Abstract
In the last few years CT has played an increasingly important role in the diagnosis of pulmonary embolism (PE), mainly brought about by the advent of fast CT image acquisition techniques (Remy-Jardin and Remy 1999; Schoepf et al. 2000a,b, 2002). Competing imaging modalities are receding: nuclear medicine imaging, once the first study in the diagnostic algorithm of PE, is in decline. The high percentage of indeterminate studies (73% of all performed; Pioped-Investigators 1990), poor inter-observer correlation (Blachere et al. 2000), and notorious lack of specificity (Pioped-Investigators 1990) contribute to this change. Pulmonary angiography, the one-time gold-standard for the diagnosis of PE, is performed infrequently (Schluger et al. 1994), is limited in its inter-observer reproducibility (Diffin et al. 1998; Stein et al. 1999) and does not exceed multislice CT in its accuracy for detecting isolated peripheral clot (Baile et al. 2000).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Baile E, King GG, Muller NL, D’Yachkova Y, Coche EE, Pare PD, Mayo JR (2000) Spiral computed tomography is comparable to angiography for the diagnosis of pulmonary embolism. Am J Respir Crit Care Med 161:1010–1015
Blachere H, Latrabe V, Montaudon M et al (2000) Pulmonary embolism revealed on helical CT angiography: comparison with ventilation-perfusion radionuclide lung scanning. AJR Am J Roentgenol 174:1041–1047
Cham MD, Yankelevitz DF, Shaham D et al (2000) Deep venous thrombosis: detection by using indirect CT venography. The Pulmonary Angiography-Indirect CT Venography Cooperative Group. Radiology 216:744–751
Costello P (1994) Thoracic helical CT. Radiographics 14:913–918
Diffin D, Leyendecker JR, Johnson SP, Zucker RJ, Grebe PJ (1998) Effect of anatomic distribution of pulmonary emboli on interobserver agreement in the interpretation of pulmonary angiography. AJR Am J Roentgenol 171:1085–1089
Duwe KM, Shiau M, Budorick NE, Austin JH, Berkmen YM (2000) Evaluation of the lower extremity veins in patients with suspected pulmonary embolism: a retrospective comparison of helical CT venography and sonography. AJR Am J Roentgenol 175:1525–1531
Frazier AA, Galvin JR, Franks TJ, Rosado-De-Christenson ML (2000) From the archives of the AFIP: pulmonary vasculature: hypertension and infarction. Radiographics 20: 491–524; quiz 530–531, 532
Garg K, Kemp JL, Wojcik D et al (2000) Thromboembolic disease: comparison of combined CT pulmonary angiography and venography with bilateral leg sonography in 70 patients. AJR Am J Roentgenol 175:997–1001
Garg K, Sieler H, Welsh CH, Johnston RJ, Russ PD (1999) Clinical validity of helical CT being interpreted as negative for pulmonary embolism: implications for patient treatment. AJR Am J Roentgenol 172:1627–1631
Ghaye B, Szapiro D, Mastora I et al (2001) Peripheral pulmonary arteries: how far in the lung does multi-detector row spiral CT allow analysis? Radiology 219:629–636
Goldhaber S (1997) Pulmonary embolism thrombolysis. Broadening the paradigm for its application. Circulation 96:716–718
Goodman L, Curtin JJ, Mewissen MW, Foley WD, Lipchik RJ, Crain MR, Sagar KB, Collier BD (1995) Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: helical CT versus angiography. AJR Am J Roentgenol 164:1369–1374
Goodman LR, Lipchik RJ, Kuzo RS, Liu Y, McAuliffe TL, O’Brien DJ (2000) Subsequent pulmonary embolism: risk after a negative helical CT pulmonary angiogram — prospective comparison with scintigraphy. Radiology 215:535–542
Groell R, Peichel KH, Uggowitzer MM, Schmid F, Hartwagner K (1999) Computed tomography densitometry of the lung: a method to assess perfusion defects in acute pulmonary embolism. Eur J Radiol 32:192–196
Gurney JW (1993) No fooling around: direct visualization of pulmonary embolism. Radiology 188:618–619
