The diagnostic yield for computed tomography pulmonary angiography in patients with anticoagulation

BACKGROUND:Patients who present to the emergency department(ED)for suspected pulmonary embolism(PE)are often on active oral anticoagulation(AC).However,the diagnostic yield of computed tomography pulmonary angiography(CTPA)in screening for PE in patients who present on AC has not been well characterized.We aim to investigate the diagnostic yield of CTPA in diagnosing PE depending on AC status.METHODS:We reviewed and analyzed the electronic medical records of patients who underwent CTPA for PE at a university hospital ED from June 1,2019,to March 25,2022.Primary outcome was the incidence of PE on CTPA depending on baseline AC status and indication for AC.RESULTS:Of 2,846 patients,242 were on AC for a history of venous thromboembolism(VTE),210 were on AC for other indications,and 2,394 were not on AC.The incidence of PE on CTPA was significantly lower in patients on AC for other indications(5.7%)when compared to patients on AC for prior VTE(24.3%)and patients not on AC at presentation(9.8%)(P<0.001).In multivariable analysis among the whole cohort,AC was associated with a positive CTPA(odds ratio[OR]0.26,95%confidence interval[CI]:0.15-0.45,P<0.001).CONCLUSION:The incidence of PE among patients undergoing CTPA in the ED is lower in patients previously on AC for indications other than VTE when compared to those not on AC or those on AC for history of VTE.AC status and indication for AC may affect pre-test probability of a positive CTPA,and AC status therefore warrants consideration as part of future diagnostic algorithms among patients with suspected PE.

Reproducibility of thrombus volume quantification in multicenter computed tomography pulmonary angiography studies

AIM To evaluate reproducibility of pulmonary embolism(PE) clot volume quantification using computed tomography pulmonary angiogram(CTPA) in a multicenter setting.METHODS This study was performed using anonymized data in conformance with HIPAA and IRB Regulations(March 2015-November 2016). Anonymized CTPA data was acquired from 23 scanners from 18 imaging centers using each site's standard PE protocol. Two independent analysts measured PE volumes using a semi-automated region-growing algorithm on an FDA-approved image analysis platform. Total thrombus volume(TTV) was calculated per patient as the primary endpoint. Secondary endpoints were individual thrombus volume(ITV), Qanadli score and modified Qanadli score per patient. Inter-and intra-observer reproducibility were assessed using intra-class correlation coefficient(ICC) and BlandAltman analysis. RESULTS Analyst 1 found 72 emboli in the 23 patients with a mean number of emboli of 3.13 per patient with a range of 0-11 emboli per patient. The clot volumes ranged from 0.0041-47.34 cm3(mean +/-SD, 5.93 +/-10.15 cm3). On the second read, analyst 1 found the same number and distribution of emboli with a range of volumes for read 2 from 0.0041 – 45.52 cm3(mean +/-SD, 5.42 +/-9.53 cm3). Analyst 2 found 73 emboli in the 23 patients with a mean number of emboli of 3.17 per patient with a range of 0-11 emboli per patient. The clot volumes ranged from 0.00459-46.29 cm3(mean +/-SD, 5.91 +/-10.06 cm3). Inter-and intraobserver variability measurements indicated excellent reproducibility of the semi-automated method for quantifying PE volume burden. ICC for all endpoints was greater than 0.95 for inter-and intra-observer analysis. Bland-Altman analysis indicated no significant biases.CONCLUSION Semi-automated region growing algorithm for quantifying PE is reproducible using data from multiple scanners and is a suitable method for image analysis in multicenter clinical trials.

