Multislice CT angiography of peripheral pulmonary embolism
Bahaa Mohammed Elrefaey Hassan;
Abstract
The diagnosis of pulmonary embolism remains a major problem. Because of variable and non specific symptoms, imaging is required to establish the diagnosis.
The advent of chest CT scanning for the diagnosis of pulmonary embolism was hailed as an improvement, even before recent studies were undertaken. By 2001, CT scanning was being used more often than lung scanning to investigate suspected pulmonary embolism.
There are now multiple generations of CT scanners, but even first generations machines delivered images that were dramatic in clarity, rapidly acquired, and accurate in delineating the proximal pulmonary article tree. This non invasive technology has evolved rapidly. A 16-slice multi detector-row CT scanner can image the entire chest with sub millimeter resolution and requires a breath hold of less than 10 seconds.
MDCT pulmonary angiography and venography for suspected venous thrombo-embolism are safe, readily available, and increasingly being used. Recent advanced in technology allows faster scanning, thinner images and more reproducible interpretations.
The most important advantage of CT over other imaging modalities is that both mediastinal and parenchymal structures are evaluated, and thrombus is directly visualized. Studies have shown that up to two thirds of patients with an initial suspicion of PE receive another diagnosis, some with life threatening diseases, such as aortic dissection, pneumonia, lung cancer and pneumothorax. Most of these diagnoses are amenable to CT visualization, so that in many cases a specific etiology for the patient's symptoms and important additional diagnosis can be established.
Use of high resolution multi detector CT protocols was shown to improve visualization of pulmonary arteries and the detection of small sub segmental emboli and such small peripheral clots that might have gone unnoticed in the past are now frequently detected, even in patients with minor symptoms.
In suspected PE, establishing an unequivocal diagnosis as to the presence or absence of emboli or other disease based on a high quality multi detector row CT examination may reduce the overall radiation burden to the patients, since further work up with other tests that involve ionizing radiation may be less frequently required.
As compared with single detector CT scanning, pulmonary angiography with multi detector row CT significantly improves vessel visualization in the middle and peripheral lung zones.
And comparing MSCT with V/Q scintigraphy which is still considered as one of the most important tools of PE diagnosis, MSCT proved to have better specificity as well as its ability to detect the embolus itself not its consequences as V/Q scan.
Multi planar reconstructions improve the ability to identify the middle and peripheral vessels and connect them with their central arteries of origin. Narrower collimation improves the quality of the transverse and multi planar images, and faster acquisition times make the examination better and tolerated and improve contrast and spatial resolution, which may improve detection of peripheral pulmonary emboli.
Also recent advantages in MSCT as Paddle Wheel Reformatted Images shows that the non stopping advances in MSCT explains why MSCT pulmonary angiography is becoming the study of choice in diagnosis of PE.
The advent of chest CT scanning for the diagnosis of pulmonary embolism was hailed as an improvement, even before recent studies were undertaken. By 2001, CT scanning was being used more often than lung scanning to investigate suspected pulmonary embolism.
There are now multiple generations of CT scanners, but even first generations machines delivered images that were dramatic in clarity, rapidly acquired, and accurate in delineating the proximal pulmonary article tree. This non invasive technology has evolved rapidly. A 16-slice multi detector-row CT scanner can image the entire chest with sub millimeter resolution and requires a breath hold of less than 10 seconds.
MDCT pulmonary angiography and venography for suspected venous thrombo-embolism are safe, readily available, and increasingly being used. Recent advanced in technology allows faster scanning, thinner images and more reproducible interpretations.
The most important advantage of CT over other imaging modalities is that both mediastinal and parenchymal structures are evaluated, and thrombus is directly visualized. Studies have shown that up to two thirds of patients with an initial suspicion of PE receive another diagnosis, some with life threatening diseases, such as aortic dissection, pneumonia, lung cancer and pneumothorax. Most of these diagnoses are amenable to CT visualization, so that in many cases a specific etiology for the patient's symptoms and important additional diagnosis can be established.
Use of high resolution multi detector CT protocols was shown to improve visualization of pulmonary arteries and the detection of small sub segmental emboli and such small peripheral clots that might have gone unnoticed in the past are now frequently detected, even in patients with minor symptoms.
In suspected PE, establishing an unequivocal diagnosis as to the presence or absence of emboli or other disease based on a high quality multi detector row CT examination may reduce the overall radiation burden to the patients, since further work up with other tests that involve ionizing radiation may be less frequently required.
As compared with single detector CT scanning, pulmonary angiography with multi detector row CT significantly improves vessel visualization in the middle and peripheral lung zones.
And comparing MSCT with V/Q scintigraphy which is still considered as one of the most important tools of PE diagnosis, MSCT proved to have better specificity as well as its ability to detect the embolus itself not its consequences as V/Q scan.
Multi planar reconstructions improve the ability to identify the middle and peripheral vessels and connect them with their central arteries of origin. Narrower collimation improves the quality of the transverse and multi planar images, and faster acquisition times make the examination better and tolerated and improve contrast and spatial resolution, which may improve detection of peripheral pulmonary emboli.
Also recent advantages in MSCT as Paddle Wheel Reformatted Images shows that the non stopping advances in MSCT explains why MSCT pulmonary angiography is becoming the study of choice in diagnosis of PE.
Other data
| Title | Multislice CT angiography of peripheral pulmonary embolism | Other Titles | تصوير انسداد الشرايين الرئوية الطرفية باستخدام الأشعة المقطعية متعددة المقاطع | Authors | Bahaa Mohammed Elrefaey Hassan | Issue Date | 2015 |
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