The ventilator was turned off at end-inspiration and spiral CT scans were obtained (∼ 45 s). Notably, 3 of 11 patients with PE had upper extremity sources. 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. Summary. Victor F. Tapson, MD, FCCP, Duke University Medical Center March, 2005 Review: Moores LK, Jackson WL Jr, Shorr AF, Jackson JL.Meta-Analysis: Outcomes in Patients with Suspected Pulmonary Embolism Managed with Computed Tomographic Pulmonary Angiography. Angiography is an imaging test that uses x-rays and a special dye to see inside the arteries. A 6.3-Fr Grollman angiographic catheter was also advanced into the main pulmonary artery using a catheter guide wire (Seldinger technique). The negative predictive value of CTPA is 93% to 96%. To evaluate the accuracy of spiral computed tomography (CT) in the noninvasive diagnosis of pulmonary embolism (PE). For CT Angiography, there is no need for sedation or general anesthesia. 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. Eighty-four of the 86 emboli injected (98%) were recovered in the lung casts. Computed tomography pulmonary angiography (CTPA) is used for diagnosis. Would you like email updates of new search results? Purpose: To evaluate the accuracy of spiral computed tomography (CT) in the noninvasive diagnosis of pulmonary embolism (PE). Remy-Jardin M, Remy J, Wattinne L, Giraud F. Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the single-breath-hold technique--comparison with pulmonary angiography. After acquisition of the data, overlapping reconstructions were made using the standard algorithm. CT pulmonary angiography (CTPA) is a medical diagnostic test that employs computed tomography to obtain an image of the pulmonary arteries. Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: helical CT versus angiography. The right external and internal jugular veins were isolated for later insertion of a Swan-Ganz catheter (5-Fr), and a Grollman angiographic catheter, respectively. PEEP was maintained until the cast had completely hardened (approximately 4 h) and the lungs were then carefully removed from the chest. Clipboard, Search History, and several other advanced features are temporarily unavailable. A total of 86 emboli were injected, ranging from 3 to 8 per pig. Also shown, in parenthesis, are the number of false negatives and positives that were in identical locations for both readers. 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. CT angiography may also cost less than catheter angiography. CT pulmonary angiography (CTPA) is a medical diagnostic test that employs computed tomography to obtain an image of the pulmonary arteries. We have calculated that in order to do a per pig study in which an appropriate number of unaffected pigs were included and which had sufficient power to detect an approximately 10% difference in accuracy between the techniques, we would have had to study more than 200 pigs. The images were read in random order. Therefore, we have adopted a per embolus experimental design for pragmatic reasons. CTPA was introduced in the 1990s as an alternative to ventilation/perfusion scanning, which relies on radionuclide imaging of the blood vessels of the lung. Pulmonary embolism: prospective comparison of spiral CT with ventilation–perfusion scintigraphy. The two emboli lost from the cast as well as the five found outside the scanned volume were not included in the analysis. 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. 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. Table 4. CT generates ionising radiation, and thus, abdominal shielding may be used. It is a preferred choice of imaging in the diagnosis of PE due to its minimally invasive nature for the patient, whose only requirement for the scan is an intravenous line. View larger version (18K) Fig. Comparison of angiography to the vascular cast clearly demonstrated that angiography had both false-positive and false-negative diagnoses. 2D axial images show presence of thrombus in the main pulmonary arteries with extension to the segmental and subsegmental pulmonary arterial braches on both sides resulting in filling defects (A-C). 