A preview of this full-text is provided by Springer Nature. This study aims to prove that the test bolus technique provides a better selective imaging study of the pulmonary arterial system in comparison to the automatic bolus-tracking technique. Improvements in the technical success rate and reliability of this modality will mean more widespread use in the future. Using the data from Registro Informatizado Enfermedad TromboEmbolica (RIETE), a prospective international registry of patients with venous thromboembolism (March 2001-January 2019), we explored the imaging modalities used in patients with acute PE. Conclusions: using anatomical charts. An exploratory objective of this study was t, All technical and personal data were removed from the images, A two-sided binominal test with a signicance level of 0.05 and a power of 0.8 wer, Simplied image reconstruction work ow of the monoenergetic recon, 73-year-old woman with a peripheral pulmonary embolism (white arrows). In a next step, the lower spatial frequency stack at low keV is combined with the high spatial frequency stack at optimal keV from a noise perspective to combine the benefits of both images stacks. DE CTPA utilizing image reconstruction at 40/50 keV allowed for a reduction of 84% in iodine load while maintaining CNR, which is especially important in patients with acute/chronic renal failure. Methods To illustrate the role of pulmonary perfusion in the diagnosis of acute and chronic pulmonary thromboembolism. SNR and CNR calculations were highest at 40 keV MEI+ followed by 55 keV and CTpv with significant differences to high keV MEI+ (85-100). a call of encouragement from the President of the United States. 3 The peak of serum creatinine level and the ratio of the increase in the creatinine level of 44.2 μ mol/L or more and the increase of 88.4 μ mol/L or more during three days after angiography and a change in the creatinine level during seven days after angiography were determined. Radiologic Technologist 16,525 views Method: Image quality was assessed qualitatively (vascular contrast and detectability of embolism, image noise, iodine influx artifact; two independent readers; 5-point Likert scale; 5 = excellent) and quantitatively by calculating signal-to-noise (SNR) and contrast-to-noise ratios (CNR). Images were acquired with a 3rd generation DE-CT system in DE mode (100/Sn150 kV) and activated tube current modulation 90 s after contrast agent administration. With the exception of severe air and fat embolism, the haemodynamic consequences of non-thrombotic emboli are usually mild. The pulmonary vasculature may be evaluated with various invasive and noninvasive methods. In 2008, all CTPA were being performed on 16-slice Sensitivity analyses examining only patients with stable prescan serum creatinine levels and incorporating intravenous fluid administration at the time of the CT scan into the model were also performed. may revoke this licence to you at any time and remove access to any copies of the Springer Nature journal content which have been saved. Results: Objectives To perform CT pulmonary angiography (CTPA) using a minimal amount of iodinated contrast media. Rationale and objectives: Conclusion: Its main use is to diagnose pulmonary embolism (PE). Results: Eighty-seven patients were involved in the result analysis. Conclusion: Nephropathy induced by contrast media may be less likely to develop in high-risk patients when iodixanol is used, rather than a low-osmolar, nonionic contrast media iopromide. Historically, catheter-directed pulmonary angiography has been used most commonly for the diagnosis of suspected pulmonary embolism (PE). Intravenous contrast material administration was not associated with an increased risk of AKI, emergent dialysis, and short-term mortality in a cohort of patients with diminished renal function. However, the diagnostic and prognostic significance remains unclear. 4841 slices with mean density 280.0 ± 63 HU are analyzed. Join ResearchGate to find the people and research you need to help your work. Criteria to be used for Chest CTA or a CT is requested for Pulmonary Emboli which cannot be approved based on Interqual or Milliman criteria. The use of computed tomography pulmonary angiography varied between 13.3% and 98.3% across the countries, and its use increased over time (46.5% in 2002 to 91.7% in 2018, P<0.001). New approaches and strategies in CT scanning have resulted in decreased radiation exposure as well as a significant decrease in contrast material used without decreasing the sensitivity for detection of pulmonary embolism. To examine the effect of intravenous iodinated contrast material administration on the subsequent development of acute kidney injury (AKI), emergent dialysis, and short-term mortality using a propensity score-adjusted analysis of computed tomographic scan recipients with chronic kidney disease (CKD). Mean patient weight was 71 kg (range 50–85 kg). Imaging & Therapy Division, Siemens Healthcare, Forchheim, is prospective single-center study was a, . The mean change in the creatinine level in the iodixanol group was less than that in the iopromide group 7 days after angiography (P < 0.05). Similar studies to reduce volume of contrast were done by Wichmann et al. Purpose: [13], Szucs et al. Moving beyond planar ventilation/perfusion (V/Q) scintigraphy, nuclear imaging offers several new approaches, including the use of single photon emission computed tomography (SPECT) and SPECT/CT resulting in superior diagnostic performance and a decrease in nondiagnostic studies, potentially surpassing the diagnostic capabilities of computed tomography pulmonary angiography. Linear blended 120 kilovoltage (kV) images (LB120) dual-energy (DE) data sets (50% 100 kV and 50% 140 kV) were compared to noise-optimised virtual monoenergetic image reconstruction (VMI+) at 40 kiloelectron volts (VMI+40). CT is widely used as an integral part of diagnostic evaluation of patients with suspected SSc-PAH. RESULTS:Ten weeks after model construction, the bodyweight of rats in the model group was significantly lower than that in the sham-operated group. For reduction of beam-hardening artifacts, VM imaging at 120 keV is useful for the initial assessment. Non-thrombotic PE does not represent a distinct clinical syndrome. 