Computed tomography pulmonary angiography using a 20% reduction in contrast medium dose delivered in a multiphasic injection

AIM To evaluate the feasibility of reducing the dose of iodinated contrast agent in computed tomography pulmonary angiography(CTPA). METHODS One hundred and twenty-seven patients clinically suspected of having pulmonary embolism underwent spiral CTPA, out of whom fifty-seven received 75 mL and the remaining seventy a lower dose of 60 mL of contrast agent. Both doses were administered in a multiphasic injection. A minimum opacification threshold of 250 Hounsfield units(HU) in the main pulmonary artery is used for assessing the technical adequacy of the scans. RESULTS Mean opacification was found to be positively correlated to patient age(Pearson's correlation 0.4255, P < 0.0001) and independent of gender(male:female, 425.6 vs 450.4,P = 0.34). When age is accounted for, the study and control groups did not differ significantly in their mean opacification in the main(436.8 vs 437.9, P = 0.48),left(416.6 vs 419.8, P = 0.45) or the right pulmonary arteries(417.3 vs 423.5, P = 0.40). The number of sub-optimally opacified scans(the mean opacification in the main pulmonary artery < 250 HU) did not differ significantly between the study and control groups(7 vs 10).CONCLUSION A lower dose of iodine contrast at 60 mL can be feasibly used in CTPA without resulting in a higher number of sub-optimally opacified scans.

Significance of an additional unenhanced scan in computed tomography angiography of patients with suspected acute aortic syndrome

AIM To assess potential benefits of an additional unenhanced acquisition in computed tomography angiography(CTA) in patients with suspected acute aortic syndrome(AAS).METHODS A total of 103 aortic CTA(non-electrocardiography-gated, 128 slices) performed due to suspected AAS were retrospectively evaluated for acute aortic dissection(AAD), intramural hematoma(IMH), or penetrating aortic ulcer(PAU). Spiral CTA protocol consisted of an unenhanced acquisition and an arterial phase. If AAS was detected, a venous phase(delay, 90 s) was added. Images were evaluated for the presence and extent of AAD, IMH, PAU, and related complications. The diagnostic benefit of the unenhanced acquisition was evaluated concerning detection of IMH.RESULTS Fifty-six(30% women; mean age, 67 years; median, 68 years) of the screened individuals had AAD or IMH. A triphasic CT scan was conducted in 76.8%(n =43). 56% of the detected AAD were classified as Stanford type A, 44% as Stanford type B. 53.8% of the detected IMH were classified as Stanford type A, 46.2% as Stanford type B. There was no significant difference in the involvement of the ascending aorta between AAD and IMH(P = 1.0) or in the average age between AAD and IMH(P = 0.548), between Stanford type A and Stanford type B in general(P = 0.650) and between Stanford type A and Stanford type B within the entities of AAD and IMH(AAD: P = 0.785; IMH: P = 0.146). Only the unenhanced acquisitions showed a significant density difference between the adjacent lumen and the IMH(P = 0.035). Subadventitial hematoma involving the pulmonary trunk was present in 5 patients(16%) with Stanford A AAD. The difference between the median radiation exposure of a triphasic(2737 mGy*cm) compared to a biphasic CT scan(2135 mGy*cm) was not significant(P = 0.135).CONCLUSION IMH is a common and difficult to detect entity of AAS. An additional unenhanced acquisition within an aortic CTA protocol facilitates the detection of IMH.

Triple rule-out computed tomography angiography:Evaluation of acute chest pain in COVID-19 patients in the emergency department

