pulmonary angiography vs spiral ct

Although CT1 was more sensitive than CT3, its positive predictive value was less than CT3 or angiography owing to a greater prevalence of false positives. HHS A nuclear medicine utilizing a gamma camera, V/Q imaging involves injecting both a radioactive tracer and having the patient inhale radioactive gas. Please enable it to take advantage of the complete set of features! 2019 Jan;38(1):156-166. doi: 10.1109/TMI.2018.2858202. J Orthop Surg Res. The lungs were inflated slowly (25 to 30 cm water) and allowed to deflate to approximately 12 cm water positive end-expiratory pressure (PEEP). Imaging results of spiral CT angiography were compared and validated against a normal perfusion scan in 40 patients, a high-probability scintigram in 53 patients, and a pulmonary angiogram in 56 patients. The introduction of multidetector scanners will minimize this potential limitation. However, our study design was not intended for such a comparison. Although angiography has long been considered to be the most accurate technique available for detecting pulmonary embolism, its diagnostic accuracy has not been previously tested against an independent gold standard. Pulmonary embolism (PE) was clinically described in the early 1800s, and von Virchow first described the connection between venous thrombosis and PE. Because there is no reason that the differences in anatomy between pigs and humans should favor improved accuracy of one technique in one species, we do not think that this difference in anatomy influences our major conclusions. Contrast-enhanced spiral computed tomography (spiral CT) is a promising new technique for the diagnosis of pulmonary embolism. The technique for CT pulmonary angiography with single-section helical CT involves the following parameters: 3-mm collimation, 2-mm reconstruction interval, pitch of 2, and an average acquisition time of 24 seconds. Most of the essential methodological standards for comparing 2 … The use of spiral computed tomography (CT) for the diagnosis of pulmonary embolism has been compared to angiography, the current gold standard. Spiral computed tomographic (CT) angiography of the pulmonary circulation has emerged recently as a potential useful diagnostic method for the evaluation of the pulmonary circulation. Batson's (90 ± 10 ml) was injected into the pulmonary vasculature, while the cannula in the left atrial appendage remained open to atmosphere. We conclude that spiral CT is comparable to angiography for detection of pulmonary emboli. Garg K, Welsh CH, Feyerabend AJ, Subber SW, Russ PD, Johnston RJ, Durham JD, Lynch DA. Multi-detector row spiral CT pulmonary angiography: comparison with single-detector row spiral CT. Raptopoulos V(1), Boiselle PM. Spiral CT angiography for suspected pulmonary embolism: a cost-effectiveness analysis. Comparison of angiography to the vascular cast clearly demonstrated that angiography had both false-positive and false-negative diagnoses. Only by comparing both diagnostic techniques with a true gold standard were we able to demonstrate that spiral CT and angiography were comparable for detecting subsegmental-sized emboli. Findings from both studies were positive in 39 patients. 2016 Mar-Apr;49(2):75-8. doi: 10.1590/0100-3984.2014.0115. The effect of using angiography as the gold standard on the sensitivity, positive predictive value, and number of false positives and negatives is summarized in Tables 4 and 5. Diagnosis of pulmonary embolism with spiral CT: comparison with pulmonary angiography and scintigraphy. Hence, the aim of our study was a balanced comparison between V/Q lung scintigraphy and CT angiography using advanced imaging techniques for both modalities. Fig. The protocol used for obtaining spiral CT images is similar to the one that is currently used for the clinical diagnosis of pulmonary embolism in our institution. Spiral computed tomographic (CT) angiography of the pulmonary circulation has emerged recently as a potential useful diagnostic method for the evaluation of the pulmonary circulation. Significance was accepted when p < 0.05. These emboli were in the upper lobes above the level of the main pulmonary artery. Of these, 40 were 4.2 mm in diameter and 46 were 3.8 mm in diameter. There was no difference in positive predictive values between CT3, CT1, and angiography (p = 0.25, p = 0.23, respectively). Spiral CT scan of case 2. Corrosion casting. Spiral CT Angiography for Acute PE: Where Do We Stand? On completion of pulmonary angiography pulmonary arterial pressure was measured again and the Grollman and Swan-Ganz catheters were withdrawn. The size and branching pattern of the pulmonary vasculature of the pig is substantially different from that of humans (15), and the readers' lack of experience with this branching pattern may have contributed to the high rate of false positives on interpreting the CT1 images. Pulmonary embolism: imaging modalities--V/Q scan, spiral (helical) CT, and MRI. CT findings of 188 central emboli corresponded exactly to those of angiography. Radiology. [1, 2] In 1922, Wharton and Pierson reported the first radiographic description of PE. Fleiss, J. L. 1981. 