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Detection of pulmonary fat embolism with dual-energy CT: an experimental study in rabbits

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Abstract

Objectives

To evaluate the use of dual-energy CT imaging of the lung perfused blood volume (PBV) for the detection of pulmonary fat embolism (PFE).

Methods

Dual-energy CT was performed in 24 rabbits before and 1 hour, 1 day, 4 days and 7 days after artificial induction of PFE via the right ear vein. CT pulmonary angiography (CTPA) and lung PBV images were evaluated by two radiologists, who recorded the presence, number, and location of PFE on a per-lobe basis. Sensitivity, specificity, and accuracy of CTPA and lung PBV for detecting PFE were calculated using histopathological evaluation as the reference standard.

Results

A total of 144 lung lobes in 24 rabbits were evaluated and 70 fat emboli were detected on histopathological analysis. The overall sensitivity, specificity and accuracy were 25.4 %, 98.6 %, and 62.5 % for CTPA, and 82.6 %, 76.0 %, and 79.2 % for lung PBV. Higher sensitivity (p < 0.001) and accuracy (p < 0.01), but lower specificity (p < 0.001), were found for lung PBV compared with CTPA. Dual-energy CT can detect PFE earlier than CTPA (all p < 0.01).

Conclusion

Dual-energy CT provided higher sensitivity and accuracy in the detection of PFE as well as earlier detection compared with conventional CTPA in this animal model study.

Key points

• Fat embolism occurs commonly in patients with traumatic bone injury.

• Dual-energy CT improves diagnostic performance for pulmonary fat embolism detection.

• Dual-energy CT can detect pulmonary fat embolism earlier than CTPA.

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Abbreviations

CTPA:

Computed tomography pulmonary angiography

FES:

Fat embolism syndrome

MIP:

Maximum intensity projection

PE:

Pulmonary embolism

PFE:

Pulmonary fat embolism

PBV:

Perfusion blood volume

PPV:

Positive predictive value

NPV:

Negative predictive value

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Acknowledgments

The scientific guarantor of this study is Guang Ming Lu. U. Joseph Schoepf is a consultant for and receives research support from Astellas, Bayer, Bracco, GE, Medrad, and Siemens. The other authors have no conflicts of interest to declare. This study received funding from the Natural Science Foundation of China (no. 81401409 to C.X.T.) and the Program for New Century Excellent Talents in University (NCET-12-0260 to L.J.Z.). No complex statistical methods were necessary for the analysis of the results. Institutional Review Board approval was obtained. Approval from the institutional Animal Care Committee was obtained. No study subjects or cohorts have been previously reported. Methodology: prospective, diagnostic or prognostic experimental study performed at one institution.

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Authors and Affiliations

  1. Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China

    Chun Xiang Tang, Chang Sheng Zhou, Yan E. Zhao, U. Joseph Schoepf, Zong Hong Han, Li Qi, Long Jiang Zhang & Guang Ming Lu

  2. Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29401, USA

    U. Joseph Schoepf, Stefanie Mangold & B. Devon Ball

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  1. Chun Xiang Tang
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  2. Chang Sheng Zhou
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Correspondence to Long Jiang Zhang.

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Tang, C.X., Zhou, C.S., Zhao, Y.E. et al. Detection of pulmonary fat embolism with dual-energy CT: an experimental study in rabbits. Eur Radiol 27, 1377–1385 (2017). https://doi.org/10.1007/s00330-016-4512-2

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  • DOI: https://doi.org/10.1007/s00330-016-4512-2

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