BACKGROUND The aim of this study was to define clinical evidence supporting that triple ruleout computed tomography angiography(TRO CTA)is a comprehensive and feasible diagnostic tool in patients with novel coronavirus disease 2019(COVID-19)who were admitted to the emergency department(ED)for acute chest pain.Optimizing diagnostic imaging strategies in COVID-19 related thromboembolic events,will help for rapid and noninvasive diagnoses and results will be effective for patients and healthcare systems in all aspects.AIM To define clinical evidence supporting that TRO CTA is a comprehensive and feasible diagnostic tool in COVID-19 patients who were admitted to the ED for acute chest pain,and to assess outcomes of optimizing diagnostic imaging strategies,particularly TRO CTA use,in COVID-19 related thromboembolic events.METHODS TRO CTA images were evaluated for the presence of coronary artery disease,pulmonary thromboembolism(PTE),or acute aortic syndromes.Statistical analyses were used for evaluation of significant association between the variables.A two tailed P-value<0.05 was considered statistically significant.RESULTS Fifty-three patients were included into the study.In 31 patients(65.9%),there was not any pathology,while PTE was diagnosed in 11 patients.There was no significant relationship between the rates of pathology on CTA and history of hypertension.On the other hand,the diabetes mellitus rate was much higher in the acute coronary syndrome group,particularly in the PTE group(8/31=25.8%vs 6/16=37.5%,P=0.001).The rate of dyslipidemia was significantly higher in the group with pathology on CTA while compared to those without pathology apart from imaging findings of the pneumonia group(62.5%vs 38.7%,P<0.001).Smoking history rates were similar in the groups.Platelets,D-dimer,fibrinogen,C-reactive protein,and erythrocyte sedimentation rate values were higher in COVID-19 cases with additional pathologies.CONCLUSION TRO CTA is an effective imaging method in evaluation of all thoracic vascular systems at once and gives accurate results in COVID-19 patients.

Gadolinium Enhances Dual-energy Computed Tomography Scan of Pulmonary Artery

Objective To evaluate the feasibility of using gadopentetate dimeglumine(Gd-DTPA)for dual-energy computed tomography pulmonary angiography(CTPA).Methods Sixty-six patients were randomly divided into three groups and underwent CTPA.Group A had a turbo flash scan using an iohexol injection,Group B had a turbo flash scan using Gd-DTPA,and Group C had a dual-energy scan using Gd-DTPA.The original images of Group C were linearly blended with a blending factor of 0.5 or reconstructed at 40,50,60,70,80,90,100,and 110 keV,respectively.The groups were compared in terms of pulmonary artery CT value,image quality,and radiation dose.Results The pulmonary artery CT values were significantly higher in Group C40keV than in Groups B and C,but lower than in Group A.There was no significant difference in the image noise of Groups C40keV,B,and C.Moreover,Group A had the largest beam hardening artifacts of the superior vena cava(SVC),followed by Groups B and C.Group C40keV showed better vascular branching than the other three groups,among which Group B was superior to Group A.The subjective score of the image quality of Groups A,B,and C showed no significant difference,but the score was significantly higher in Group C40keV than in Groups A and B.The radiation dose was significantly lower in Group B than in Groups A and C.Conclusion Gd-CTPA is recommended to patients who are unsuitable for receiving an iodine-based CTPA.Furthermore,a turbo flash scan could surpass a dual-energy scan without consideration for virtual monoenergetic imaging.

疑诊肺栓塞患者CTPA检查指南依从性分析

目的 分析急诊疑诊肺栓塞(pulmonary embolism,PE)患者计算机断层扫描肺血管造影(CTPA)检查指南依从性。方法 本研究为单中心回顾性研究。收集2018年1月1日至2021年12月31日在北京大学第三医院急诊就诊进行CTPA检查患者的临床资料,根据CTPA检查结果分为PE组和非PE组,根据欧州心脏病学会(ESC)指南推荐,计算每位患者PE临床可能性的简化Wells评分(mWS)、改良的Geneva评分(rGS)和YEARs评分,并进行指南依从性分析。结果 共纳入1 062例疑诊PE患者,根据CTPA结果分为PE组341例,非PE组721例,CTPA阳性率32.1%,按照3种评分推荐流程进行CTPA的指南依从率分别为75.8%、79.8%及65.6%,当依从指南推荐时,可将CTPA阳性率分别提高至39.0%(P=0.002)、37.3%(P=0.018)和40.2%(P<0.001)。其中有68例患者尽管各类临床可能性评分分类至少有一种为“低危”或“不可能”,但CTPA仍为阳性结果。结论 依从指南推荐的CTPA检查流程可明显提高PE诊断阳性率,同时,应进一步关注评分阴性PE患者,从而提高诊断准确性。