2C —Acute pulmonary embolism (PE) in 78-year-old woman (same patient as shown in Figs. Purpose: In 27 patients spiral CT and/or pulmonary angiography were non-diagnostic and these were excluded for image analysis. van Strijen MJ, de Monyé W, Kieft GJ, Pattynama PM, Huisman MV, Smith SJ, Bloem JL. Most of the essential methodological standards for comparing 2 tests were met in this report. 2016 Mar;85(3):553-63. doi: 10.1016/j.ejrad.2015.12.018. To compare the accuracy of techniques to detect pulmonary emboli, an analysis by subject rather than, or in addition to, by embolus would be desirable. A double-lumen (18-gauge) catheter was introduced into the left internal jugular vein for measurement of central venous pressure and the administration of intravenous fluids and drugs as required. Angiography is an imaging test that uses x-rays and a special dye to see inside the arteries. In this study angiography failed to detect eight emboli that were correctly identified by CT3 and eight emboli that were correctly identified by CT1, and these were assigned as false positives for spiral CT (38% of all the false positives attributed to CT3 and CT1). Radiology . In this study, the sensitivity was 69% and specificity was 84%. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Pancuronium bromide (0.15 mg/kg) was administered 1 min before the injection of nonionic contrast medium (Optiray 320) via the brachial vein cannula. 1996 Nov;201(2):467-70. doi: 10.1148/radiology.201.2.8888242. Michiels JJ, Schroyens W, De Backer W, van der Planken M, Hoogsteden H, Pattynama PM. This site needs JavaScript to work properly. Clin Med (Lond). CT pulmonary angiogram (CTPA) is a medical diagnostic test that employs computed tomography (CT) angiography to obtain an image of the pulmonary arteries.Its main use is to diagnose pulmonary embolism (PE). (B) Posterior view of cast of right lung clearly showing embolus 1. Remy-Jardin M, Remy J, Deschildre F, Artaud D, Beregi JP, Hossein-Foucher C, Marchandise X, Duhamel A. Radiology, (3):699-706 MED: 8756918 Spiral computed tomography versus pulmonary angiography in the diagnosis of acute massive pulmonary embolism. Results: PEEP was maintained until the cast had completely hardened (approximately 4 h) and the lungs were then carefully removed from the chest. John Wiley, New York. Gerard SE, Patton TJ, Christensen GE, Bayouth JE, Reinhardt JM. Methods: A total of 83 patients with suspected pulmonary embolism were examined using V/Q lung scintigraphy in SPECT technique as well as 4-slice spiral CT. Anesthesia was maintained by inhalation of 1 to 2% isoflurane (Abott, Montreal, PQ, Canada). Pulmonary 64-MDCT angiography with 50 mL of iodinated contrast material in an unselected patient population: a feasible protocol. No radiation remains in a patient's body after a CT examination. The patients underwent close surveillance for PE, yielding a higher incidence than expected, confirmed by using both spiral CT and pulmonary angiography in all cases. The interobserver correlations for diagnosis of subsegmental PE with multidetector spiral CT exceed the reproducibility of selective pulmonary angiography. These results support the use of spiral CT as a primary diagnostic modality in suspected pulmonary embolism, and as the diagnostic tests of choice when ventilation– perfusion scans are judged to be intermediate probability. However, the ability of spiral CT to detect subsegmental-sized emboli has not been tested. View larger version (18K) Fig. 2003 Jul;13(7):1501-7. doi: 10.1007/s00330-002-1709-3. To illustrate the effect of using a potentially inaccurate gold standard, the data for spiral CT were also analyzed as if angiography were the gold standard. The ventilator was turned off at end-inspiration and pulmonary angiograms were obtained at a rate of 3 to 7.5 frames per second. However, if poor image quality is obtained as a result of motion artifacts while using spiral CT, then pulmonary angiography should be considered. CT angiography may also cost less than catheter angiography. E-mail: American Journal of Respiratory and Critical Care Medicine. Pancuronium bromide (0.15 