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. If the methacrylate emboli did not completely interrupt blood flow through the vessels in which they lodged then they might be easier to identify using CT rather than angiography. Epub 2018 Aug 10. Clin Med (Lond). Pulmonary embolism: imaging modalities--V/Q scan, spiral (helical) CT, and MRI. Pulmonary embolism: diagnosis with contrast-enhanced electron-beam CT and comparison with pulmonary angiography. Nagle SK, Schiebler ML, Repplinger MD, François CJ, Vigen KK, Yarlagadda R, Grist TM, Reeder SB. Sixteen female juvenile pigs (Large White-Landrace Cross) weighing 29 ± 2 kg were studied in the supine position. 2003 Jul;13(7):1501-7. doi: 10.1007/s00330-002-1709-3. This phantom study investigated the effects of patient shielding and scan length reduction on the fetal and maternal ionising radiation dose from CTPA. For CT Angiography, there is no need for sedation or general anesthesia. Pulmonary embolism is a commonly encountered clinical problem that is potentially fatal (1). On completion of pulmonary angiography pulmonary arterial pressure was measured again and the Grollman and Swan-Ganz catheters were withdrawn. NLM Fig. This site uses cookies. Results: CT angiography of the heart is a useful way of detecting blocked coronary arteries. Summary. CT also shows more proximal nonobstructive thrombus (arrowhead) within main pulmonary artery, more easily seen on CT than on angiogram (A). The average rate of injection was 14 ml/ s, and the total dose was 28 ml. Pulmonary angiography is a test to see how blood flows through the lung. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. By continuing to browse Semin Vasc Med. 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. Specifications were: CT3: pitch 2, 320 mA, 1 s rotation time and 120 kVp, preparation delay of 13 ± 3.5 s, contrast volume 72 ± 3 ml/run at a rate of 1.7 ± 0.1 ml/s. John Wiley, New York. Four cases of pulmonary sequestration are reported which were successfully diagnosed using spiral CT angiography. The pulmonary vascular tree of the pig is not identical to that of humans; there is one large main pulmonary arterial trunk with many smaller vessels as opposed to the more dichotomous branching structure of the human pulmonary vascular tree. The combined emboli were 2 to 3 times the length of single emboli, but never wider. Multi-detector row spiral CT pulmonary angiography: comparison with single-detector row spiral CT. Raptopoulos V(1), Boiselle PM. Contemporary diagnostic approaches to acute pulmonary emboli. For the past 40 years, physicians have used ventilation/perfusion (V/Q) imaging to diagnose potentially life-threatening pulmonary embolisms (PEs). Corrosion casting. 3 Blum AG, Delafau F, Grignon B, et al. Similarly, angiography detected 12 false-positive interpretations of pulmonary emboli that were (correctly) not diagnosed by CT3 and 12 that were (correctly) not diagnosed by CT1. This phantom study investigated the effects of patient shielding and scan length reduction on the fetal and maternal ionising radiation dose from CTPA. The results of this study illustrate the difficulty of assessing a new diagnostic technique when the accepted gold standard is less than perfect. The prospective sensitivity of CT was 91%, the specificity was 78%, the positive predictive value was 100%, and the negative predictive value was 89%. Significance was accepted when p < 0.05.  |  USA.gov. Main Street Radiology installed the first 16-detector spiral CT in Queens. These sized emboli are comparable to those of human subsegmental pulmonary arteries (13). COVID-19 is an emerging, rapidly evolving situation. However, our emboli were made so that they would lodge in branches of the major trunk which are the same size (3.8 to 4.2 mm) as human subsegmental pulmonary arteries (14). HHS Diagnosis of pulmonary embolism with spiral CT: comparison with pulmonary angiography and scintigraphy. The sensitivity and positive predictive value of angiography and spiral CT were calculated. In comparison to pulmonary angiography it is less invasive, less expensive, and its use may be more acceptable to physicians . Purpose: Statistical Methods for Rates and Proportions. Complications and validity of pulmonary angiography in acute pulmonary embolism. Materials and methods: A prospective study was performed in 75 patients who were evaluated with spiral CT and pulmonary angiography of each lung to detect central PE; 25 of the patients also underwent ventilation-perfusion (V-P) scanning. Spiral CT scans were technically suboptimal in three patients. Pulmonary embolism: diagnosis with spiral CT and ventilation-perfusion scanning--correlation with pulmonary angiographic results or clinical outcome. 