Effect of varying computed tomography acquisition and reconstruction parameters on semi-automated clot volume quantification

AIM To examine effects of computed tomography(CT)image acquisition/reconstruction parameters on clot volume quantification in vitro for research method validation purposes.METHODS This study was performed in conformance with HIPAA and IRB Regulations(March 2015-November 2016).A ten blood clot phantom was designed and scanned on a dual-energy CT scanner(SOMATOM Force,Siemens Healthcare Gm BH,Erlangen,Germany)with varying pitch,iterative reconstruction,energy level and slicethickness.A range of clot and tube sizes were used in an attempt to replicate in vivo emboli found within central and segmental branches of the pulmonary arteries in patients with pulmonary emboli.Clot volume was the measured parameter and was analyzed by a single image analyst using a semi-automated region growing algorithm implemented in the FDA-approved Siemens syngo.via image analysis platform.Mixed model analysis was performed on the data.RESULTS On the acquisition side,the continuous factor of energy showed no statistically significant effect on absolute clot volume quantification(P=0.9898).On the other hand,when considering the fixed factor of pitch,there were statistically significant differences in clot volume quantification(P<0.0001).On the reconstruction side,with the continuous factor of reconstruction slice thickness no statistically significant effect on absolute clot volume quantification was demonstrated(P=0.4500).Also on the reconstruction side,with the fixed factor of using iterative reconstructions there was also no statistically significant effect on absolute clot volume quantification(P=0.3011).In addition,there was excellent R^2 correlation between the scale-measured mass of the clots both with respect to the CT measured volumes and with respect to volumes measure by the water displacement method.CONCLUSION Aside from varying pitch,changing CT acquisition parameters and using iterative reconstructions had no significant impact on clot volume quantification with a semi-automated region growing algorithm.

肺血栓栓塞症CTPA假阳性诊断常见原因分析及影像表现

目的:分析肺血栓栓塞症(PTE)CT肺动脉成像(CTPA)假阳性诊断的常见原因,以降低PTE的误诊率。方法:搜集我院62例PTE假阳性诊断病例的CTPA资料,观察肺动脉CTPA表现,分析误诊原因并对其进行分型,统计各型的发生率。结果:肺血栓栓塞CTPA假阳性诊断的常见原因包括:①呼吸运动及心脏传导搏动伪影引起的假阳性诊断(17.74%,11/62),假性栓子表现为紧贴肺动脉管壁一侧的窄带状稍低密度影,常累及多支血管;②上腔静脉内高浓度对比剂引起的硬射线伪影导致假阳性诊断(8.06%,5/62),表现为上腔静脉内对比剂浓度较高,周围见放射状分布的条纹状低密度影,累及邻近右肺动脉或右肺上叶肺动脉;③将肺门淋巴结误诊为栓子(12.90%,8/62),假性栓子常位于肺动脉分叉处,邻近肺动脉管壁轮廓光整,未见明显充盈缺损;④肺血管阻力局限性增高所致假阳性诊断(27.42%,17/62),表现为肺动脉期肺动脉管腔内条片状低密度影,主动脉期该条片状低密度影消失,邻近肺组织内常见慢性炎症或伴有同侧胸腔积液;⑤心血管功能差、肺循环减慢所致假阳性诊断(16.13%,10/62),CTPA表现为肺动脉远端分支强化程度减低,管腔内对比剂充盈不良;⑥纵隔及肺门淋巴结肿大压迫邻近肺动脉所致假阳性诊断(9.68%,6/62),CTPA表现为肺门及纵隔多发淋巴结增大、钙化,邻近肺动脉管腔受压狭窄,多见于尘肺及肺结核患者;⑦将支气管黏液栓误诊为肺动脉血栓(8.06%,5/62),表现为肺动脉走行区条状无强化低密度影,近端与支气管相连,周围见肺动脉分支伴行。结论:肺栓塞CTPA假阳性诊断的类型多样,正确识别各型误诊病例的图像特点,规范扫描方案,优化扫描策略,掌握正确的分析方法,有助于降低PTE的假阳性诊断率。