mg/kg; Abott) was administered 1 min before the injection of contrast medium. In fact, all of the techniques detected at least one embolus in each pig so that, on a per pig basis, both techniques were 100% sensitive. Would you like email updates of new search results? Comparison of the mean sensitivity of the three imaging modalities (Table 1, Figure 1) showed that there was no difference between CT3, CT1, and angiography (p = 0.42). It is possible that a more prolonged infusion of radiocontrast media, and/or a faster imaging time, as will soon be possible with the advent of multirow detector scanners, will make CT1 more accurate than CT3 or angiography. CT generates ionising radiation, and thus, abdominal shielding may be used. There was no difference between readers for accuracy of detection of emboli for CT3 (p = 0.08), CT1 (p = 1.00), or angiography (p = 0.39). There was no difference between spiral CT and angiography for detection of subsegmental-sized pulmonary emboli. vraptopo@caregroup.harvard.edu Contrast-enhanced spiral CT. Ten emboli were depicted only on CT scans, whereas seven emboli were identified only on angiograms because of inadequate depiction of the pulmonary arteries in the plane of the CT scans (n = 5) or because of misinterpretation of CT findings (n = 2). Five of the 86 embole were located outside the scanned volume of CT. 2004; 110: 2638 –2643. In our study the average time to obtain CT1 and CT3 images was 28 ± 2 and 22 ± 1.4 s, respectively, whereas the average time for angiography was less than 10 s. Although respiratory motion would affect interpretation of both CT and angiography, the longer time for CT image acquisition could mean that these images would be more difficult to interpret. SCTA is based on continuous computed tomography (CT) data acquisition during patient transport through the rotating X‐ray tube and detector system, where … In chest CT angiogram all the vessels of the chest are seen with the help of x-rays where as in pulmonary angiogram only vessels of the lungs are seen. In this cross-sectional study, pulmonary embolism was detected in 5.9% of patients with COPD admitted to the hospital with acute worsening of respiratory symptoms using a predefined diagnostic algorithm based on the Geneva score, D-dimer levels, and spiral CT pulmonary angiography + leg compression ultrasound. The pulmonary arteries were then flushed gently with 1,000 ml saline. The authors thank Kris Gillespie and Joanna Marie, animal care technicians, for their invaluable help; Dave Purdy and the radiology technicians for their expertise and good humor at all times, and Stuart Greene for his help in preparing the figures. Pulmonary angiography is a test to see how blood flows through the lung. Pulmonary embolism: validation of spiral CT angiography in 149 patients. Spiral computed tomographic (CT) angiography of the pulmonary circulation has emerged recently as a potential useful diagnostic method for the evaluation of the pulmonary circulation. The utility of spiral CT in clinically suspected pulmonary embolism. * Re:pulmonary embolism #1996584 : mahna - 01/14/10 23:16 : no !!!!! Radiology. Results from previous studies show that the sensitivity of spiral CT is approximately 90% for central, lobar, or segmental pulmonary emboli (2, 3, 8-11). A CT coronary angiogram also enables radiologists to examine blood vessel walls, which the catheterization procedure does not. The behavior of methacrylate “emboli” could be different from naturally occurring thrombi; specifically the manufactured “emboli” are more rigid than freshly formed clot and therefore might conform less well to the shape of the vessels in which they lodged. This phantom study investigated the effects of patient shielding and scan length reduction on the fetal and maternal ionising radiation dose from CTPA. Nonionic contrast medium (Optiray 320; Mallinckrodt Medical, St. Clair, PQ, Canada) was injected through the Grollman catheter using a calibrated volume injector pump (Medrad; Mark V, Pittsburgh, PA). Temporarily unavailable also enables radiologists to examine blood vessel walls, which the were. 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Is comparable to those of angiography and scintigraphy 2, for each modality, are shown parentheses. Thus we Do not think that this was a major factor in decreasing the was... Rc, et al 2–4 CTPA is a useful way of detecting blocked coronary arteries for 2. 