artery of seven swine (body weight: 42.6±9.6 kg) to produce different PE severities. A total of 33 embolic conditions were generated, where the PE location was adjusted under fluoroscopic guidance. Each PE was induced by balloon inflation followed by computed tomography (CT) pulmonary angiography and dynamic CT perfusion scans using a 320-slice CT scanner. Following image acquisition, the CTPA and the MCP technique were used to automatically assign the ischemic perfusion territory distal to the balloon. Dynamic CT perfusion was used as the reference standard (REF) where the low perfusion territory was designated as the ischemic territory. The accuracy of the MCP technique was then evaluated by quantitatively comparing the MCP-derived distal territories to the perfusion-derived reference distal territories by mass correspondence using linear regression, Bland-Altman analysis, and paired sample t-test. The spatial correspondence was also assessed. Results:The MCP-derived distal territory masses (Mass MCP , g) and the reference standard ischemic territory masses (Mass REF , g) were related by Mass MCP =1.02Mass REF − 0.62 g (r=0.99, paired t-test P=0.51). The mean Dice similarity coefficient was 0.84±0.08. Conclusions:The MCP technique enables accurate assessment of lung tissue at risk distal to a PE using CTPA. This technique can potentially be used to quantify the fraction of lung tissue at risk distal to PE to further improve the risk stratification of PE.

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“…Whether patients with isolated SSPE benefit from anticoagulant treatment is currently uncertain. 4 There is growing evidence from observational studies that withholding anticoagulation may be safe in patients with isolated SSPE who are at low risk of recurrent or progressive VTE, [22][23][24][25][26][27] but most of such patients currently receive anticoagulant treatment, [28][29][30][31] potentially exposing them to an unnecessary risk of bleeding. Given the ongoing controversy and clinical equipoise about the risk-benefit ratio of anticoagulation for isolated SSPE, we aim to evaluate the efficacy and safety of clinical surveillance without anticoagulation compared with standard anticoagulation treatment in low-risk patients with SSPE in a randomised clinical trial.…”

Section: Introductionmentioning

confidence: 99%

Clinical Surveillance vs. Anticoagulation For low-risk patiEnts with isolated SubSegmental Pulmonary Embolism: protocol for a multicentre randomised placebo-controlled non-inferiority trial (SAFE-SSPE)

et al. 2020

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IntroductionThe clinical significance of subsegmental pulmonary embolism (SSPE) is currently unclear. Although growing evidence from observational studies suggests that withholding anticoagulant treatment may be a safe option in selected patients with isolated SSPE, most patients with this condition receive anticoagulant treatment, which is associated with a 90-day risk of recurrent venous thromboembolism (VTE) of 0.8% and major bleeding of up to 5%. Given the ongoing controversy concerning the risk-benefit ratio of anticoagulation for isolated SSPE and the lack of evidence from randomised-controlled studies, the aim of this clinical trial is to evaluate the efficacy and safety of clinical surveillance without anticoagulation in low-risk patients with isolated SSPE.Methods and analysisSAFE-SSPE (Surveillance vs. Anticoagulation For low-risk patiEnts with isolated SubSegmental Pulmonary Embolism, a multicentre randomised placebo-controlled non-inferiority trial) is an international, multicentre, placebo-controlled, double-blind, parallel-group non-inferiority trial conducted in Switzerland, the Netherlands and Canada. Low-risk patients with isolated SSPE are randomised to receive clinical surveillance with either placebo (no anticoagulation) or anticoagulant treatment with rivaroxaban. All patients undergo bilateral whole-leg compression ultrasonography to exclude concomitant deep vein thrombosis before enrolment. Patients are followed for 90 days. The primary outcome is symptomatic recurrent VTE (efficacy). The secondary outcomes include clinically significant bleeding and all-cause mortality (safety). The ancillary outcomes are health-related quality of life, functional status and medical resource utilisation.Ethics and disseminationThe local ethics committees in Switzerland have approved this protocol. Submission to the Ethical Committees in the Netherlands and Canada is underway. The results of this trial will be published in a peer-reviewed journal.Trial registration numberNCT04263038.

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The value of 64-detector row computed tomography for the exclusion of pulmonary embolism

Cited by 16 publications

References 40 publications

SPECT/CT and pulmonary embolism

SPECT/CT and pulmonary embolism

Validation of an automated technique for quantification of pulmonary perfusion territories using computed tomography angiography

Clinical Surveillance vs. Anticoagulation For low-risk patiEnts with isolated SubSegmental Pulmonary Embolism: protocol for a multicentre randomised placebo-controlled non-inferiority trial (SAFE-SSPE)

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