The application study of dual-energy CT nonlinearblending technique in pulmonary angiography

Objective This study aimed to explore the feasibility of enhancing image quality in computed tomography(CT) pulmonary angiography (CTPA) and reducing radiation dose using the nonlinear blending (NLB)technique of dual-energy CT.Methods A total of 61 patients scheduled for CTPA were enrolled, and 30 patients underwent dual-energyscanning. Nonlinear blending images (NLB group) and three groups of linear blending images (LB group,80 kV group, and 140 kV group) were reconstructed after scanning;31 patients underwent single-energyscanning (120 kV group). The CT values and standard deviations of the pulmonary trunk, left and rightpulmonary arteries, and ipsilateral back muscle at the bifurcation level of the left and right pulmonaryarteries were measured. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the fivegroups were calculated. The subjective image quality of the five groups was assessed. The radiation dosesof the dual- and single-energy groups were recorded and calculated.Results The CNR and SNR values of blood vessels in the NLB group were significantly higher than thosein the LB, 140 kV, and 80 kV groups (CNR of pulmonary artery trunk: t = 3.50, 4.06, 7.17, all P < 0.05;SNRof pulmonary trunk: t = 3.76, 4.71, 6.92, all P < 0.05). There were no statistical differences in the CNR andSNR values between the NLB group and 120 kV group (P > 0.05). The effective radiation dose of the dualenergygroup was lower than that of the single-energy group (t = –4.52, P < 0.05). The subjective scores ofimages in the NLB group were the highest (4.28 ± 0.74).Conclusion The NLB technique of dual-energy CT can improve the image quality of CTPA and reducethe radiation dose, providing more reliable imaging data for the clinical diagnosis of pulmonary embolism.

双低剂量肺动脉血管造影(CTPA)成像技术在诊断肺动脉栓塞的可行性研究

目的探讨64排螺旋CT在低碘对比剂剂量和低辐射剂量下施行肺动脉血管造影(CTPA)成像技术在诊断肺动脉栓塞的可行性。方法选取本院2021-2023年度疑似患有肺动脉栓塞的受检者60例。所有受检者均接受CTPA检查,将受检者分为常规剂量组管电压120KV,碘对比剂剂量30~40ml(30例)和低剂量组管电压100KV,碘对比剂剂量15mL(30例)均使用非离子型水溶性碘对比剂碘美普尔(400gl/100mL)。两组受检者均憋气扫描完成,比较两组受检者的CT值、背景噪声、信噪比(signal to noise ratio,SNR)、容积CT剂量指数(computed tomography dose index,CTDIvoI)、剂量长度乘积(dose length product,DLP)。结果低剂量组与常规剂量组的CT值、背景噪声、SNR、DLP、CTDIvoI相比有差异有统计学意义(P<0.01)。低剂量组与常规剂量组的图像质量相比没有统计学意义(P>0.05)。低剂量组与常规剂量组相比,其动脉栓塞检出率没有统计学意义(P>0.05)。结论在肺动脉血管造影(CTPA)成像上选用双低剂量,能够减少受检者发生碘对比剂肾病(contrast induced nephronpathy,CIN)并降低所承受到的辐射剂量,且双低剂量CTPA成像对肺动脉栓塞检查可行性高值得临床应用及推广。

Value of Coronary Sinus During Computed Tomography Pulmonary Angiography for Predicting Pulmonary Hypertension in Patients with Acute Pulmonary Embolism