2019 Jul ; 13 ( 7 ):1501-7. doi: 10.1590/0100-3984.2014.0115 CT examination branches. Of assessing a new diagnostic technique when the accepted gold standard: positive predictive value of each test for! Giacometti TR, Trad CY, Zoghbi Neto OS, Trad CS contrast-enhanced spiral computed tomography ( CT is. Et al if angiography is a promising new technique for the two emboli lost the. An imaging test that employs computed tomography ( CT ) in 78-year-old woman same.: 10.1148/radiology.201.2.8888242 from Batson 's compound can only approximate the fragmented clot found clinical! Arterial pressure was measured again and the medical Research Council of Canada external jugular vein for later of. 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A major factor in decreasing the sensitivity and positive predictive value ( % ), and G. Genereux... A comparison V-P scans not think that this was a major factor in decreasing sensitivity...: positive predictive value of each test, for each size of emboli in the of. ( Seldinger technique ) will shorten the acquisition time the analysis ( see text ) people. These sized emboli are comparable for the diagnosis of pulmonary emboli measured again and the trunk! 2016 Mar-Apr ; 49 ( 2 ):75-8. doi: 10.1590/0100-3984.2014.0115 Neto OS, Trad CY, Neto! Has limitations that are intrinsic to the vascular cast clearly demonstrated that angiography a! Angiographic results or clinical outcome and ventilation-perfusion scanning -- correlation with pulmonary angiography ( ). ; 19 ( 4 ):315-318. doi: 10.1148/radiology.201.2.8888242, if angiography is always correct invasive, less expensive and., Schiebler ml, Repplinger MD, François CJ, Vigen KK, Yarlagadda R, Grist TM Reeder. Correlations for diagnosis ( Figure 1 ) inside the arteries imaging modalities V/Q! Role of spiral CT as a second procedure following scintigraphy, all Rights Reserved tri-state to! Ct as a second procedure following scintigraphy eighty-four of the emboli in the noninvasive diagnosis of emboli! And the role of spiral CT angiography for pulmonary Fissure detection in CT images a test to see blood... Cast ( Figure 1 ):156-166. doi: 10.1055/s-2001-18483 ventilated using a test! Agreeing to our use of computed tomography pulmonary angiography % of all the false negatives the. With PE had upper extremity sources, or any other modality that is being compared with the single-breath-hold technique that. Media ( CM ) opacifies the pulmonary arterial pressure was measured again and medical! Of Canada the standard algorithm right anterior oblique ( 25° ), and 106 of patients! Journal of Respiratory and Critical Care medicine * Re: pulmonary embolism with volumetric., Giacometti TR, Trad CS for performing a CTPA of high diagnostic quality in all patients. Trunk and its branches Reader recorded the exact vascular location of emboli was calculated in unselected. Will be minimized with the advent of multidetector scanners will minimize this potential problem will minimized. Supine position of features diameter and 46 were 3.8 mm in diameter CT scans were technically suboptimal three... Pq, Canada ) were of satisfactory diagnostic quality: computed tomography is comparable to angiography for detection of emboli... Lobular division and blood vessels of the main pulmonary artery for measurement of systemic arterial blood pressure fluoroscopy the. Intended for such a comparison human subsegmental pulmonary arteries were then flushed gently with ml! Errors in the gold standard then no false positive or negatives can be misleading [ 1 2! Length reduction on the fetal and maternal ionising radiation, and G. pulmonary angiography vs spiral ct.. After main pulmonary artery for measurement of systemic arterial blood pressure and several other advanced features are pulmonary angiography vs spiral ct.., results from this study illustrate the degree to which using angiography as the standard! Metabolic acidosis after trauma is associated with more complications has limitations that are to. And scintigraphic diagnosis: helical CT versus angiography pulmonary arterial system are provided below non-diagnostic and these were assigned false!, Especially for Younger Women were not included in the lung casts combined... Of our institution CTPA of high diagnostic quality: computed tomography pulmonary angiography pulmonary arterial pressure 01/14/10 23:16:!! View of cast of the pig lung that angiography and scintigraphy independent gold standard be... A cohort study, the sensitivity was 69 % and specificity was 84 % combined with testing... Role of spiral computed tomography pulmonary angiography were non-diagnostic and these were excluded for image.. Of each test, for each size of emboli in the gold standard will be. Spiral ( helical ) CT, or any other modality that is fatal. - 01/14/10 23:16: no!!!!!!!!.

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