Skip to main content

Multislice CT Imaging of Pulmonary Embolism

  • Chapter
Multislice CT

Part of the book series: Diagnostic Imaging ((Med Radiol Diagn Imaging))

  • 283 Accesses

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).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 74.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

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

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    PubMed  CAS  Google Scholar 

  • Costello P (1994) Thoracic helical CT. Radiographics 14:913–918

    PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    PubMed  CAS  Google Scholar 

  • Goldhaber S (1997) Pulmonary embolism thrombolysis. Broadening the paradigm for its application. Circulation 96:716–718

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • Gurney JW (1993) No fooling around: direct visualization of pulmonary embolism. Radiology 188:618–619

    PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    Google Scholar 

  • Hu H, He HD, Foley WD, Fox SH (2000) Four multidetector-row helical CT: image quality and volume coverage speed. Radiology 215:55–62

    PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • Kalender WA (1994) Technical foundations of spiral CT. Semin Ultrasound CT MR 15:81–89

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • McCollough CH, Zink FE (1999) Performance evaluation of a multislice CT system. Med Phys 26:2223–2230

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    PubMed  CAS  Google Scholar 

  • 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

    PubMed  CAS  Google Scholar 

  • Patriquin L, Khorasani R, Polak JF (1998) Correlation of diagnostic imaging and subsequent autopsy findings in patients with pulmonary embolism. AJR 171:347–349

    Article  PubMed  CAS  Google Scholar 

  • PIOPED Investigators (1990) Value of the ventilation / perfusion scan in acute pulmonary embolism. JAMA 95: 498–502

    Google Scholar 

  • 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

    PubMed  CAS  Google Scholar 

  • Remy-Jardin M, Remy J (1999) Spiral CT angiography of the pulmonary circulation. Radiology 212:615–636

    PubMed  CAS  Google Scholar 

  • 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

    PubMed  CAS  Google Scholar 

  • 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

    PubMed  CAS  Google Scholar 

  • 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

    PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    PubMed  CAS  Google Scholar 

  • Schluger N, Henschke C, King T et al (1994) Diagnosis of pulmonary embolism at a large teaching hospital. J Thorac Imaging 9:180–184

    Article  PubMed  CAS  Google Scholar 

  • Schoepf U, Becker CR ,Bruening RD et al (1999) Electrocardio-graphically gated thin-section CT of the lung. Radiology 212:649–654

    PubMed  CAS  Google Scholar 

  • 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

    PubMed  CAS  Google Scholar 

  • 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

    PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Stein PD, Alavi A et al (1992) Complications and validity of pulmonary angiography in acute pulmonary embolus. Circulation 85:462–468

    Article  PubMed  CAS  Google Scholar 

  • 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

    PubMed  CAS  Google Scholar 

  • 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

    PubMed  Google Scholar 

  • 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

    PubMed  CAS  Google Scholar 

  • Tetalman MR, Hoffer PB, Heck LL, Kunzmann A, Gottschalk A (1973) Perfusion Lung Scan in Normal Volunteers. Radiology 106:593–594

    PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints 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

Publish with us

Policies and ethics