Objective:Computed tomography pulmonary angiography(CTPA)parameters are valuable for predicting pulmonary hypertension(PH)in patients with pulmonary embolism(PE).However,few studies have used the coronary sinus ostium area(CSOA),derived from CTPA,to detect PH.This study aimed to compare the prognostic values of the CSOA,coronary sinus ostium diameter(CSOD),and right ventricular(RV)/left ventricular(LV)ratio for PH.Methods:This study retrospectively analyzed 78 patients(mean age,(51.94±12.33)years;53.8%male)with acute PE confirmed by CTPA at the Sixth and Eighth Medical Centers of the People’s Liberation Army General Hospital between June 2018 and June 2020.Patients were categorized into 2 groups using a pulmonary artery systolic pressure(PASP)cut-off of 30 mmHg.CTPA parameters were compared between these groups.Results:Patients with PASP>30 mmHg(n=22)had a larger CSOA,CSOD,RV diameter,RV/LV ratio,and inferior vena cava diameter compared with patients with PASP≤30 mmHg(n=56).The CSOA had an area under the receiver-operating characteristic curve(AUC,0.84;95%confidence interval(CI),0.74–0.94;P<0.001)similar to that of the RV/LV ratio(AUC,0.85;95%CI,0.73–0.99;P<0.001),while that of the CSOD was smaller(AUC,0.66;95%CI,0.51–0.81;P<0.05).Conclusion:Both CSOA and CSOD demonstrated a good ability to predict PH,while CSOA better predicted PASP>30 mmHg.

CTPA对急性肺动脉栓塞危险分层的预测价值

目的:探讨CT肺动脉成像(CTPA)对急性肺动脉栓塞(APE)危险分层的预测价值。方法:回顾性分析360例APE患者,根据临床危险分层分为低危组(203例)和中/高危组(157例),采用χ^(2)检验、Mann-Whitney U检验和独立样本t检验比较2组间临床资料和CTPA影像指标的差异。采用logistic回归分析筛选出APE危险分层的独立预测因素,并以ROC曲线评价单个独立预测因素及联合多指标的预测效能。结果:低危组与中/高危组的年龄、伴肺气肿、升主动脉直径(AAd)、肺动脉主干直径(MPAd)、肺动脉直径与升主动脉直径之比(rPA)、肺动脉主干栓塞、胸腔积液、心包积液、肺动脉栓塞指数(PAOI)和PAOI分级的差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,年龄、PAOI分级、MPAd、胸腔积液是APE危险分层的独立预测因素。对各独立预测因素及多指标联合行ROC曲线分析显示,多指标联合预测中/高危组的AUC为0.801(95%CI 0.755~0.846),较年龄、PAOI分级、MPAd、胸腔积液的AUC大,差异均有统计学意义(均P<0.001)。结论:CTPA不但可明确APE的诊断,其影像指标对APE危险分层具有较好的预测价值。

探讨深度学习重建算法对CTPA图像质量的影响

目的:对比滤波反投影重建算法(FBP)及常规迭代重建算法(ASiR-V),研究深度学习重建(DLIR)算法对肺动脉CT血管成像(CTPA)图像质量的影响.方法:在GE APEX CT上收集进行CTPA检查的患者30例,分别采用5种重建方式(FBP,常规临床参数的ASiR-V40%,DLIR-L/M/H)重建.分别测量肺动脉主干、左右肺动脉干、肺动脉主干层面椎旁肌肉的CT值、噪声(SD),计算其信噪比(SNR)、对比度噪声比(CNR),并进行客观评价.由2名高年资医师对所有图像进行评分.结果:5组图像在肺动脉主干、左、右肺动脉干的CT值差异均没有统计学意义(P>0.05);但5组图像的SD、CNR、SNR值差异均有统计学意义(P<0.01).DLIR的图像质量要显著优于ASiR-V,随着DLIR强度升高,SD值降低,SNR值升高.每名医师组内及2名医师组间的主观评分一致性均高,组内相关系数(ICC)值分别为0.838、0.879、0.843,5组图像主观评分差异均有统计学意义(P<0.01).图像质量趋势为DLIR-H>DLIR-M>DLIR-L>ASiR-V40%>FBP.结论:与FBP、ASiR-V40%算法相比,DLIR算法(TrueFidelity^(TM))能够显著降低图像噪声,提高SNR,且DLIR-H提供了最佳的主客观图像.DLIR算法在提高CTPA图像质量临床应用方面表现出巨大潜力.