Hoffman E, McLennan G (1997) Assessment of the pulmonary structure-function relationship and clinical outcome measures: quantitative volumetric CT of the lung. Acad Radiol 4:758–776
Hoffman E, Tajik JK, Petersen G, Reiners TJ, Thompson BH, Stanford W (1995) Perfusion deficit versus anatomic visualization in detection of pulmonary emboli via electron-beam CT: validation in swine, medical imaging: physiology and function from multidimensional images. Proc SPIE 2433:1995
Hu H, He HD, Foley WD, Fox SH (2000) Four multidetector-row helical CT: image quality and volume coverage speed. Radiology 215:55–62
Hull R, Raskob GE, Ginsberg JS, Panju AA, Brill-Edwards P, Coates G, Pineo GF (1994) A noninvasive strategy for the treatment of patients with suspected pulmonary embolism. Arch Intern Med 154:289–297
Kalender WA (1994) Technical foundations of spiral CT. Semin Ultrasound CT MR 15:81–89
Klingenbeck-Regn K, Schaller S, Flohr T, Ohnesorge B, Kopp AF, Baum U (1999) Subsecond multislice computed tomography: basics and applications. Eur J Radiol 31:110–124
Konstantinides SGA, Olschewski M, Heinrich F, Grosser K, Rauber K, Iversen S, Redecker M, Kienast J, Just H, Kasper W (1997) Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism. Results of a multicenter registry. Circulation 96:882–888
Loud P, Grossman CD, Klippenstein DL, Ray CE (1998) Combined CT venography and pulmonary angiography: a new diagnostic technique for suspected thrombembolic disease. AJR Am J Roentgenol 170:951–954
Loud PA, Katz DS, Klippenstein DL, Shah RD, Grossman ZD (2000) Combined CT venography and pulmonary angiography in suspected thromboembolic disease: diagnostic accuracy for deep venous evaluation. AJR Am J Roentgenol 174:61–65
McCollough CH, Zink FE (1999) Performance evaluation of a multislice CT system. Med Phys 26:2223–2230
Meaney J, Weg JG, Chenevert TL, Stafford-Johnson D, Hamilton BH, Prince MR (1997) Diagnosis of pulmonary embolism with magnetic resonance angiography. N Engl J Med 336:1422–1427
Novelline R, Baltarowich O, Athanasoulis C, Greenfield A, McKusick K (1978) The clinical course of patients with suspected pulmonary embolism and a negative pulmonary angiogram. Radiology 126:561–567
Oser RF, Zuckerman DA, Gutierrez FR, Brink JA (1996) Anatomic distribution of pulmonary emboli at pulmonary angiography: implications for cross sectional imaging. Radiology 199:31–35
Patriquin L, Khorasani R, Polak JF (1998) Correlation of diagnostic imaging and subsequent autopsy findings in patients with pulmonary embolism. AJR 171:347–349
PIOPED Investigators (1990) Value of the ventilation / perfusion scan in acute pulmonary embolism. JAMA 95: 498–502
Qanadli SD, Hajjam ME, Mesurolle B et al (2000) Pulmonary embolism detection: prospective evaluation of dual-section helical CT versus selective pulmonary arteriography in 157 patients. Radiology 217:447–455
Remy-Jardin M, Remy J (1999) Spiral CT angiography of the pulmonary circulation. Radiology 212:615–636
Remy-Jardin M, Remy J, Wattinne L, Giraud F (1992) Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the single-breath-hold technique — comparison with pulmonary angiography. Radiology 185:381–387
Remy-Jardin M, Remy J, Deschildre F et al (1996) Diagnosis of pulmonary embolism with spiral CT: comparison with pulmonary angiography and scintigraphy. Radiology 200: 699–706
Remy-Jardin M, Remy J, Artaud D, Deschildre F, Duhamel A (1997) Peripheral pulmonary arteries: optimization of the spiral CT acquisition protocol. Radiology 204:157–163
Remy-Jardin M, Remy J, Artaud D, Fribourg M, Beregi JP (1998) Spiral CT of pulmonary embolism: diagnostic approach, interpretive pitfalls and current indications. Eur Radiol 8:1376–1390
Roberts DA, Gefter WB, Hirsch JA et al (1999) Pulmonary perfusion: respiratory-triggered three-dimensional MR imaging with arterial spin tagging-preliminary results in healthy volunteers. Radiology 212:890–895