1988. 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. 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). Although our results show that spiral CT is comparable to pulmonary angiography for the detection of pulmonary emboli in this porcine model, a number of caveats concerning experimental design should be considered before the results are applied clinically. 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). The aim of this study was to compare contrast-enhanced spiral CT to pulmonary angiography for the detection of subsegmental-sized pulmonary emboli by using a methacrylate cast of porcine pulmonary vessels as an independent gold standard.  |  The positive predictive value for CT1 was less than that of CT3 (p = 0.014) owing to the greater number of false positive for CT1. A nuclear medicine utilizing a gamma camera, V/Q imaging involves injecting both a radioactive tracer and having the patient inhale radioactive gas. Circulation. The kilovolts peak (kVp) and millampere-second (mAs) were electronically set to provide an entrance exposure of 300 microRAD (magnification factor approximately 1.2). Multi-detector row spiral CT pulmonary angiography: comparison with single-detector row spiral CT. Raptopoulos V(1), Boiselle PM. *Number of emboli in the cast that were used in the analysis (see text). 241 Since the development of multidetector CTPA, the sensitivity and specificity have increased to 83% to 94% and 94% to 100%, respectively. To corrode the tissue surrounding the cast, the lungs were immersed in a solution of supersaturated potassium hydroxide (300 g/L water) for approximately 3 to 4 d. To determine the effectiveness of the cast as an independent gold standard for diagnosing emboli, the number of emboli recovered was calculated as a percentage of the number injected. FissureNet: A Deep Learning Approach For Pulmonary Fissure Detection in CT Images. Author information: (1)Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA. Its main use is to diagnose pulmonary embolism. Images were reviewed on a workstation at mediastinal settings (window 350 Hounsfield units [HU], level 35 HU) and lung settings (window 1,500 HU, level −750 HU). 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. Current techniques for obtaining pulmonary angiographic images for detection of emboli in humans often involve selective angiography and occasionally magnification techniques which may improve the results of angiography. 2016 Mar;85(3):553-63. doi: 10.1016/j.ejrad.2015.12.018. Radiology . With this new technology, we became one of the first centers in the tri-state area to perform CT coronary angiography. Fleiss, J. L. 1981. Weinberg DS, Narayanan AS, Moore TA, Vallier HA. Ninety-five percent confidence intervals for sensitivity and positive predictive values were calculated for each size of emboli. The use of angiography as the gold standard assumes that angiography is always correct. Bronchial tree, lobular division and blood vessels of the pig lung. [3] Images depicting clots in the pulmonary arterial system are provided below. Because of this, results from survey studies have shown that physicians are reluctant to order pulmonary angiography, even when it is appropriate (6). 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. Victor F. Tapson, MD, FCCP, Duke University Medical Center March, 2005 Review: Moores LK, Jackson WL Jr, Shorr AF, Jackson JL.Meta-Analysis: Outcomes in Patients with Suspected Pulmonary Embolism Managed with Computed Tomographic Pulmonary Angiography. 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. This study has limitations that are intrinsic to the experimental design. On two occasions, when two or more emboli impacted in the same vessel, the most distal embolus broke away from the adjacent embolus during corrosion of the lung tissue. Of these, 40 were 4.2 mm in diameter and 46 were 3.8 mm in diameter. Three views were taken during angiography, although only one is shown here. NEJM Journal Watch reviews over 250 scientific and medical journals to present important clinical … We conclude that spiral CT is comparable to angiography for detection of pulmonary emboli. Pulmonary angiograms were carried out using commercially available Digital Subtraction Angiography (CAS 2000; Toshiba, Tokyo, Japan), and a 40.6-cm image intensifier. These include differences between species that might influence lung anatomy, the use of methacrylate “emboli” rather than thrombi, the ability to ensure apnea throughout the scan, the lack of comparison of CT with selective angiography and magnification, and the per embolus rather than per pig analysis.  |  The normal chest. (A) Pulmonary arterial cast of the right lung. A 14-French (Fr) polyethylene catheter was introduced into the left external jugular vein for later injection of the emboli. CT generates ionising radiation, and thus, abdominal shielding may be used. The positive predictive values for Readers 1 and 2, for each modality, are shown in Table 2. Angiography is an imaging test that uses x-rays and a special dye to see inside the arteries. Epub 2015 Dec 29. ANGIOGRAPHY AS THE GOLD STANDARD: POSITIVE PREDICTIVE VALUE (%). CT findings of 188 central emboli corresponded exactly to those of angiography. Within the last several years, spiral computed tomography angiography (SCTA) of the pulmonary arteries has emerged as a noninvasive angiographic modality for the evaluation of patients with suspected pulmonary embolism (PE). Thus, there were 79 emboli available for diagnosis for each of the imaging modalities and these were included in the analysis; these emboli consisted of 15 large, 18 small, and 46 emboli that combined at 21 locations (17 pairs, 4 triplets) (Table 1). Supported by the British Columbia Lung Association and the Medical Research Council of Canada. E-mail: American Journal of Respiratory and Critical Care Medicine. Sensitivity and 95% confidence intervals for 3 mm and 1 mm collimation CT and angiography, respectively, were: 82% (73 to 88%), 87% (79 to 93%), 87% (79 to 93%) (p = 0.42). 2019 Jan;38(1):156-166. doi: 10.1109/TMI.2018.2858202. Michiels JJ, Schroyens W, De Backer W, van der Planken M, Hoogsteden H, Pattynama PM. 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). Strategies that combined spiral CT and ultrasonography were considerably more expensive. There was no difference between spiral CT and angiography for detection of subsegmental-sized pulmonary emboli. The interobserver correlations for diagnosis of subsegmental PE with multidetector spiral CT exceed the reproducibility of selective pulmonary angiography. Pigs were killed and the pulmonary arterial tree was cast using methacrylate. i dont think they are same thing spiral ct is 3D ct and ct angio means you inject contrast and … Diagnosis of acute pulmonary embolism: time for a new approach [Editorial]. The use of computed tomography (CT) in evaluating PE and pulmonary infarction was first described in 1978. 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. 2C —Acute pulmonary embolism (PE) in 78-year-old woman (same patient as shown in Figs. … The angiographic images and CT scans were independently assessed by two radiologists (Reader 1 and Reader 2) who were unaware of experimental sequence, number and size of emboli in each pig. Spiral CT angiography for suspected pulmonary embolism: a cost-effectiveness analysis: van Erkel A R, van Rossum A B, Bloem J L, Klevit J, Pattynama P M Record Status. We conclude that spiral CT is comparable to angiography for detection of pulmonary … Pulmonary embolism (PE) is a common condition with high mortality and morbidity. RESULTS: Spiral CT angiograms were of satisfactory diagnostic quality in all 149 patients. Gerard SE, Patton TJ, Christensen GE, Bayouth JE, Reinhardt JM. The accuracy of the readers' diagnoses for the three imaging modalities (angiography, CT3, and CT1) was verified. However, the ability of spiral CT to detect subsegmental-sized emboli has not been tested. 211. 2019 Jul;19(4):315-318. doi: 10.7861/clinmedicine.19-4-315. On completion of the surgery, emboli were injected and the pigs were transferred to the imaging suites of our institution. SCTA is based on continuous computed tomography (CT) data acquisition during patient transport through the rotating X‐ray tube and detector system, where … It is impossible to calculate the specificity (percentage of true negatives) because it is not possible to count the total number of unaffected arteries. 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). 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). Use of spiral CT and pulmonary angiography also entailed costs related to procedural complications, eg, $49 per patient in the spiral CT-alone strategy and $30 per patient in spiral CT ± leg ultrasound. 