20 Consecutive patients with incidental pulmonary embolism in contrast-enhanced oncological follow-up DE-CTpv examination were included in this study. CT pulmonary angiography (CTPA) is a medical diagnostic test that employs computed tomography to obtain an image of the pulmonary arteries. 1 Because clinical signs or symptoms are often non‐specific, diagnosis relies on imaging tests, which include radioisotope ventilation perfusion scanning and, more commonly over recent years, computed tomography pulmonary angiography (CTPA). 14,15. educed iodine load at CT pulmonary angiography with dual-energy monochro, . Image noise significantly increased at 40 keV MEI+ compared to all other MEI+ reconstructions and CTpv (p < 0.001). Seven patients had an increase in serum creatinine level of 88.4 μ mol/L or more in the iopromide group. 2–4 CTPA is a standard procedure that obtains a CT volume while intravenously injected iodinated contrast media (CM) opacifies the pulmonary arteries. Diagnostic CTPA with 17 ml contrast media is possible in non-obese patients using low kVp, high pitch and carefully designed contrast media administration. Axial slices of peripheral pulmonary, summarizes the objective image quality assessment fo, ere was a substantial agreement between both radiologists, No false positive or false negative ndings wer, . According to Johns Hopkins Medicine , CT angiographies are … CT pulmonary angiography. Enter the email address you signed up with and we'll email you a reset link. By, accessing, sharing, receiving or otherwise using the Springer Nature journal content you agree to these terms of use (“Terms”). Rates of AKI, 30-day emergent dialysis, and mortality were compared between contrast and noncontrast groups. Ten weeks after model construction, the bodyweight, blood biochemical indicators, and metabolic parameters of rats in groups were measured. Treatment is mostly supportive but may differ according to the type of embolic material and clinical severity. Conclusions: CM protocol produces moderate but diagnostic vessel enhancement with little CM (mean = 50.7 ± 6 ml) in patients smaller than 86 kg (weight-class 1 to 3) independently to left ventricular or renal function. To view a copy of this license, visit. Of the six patients of the iopromide group, four patients recovered, one died and one developed chronic renal failure. Download Free PDF. Results for 1.5 cm slices are statistically evaluated on per slice, per vessel segment ascending aortic, aortic arch, descending and abdominal aorta, right and left iliacal artery (common and external) and per patient level, regarding left-ventricular function and renal impairment. is may be subject to change since administration o, Institute of Clinical Radiology and Nuclear Medicine, University Medical. Sorry, preview is currently unavailable. However, little is known about the choice of the diagnostic modalities in practice. Results: Concluding this chapter, we discuss the potential pitfalls associated with DECT. Access to this full-text is provided by Springer Nature. Identically for all readers, pulmonary embolism (PE) was detected in 1/47 participants. Abstract Guidelines for the evaluation of venous thromboembolism (VTE) include a history and physical examination in conjunction with computed tomographic pulmonary angiography (CTPA), Doppler ultrasonography, and D‐dimer measurements. This update incorporates recent evidence about sources of bias and variability in diagnostic accuracy and is intended to facilitate the use of STARD. PDF. Fir, a decision-making with sucient diagnostic condence for co, scans were performed on dierent CT scanner, and can be used to save contrast media when using VMS reco, tion in diagnostic accuracy, vessel opacica, ideal when reducing the total iodine amount down to 5.4, patients undergoing single-pass dual-energy comp. PDF. Conclusion: After experiencing an initial embolic event, a patient may be at risk for circulatory collapse secondary to right-sided heart failure, and a … [14] and Mathias et al. 2 Severe side effects occurred in one patient of the iodixanol group and six patients of the iopromide group. Materials and methods: Pulmonary angiography (or pulmonary arteriography) is medical fluoroscopic procedure used to visualize the pulmonary arteries and much less frequently, the pulmonary veins.. adequate enhancement of the pulmonary trunk and its branches.. Conventional computed tomographic (CT) scanning is, however, at a disadvantage because of its inability to obtain multiplanar images. This single-center retrospective study was HIPAA compliant and institutional review board approved. Pulmonary Angiography Kyung Cho Nils Kucher Although right heart catheterization was first described in 1929,1 angiographic visualization of the pulmonary arteries was not performed until 1938.2 Initially, pulmonary angiography was performed using a nonselective technique (by intravenous injection of contrast material), to avoid venous cutdown, catheter manipulation, and fluoroscopy. Springer Nature supports a reasonable amount of sharing of research papers by authors, subscribers and authorised users (“Users”), for small-, scale personal, non-commercial use provided that all copyright, trade and service marks and other proprietary notices are maintained. The participants received 80 mg I/kg body weight Iohexol contrast media using a preparatory saline bolus, a dual flow contrast/saline bolus and a saline flush, and a scanner protocol with 80 kVp dual source high-pitch mode. In 84.2% (n = 4074), diagnostic quality is delivered. Main pulmonary arteries at 50 keV and peripheral pulmonary arteries at 40 keV datasets provided the highest contrast-to-noise-ratio (CNR) for both the standard DE CTPA and the optimized protocol, with significantly higher CNR values for the standard DE CTPA protocol (p < 0.05). CT Pulmonary Angiography: Quantification of Pulmonary Embolus as a Predictor of Patient Outcome—Initial Experience1. As media representatives gather in 100 further patients were either examined with a standard CTPA protocol or a standard DE CTPA (32 g iodine). Results were validated with a bootstrapped sensitivity analysis. Simplified image reconstruction work flow of the monoenergetic reconstruction algorithm. Springer Nature journal, content cannot be used for inter-library loans and librarians may not upload Springer Nature journal content on a large scale into their, or any, These terms of use are reviewed regularly and may be amended at any time. 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