The value of CT pulmonary angiography to the diagnosis of right ventricular dysfunction due to acute pulmonary embolism:compared with ultrasonographic cardiography

To analyze the value of CT pulmonary angiography（CTPA） in assessing right ventdcular dysfunction（RVD） after acute pulmonary embolism. Methods：Thirty-six patients with CTPA-confirmed PE who underwent ultrasonic cardiography（UCG） within the ensuing 24 hours were retrospectively reviewed. According to the severity of the disease, the patients were divided into the massive PE group（24 cases） and non-massive PE group（12 cases） respectively. CT scans were analyzed for findings suggestive of RVD. Scans were considered positive for RVD if the right ventricle was dilated（RVd/LVd 〉 1） or if the interventricular septum was straightened or deviated towards the left ventricle. Results were then compared with the results of UCG to estimate the value of CTPA in detecting RVD associated with PE, Results：In all cases, compared with UCG, the diagnostic sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, and negative predictive value of CTPA was 84.61%, 78.26%, 3.892, 0.197, 68.75% and 90% respectively. Kappa value was 0.60, which suggested moderate agreement between CTPA and UCG in the whole level. In the massive PE group, the diagnostic sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value of CTPA was 84.61%, 72.73%, 3.103, 0.212, 78.57% and 80% respectively. Kappa value was 0.58, which suggested moderate agreement between CTPA and UCG in the massive PE group. In the non-massive PE group, the diagnostic specificity of CTPA was 83.33%. By statistics, the value of RVd/LVd had significant difference between the massive PE and the non-massive PE group. Conclusion：CTPA can reliably detect RVD through the evaluation of cardiac morphology. However, this result requires confirmation using a larger prospective cohort study.

The dynamic study of the pulmonary artery obstruction degree and the right ventricular function in massive pulmonary embolism on CT pulmonary angiography

Objective： To analyze the value of CTPA in assessing the dissolve of embolus and the function of the right ventricle dynamically. Methods：Twenty-three cases of massive pulmonary embolism were analyzed retrospectively. The pulmonary artery obstruction index and the right ventricular function parameters were collected and analyzed on CTPA before thrombolytic therapy, 24 hours and 14 days after therapy, respectively. Results：The pulmonary artery obstruction index decreased gradually, and there was significant difference before therapy, 24 hours and 2 weeks after therapy. Twenty-four hours after therapy, the maximal short axes diameter and the maximal transverse area of right ventricle（RVd, RV~） decreased significantly, the maximal short axes diameter and the maximal transverse area of left ventricle（LVd, LVs） increased significantly, and the RVd/LVd, RVs/LVS decreased apparently. The pulmonary artery symbolic pressure before and 24 hours after therapy were apparently different. There was no significant difference between azygos vein, the super vena cava, the main pulmonary artery and vein reflux before and after therapy. Conclusion：CTPA can evaluate the pulmonary artery obstruction degree and right ventricular function dynamically.

Pulmonary artery aneurysm protruding into the bronchus as an endobronchial mass:A case report

BACKGROUND Pulmonary artery(PA)aneurysms are usually diagnosed radiographically and present as small or large lesions resembling inflammation or a neoplasm on chest radiography.It has rarely been reported as an endobronchial mass.CASE SUMMARY We report the case of a 64-year-old man who presented with recurrent hemoptysis.Bronchoscopy revealed a tumorous protrusion blocking the right middle lobe bronchus,which was confirmed to be a PA aneurysm using endobronchial ultrasound bronchoscopy and computed tomography angiography.CONCLUSION Although endobronchial PA aneurysms are rare,bronchoscopists need to add this lesion to the list of endobronchial masses for which a biopsy is to be assiduously avoided.