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. Currently, pulmonary angiography is thought to be the most definitive of the techniques used for the diagnosis of pulmonary embolism (2, 3). 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. In 27 patients spiral CT and/or pulmonary angiography were non-diagnostic and these were excluded for image analysis. After embolization spiral CT (3 mm and 1 mm collimation), and pulmonary angiography were performed. A. Paré, P. D. Paré, R. S. Fraser, and G. P. Genereux. Definition of abbreviations: 95% CI = 95% confidence interval; R1 = Reader 1; R2 = Reader 2. Correspondence and requests for reprints should be addressed to Elisabeth M. Baile, UBC Pulmonary Research Laboratory, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6 Canada. We conclude that spiral CT is comparable to angiography for detection of pulmonary emboli. However, if poor image quality is obtained as a result of motion artifacts while using spiral CT, then pulmonary angiography should be considered. Radiology. In a clinical setting a dyspneic patient may not be able to hold their breath for as long as this, and consequently, the accuracy of spiral CT could be affected. In this paper, the technique, the findings and the role of spiral CT angiography in diagnosis of pulmonary embolism are discussed. 2015 Sep 24;10:153. doi: 10.1186/s13018-015-0288-3. We studied 16 anesthetized, juvenile pigs and injected colored methacrylate beads (3.8 mm, small; 4.2 mm, large) via the jugular vein. Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease: patient- versus segment-based analysis. Clinically, detection of pulmonary emboli is a common and important diagnostic problem (1); correct diagnosis leads to appropriate therapy, but false-positive and false-negative results are associated with significant risk for the patient. Pulmonary angiography is a test to see how blood flows through the lung. However, the accuracy of pulmonary angiography has never been evaluated against an independent gold standard. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Another limitation of angiography is that it has been used less frequently than is clinically indicated because it is invasive and is associated with significant morbidity and occasional mortality (5). Contrast-enhanced spiral CT. (B) Posterior view of cast of right lung clearly showing embolus 1. Two scans were obtained: first using 3-mm collimation (CT3) and next using 1-mm collimation (CT1). 2–4 CTPA is a standard procedure that obtains a CT volume while intravenously injected iodinated contrast media (CM) opacifies the pulmonary arteries. Contrast-enhanced spiral computed tomography (spiral CT) is a promising new technique for the diagnosis of pulmonary embolism. 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). Garg K, Welsh CH, Feyerabend AJ, Subber SW, Russ PD, Johnston RJ, Durham JD, Lynch DA. vraptopo@caregroup.harvard.edu Fraser, R. G., J. In conclusion, results from this study demonstrate that angiography and spiral CT are comparable for the detection of pulmonary emboli. Please enable it to take advantage of the complete set of features! The introduction of multidetector scanners will minimize this potential limitation. * Re:pulmonary embolism #1996584 : mahna - 01/14/10 23:16 : no !!!!! Diagnosis of pulmonary embolism with spiral CT as a second procedure following scintigraphy. 1995. 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. 1. 1,2 Since the 1990s, CT pulmonary angiography (CTPA) has become the method of choice for imaging in suspected PE. Notably, 3 of 11 patients with PE had upper extremity sources. 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. :201-8. doi: 10.1148/radiology.208.1.9646814 CT were calculated for each size of emboli was calculated the,! Proportions ( 14 ) design was not diagnosed from this study ( false negative ) because it was hidden the... Been evaluated against an independent gold standard can be attributed to it confidence intervals for and... Role of spiral CT and in the upper lobes above the level of 86... Errors for the diagnosis of pulmonary emboli for such a comparison Deep Learning for... Maintained until the cast that were used in the analysis ( see )... Gently with 1,000 ml saline there is no need for sedation or general anesthesia of metabolic after... Studies were positive in 39 patients any errors in the lung casts juvenile pigs Large! 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