Schluger N, Henschke C, King T et al (1994) Diagnosis of pulmonary embolism at a large teaching hospital. J Thorac Imaging 9:180–184
Schoepf U, Becker CR ,Bruening RD et al (1999) Electrocardio-graphically gated thin-section CT of the lung. Radiology 212:649–654
Schoepf U, Helmberger T, Holzknecht N et al (2000a) Segmental and subsegmental pulmonary arteries: evaluation with electron-beam versus spiral CT. Radiology 214:433–439
Schoepf U, Bruening R, Konschitzky H, Becker CR, Knez A, Weber J, Muehling O, Herzog P, Huber A, Haberl R, Reiser M (2000b) Pulmonary embolism: comprehensive diagnosis using electron-beam computed tomography for detection of emboli and assessment of pulmonary blood flow. Radiology 217:693–700
Schoepf U, Holzknecht N, Helmberger TK, Crispin A, Hong C, Becker CR, Reiser MF (2002) Subsegmental pulmonary emboli: improved detection with thin-collimation multide-tector-row spiral CT. Radiology 222:483–490
Stein PD, Alavi A et al (1992) Complications and validity of pulmonary angiography in acute pulmonary embolus. Circulation 85:462–468
Stein PD, Henry JW, Gottschalk A (1999) Reassessment of pulmonary angiography for the diagnosis of pulmonary embolism: relation of interpreter agreement to the order of the involved pulmonary arterial branch. Radiology 210: 689–691
Swensen SJ, Sheedy PF 2nd, Ryu JH et al (2002) Outcomes after withholding anticoagulation from patients with suspected acute pulmonary embolism and negative computed tomographic findings: a cohort study. Mayo Clin Proc 77: 130–138
Teigen CL, Maus TP, Sheedy PF 2nd, Stanson AW, Johnson CM, Breen JF, McKusick MA (1995) Pulmonary embolism: diagnosis with contrast-enhanced electron beam CT and comparison with pulmonary angiography. Radiology 194: 313–319
Tetalman MR, Hoffer PB, Heck LL, Kunzmann A, Gottschalk A (1973) Perfusion Lung Scan in Normal Volunteers. Radiology 106:593–594
Tillie-Leblond I, Mastora I, Radenne F et al (2002) Risk of pulmonary embolism after a negative spiral CT angiogram in patients with pulmonary disease: 1-year clinical follow-up study. Radiology 223:461–467
Van Erkel AR, van Rossum AB, Bloem JL, Kievit J, Pattynama PNT (1996) Spiral CT angiography for suspected pulmonary embolism: a cost-effectiveness analysis. Radiology 201:29–36
Van Rossum AB, Pattynama PM, Maliens WM, Hermans J, Heijerman HG (1998a) Can helical CT replace scintigraphy in the diagnostic process in suspected pulmonary embolism? A retrolective-prolective cohort study focusing on total diagnostic yield. Eur Radiol 8:90–96
Van Rossum AB, van Erkel AR, van Persijn van Meerten EL, Ton ER, Rebergen SA, Pattynama PM (1998b) Accuracy of helical CT for acute pulmonary embolism: ROC analysis of observer performance related to clinical experience. Eur Radiol 8:1160–1164
Wildberger JE, Niethammer MU, Klotz E, Schaller S, Wein BB, Gunther RW (2001) Multislice CT for visualization of pulmonary embolism using perfusion weighted color maps. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 173: 289–294
Winer-Muram HT, Boone JM, Brown HL, Jennings SG, Mabie WC, Lombardo GT (2002) Pulmonary embolism in pregnant patients: fetal radiation dose with helical CT. Radiology 224:487–492
Yankelevitz DF, Gamsu G, Shah A et al (2000) Optimization of combined CT pulmonary angiography with lower extremity CT venography. AJR Am J Roentgenol 174:67–69
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2004 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Schoepf, U.J. (2004). Multislice CT Imaging of Pulmonary Embolism. In: Reiser, M.F., Takahashi, M., Modic, M., Becker, C.R. (eds) Multislice CT. Diagnostic Imaging. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-05379-9_15
Download citation
DOI: https://doi.org/10.1007/978-3-662-05379-9_15
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-05381-2
Online ISBN: 978-3-662-05379-9
eBook Packages: Springer Book Archive