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Densitometric CT evaluation of acute and chronic thromboembolic filling defects of the pulmonary arteries before and after contrast injection

Valutazione densitometrica dei difetti di riempimento tromboembolici acuti e cronici delle arterie polmonari prima e dopo somministrazione di mezzo di contrasto

  • Chest Radiology / Radiologia Toracica
  • Published:
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Abstract

Purpose

The aim of this study was to assess the baseline computed tomography (CT) attenuation of acute and chronic pulmonary thromboemboli, their contrast enhancement (CE), correlation with haematocrit (Ht) levels and the presence of hypertrophic bronchial arteries.

Materials and methods

From January 2006 to October 2009, we measured the baseline and postcontrast attenuation values of acute pulmonary thrombi emboli on CT angiograms of 86 patients with acute pulmonary embolism (PE) and those of chronic thrombi in 29 patients with pulmonary hypertension of various origins. The attenuation of acute thrombi was correlated with Ht and CE of chronic thrombi with the presence of hypertrophic bronchial arteries.

Results

Acute emboli had a mean baseline attenuation of 54.9 Hounsfield units (HU) and showed no CE. The attenuation of acute thrombi was not dependent on Ht. Chronic thrombi had a mean baseline attenuation of 33.8 HU, and 54% of thrombi showed significant CE. In 57% of cases, a collateral circulation had developed. In 76.5% of cases, CE and hypertrophic bronchial arteries coexisted (p=0.026). Neither thrombotic CE nor bronchial artery hypertrophy predominated in any one of the diseases associated with chronic thrombosis.

Conclusions

Before contrast administration, acute emboli coare prevalently hyperattenuating and therefore more conspicuous. Only chronic thrombi exhibit CE, and CE is significantly associated with the development of collateral circulation, which may be involved in the process of thrombotic recanalisation.

Riassunto

Obiettivo

Scopo del presente lavoro è stato valutare la densità basale dei trombi polmonari acuti e cronici, il loro contrast enhancement (CE), la correlazione con i valori di ematocrito (Ht) e la presenza di arterie bronchiali ipertrofiche (IB).

Materiali e metodi

Da gennaio 2006 a ottobre 2009 sono stati calcolati i valori densitometrici basali e postcontrastografici dei trombi acuti ricavati dalle angiotomografie computerizzate (TC) di 86 pazienti con embolia polmonare acuta e dei trombi cronici di 29 pazienti con ipertensione polmonare di diversa eziologia. La densità dei trombi acuti è stata correlata all’Ht e il CE dei trombi cronici alla presenza di IB.

Risultati

Gli emboli acuti hanno mostrato densità basale media di 54,9 UH e non hanno mostrato CE. La densità dei trombi acuti non dipendeva dall’Ht. I trombi cronici hanno mostrato densità basale media di 33,8 UH; nel 54% dei casi mostravano significativo CE. Il 57% dei casi sviluppa circoli collaterali. Nel 76,5% dei casi CE e IB erano concomitanti (p=0,026). Né il CE trombotico né l’ipertrofia delle arterie bronchiali prevalevano in una delle patologie associate a trombosi cronica.

Conclusioni

In fase pre-contrastografica i trombi polmonari acuti sono prevalentemente iperdensi e quindi meglio identificabili. Solo i trombi cronici mostrano CE; il CE si associa significativamente allo sviluppo di circoli collaterali che potrebbero essere implicati nel processo di ricanalizzazione trombotica.

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Authors and Affiliations

  1. Cardio-Thoracic-Vascular Department of Radiology, Sant’Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, Bologna, Italy

    F. De Luca, C. Modolon, F. Buia, D. Attinà, P. Fughelli & M. Zompatori

  2. Institute of Cardiology, Sant’Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, Bologna, Italy

    M. L. Bacchi Reggiani & N. Galiè

Authors
  1. F. De Luca
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  2. C. Modolon
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  3. F. Buia
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  4. D. Attinà
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  5. P. Fughelli
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  6. M. L. Bacchi Reggiani
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  7. N. Galiè
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  8. M. Zompatori
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Correspondence to F. De Luca.

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De Luca, F., Modolon, C., Buia, F. et al. Densitometric CT evaluation of acute and chronic thromboembolic filling defects of the pulmonary arteries before and after contrast injection. Radiol med 117, 979–991 (2012). https://doi.org/10.1007/s11547-012-0828-4

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  • DOI: https://doi.org/10.1007/s11547-012-0828-4

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