Role of pulmonary perfusion magnetic resonance imaging for the diagnosis of pulmonary hypertension:A review

Among five types of pulmonary hypertension,chronic thromboembolic pulmonary hypertension(CTEPH)is the only curable form,but prompt and accurate diagnosis can be challenging.Computed tomography and nuclear medicine-based techniques are standard imaging modalities to non-invasively diagnose CTEPH,however these are limited by radiation exposure,subjective qualitative bias,and lack of cardiac functional assessment.This review aims to assess the methodology,diagnostic accuracy of pulmonary perfusion imaging in the current literature and discuss its advantages,limitations and future research scope.

CT肺动脉造影推导的右心室与左心室直径比对急性肺栓塞危险分层及预后的评估价值

目的分析计算机断层扫描肺动脉造影(CTPA)推导的右心室(RV)与左心室(LV)直径比,对急性肺栓塞(APE)危险分层及预后的预测效能。方法回顾性分析2019-03至2023-04在武警贵州总队医院接受利伐他班预防急性静脉血栓的211例APE患者的电子医疗记录。根据简化版肺栓塞严重指数(sPESI)、肌钙蛋白检测、超声心动图检查将患者分为低危(n=69)、中低危(n=74)、中高危(n=68)。通过超声心动图评估RV收缩功能障碍(RVD),由影像科专家在CTPA图像上垂直于心脏长轴的单次横向扫描中测量RV和LV直径。随访90 d内的不良复合事件发生情况。结果不良结局APE患者的RV/LV更高(P<0.05),RV/LV预测APE患者短期预后的受试者工作特征曲线下面积(ROCAUC)结果为0.784,在最佳截断值(1.02)处,灵敏度79.9%,特异度75.3%。多元Logistics回归分析结果显示,RV/LV直径比>1.02为APE患者短期预后不良结局的独立危险因素。中高危患者的RV/LV直径比(1.11±0.25)高于低危(0.96±0.18)及中低危(0.99±0.28)患者(F=7.431,P=0.001)。RV/LV直径比预测中高危APE的ROCAUC为0.780。在RV/LV直径比≤1.02的70例患者中,14例(20.0%)通过超声心动图检测到RVD;在>1.02的134例患者中,77例(57.46%)通过超声心动图检测到RVD。Spearman秩相关分析结果显示,RV/LV直径比与sPESI(r_(s)=0.289)、肌酸激酶同工酶(r_(s)=0.291)、D-二聚体(r_(s)=0.386)呈正相关。结论根据CTPA推导的RV/LV直径比有助于评估APE患者的危险分层和短期不良预后。

急性Standford A型主动脉夹层合并肺动脉壁内血肿CT血管成像表现与预后

目的观察急性Standford A型主动脉夹层(AD)合并肺动脉壁内血肿(PAIH)CT血管成像(CTA)表现,分析其与预后的关系。方法回顾性分析55例急性Standford A型AD合并PAIH患者(PAIH组)及55例无PAIH的急性Standford A型AD患者(对照组)资料,对比2组主动脉及冠状动脉CTA表现,观察PAIH组术后15天血肿吸收情况,根据2组出院后1年内主动脉不良事件发生情况分析急性Standford A型AD患者预后的独立影响因素。结果PAIH组升主动脉最宽径大于对照组[(5.22±0.57)cm vs.(4.54±0.45)cm,t=6.963,P<0.001],主动脉瓣、窦管结合部、右冠窦、无冠窦及右冠状动脉更易受累,且更易出现心包积液和胸腔积液(P均<0.05)。PAIH组42例接受手术治疗,13例因病情危重未能接受手术治疗而死亡;术后15天其中36例血肿范围较前缩小。对103例完成随访,其中63例预后良好、40例预后不良。年龄及合并PAIH是急性Standford A型AD患者预后不良的独立影响因素(OR=1.07、4.71)。结论急性Standford A型AD合并PAIH的CTA表现具有一定特征性,有助于预测预后不良。