However, our emboli were made so that they would lodge in branches of the major trunk which are the same size (3.8 to 4.2 mm) as human subsegmental pulmonary arteries (14). Because there is no reason that the differences in anatomy between pigs and humans should favor improved accuracy of one technique in one species, we do not think that this difference in anatomy influences our major conclusions. The density of the solid resin is similar to blood and, in the absence of contrast media, emboli manufactured from it cannot be distinguished from blood. A polyethylene catheter (3 mm interior diameter) was inserted into the left carotid artery for measurement of systemic arterial blood pressure. A. Paré, P. D. Paré, R. S. Fraser, and G. P. Genereux. Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: helical CT versus angiography. Pulmonary angiography is a test to see how blood flows through the lung. Notably, 3 of 11 patients with PE had upper extremity sources. In a clinical setting a dyspneic patient may not be able to hold their breath for as long as this, and consequently, the accuracy of spiral CT could be affected. The negative predictive value of CTPA is 93% to 96%. 1A , 1B , 1C , 1D , and 1E ). Using spiral CT we correctly identified 117 of 135 patients with PE, and 106 of 117 patients without PE. However, the ability of spiral CT to detect subsegmental-sized emboli has not been tested. Arteries are blood vessels that carry blood away from the heart. Each reader recorded the exact vascular location of emboli, using a two-dimensional anatomic drawing of the porcine pulmonary arterial tree. 211. Results: Five of the 86 embole were located outside the scanned volume of CT. SENSITIVITY (%) FOR DETECTING PULMONARY EMBOLI USING SPIRAL CT AND ANGIOGRAPHY. 2004; 110: 2638 –2643. We have calculated that in order to do a per pig study in which an appropriate number of unaffected pigs were included and which had sufficient power to detect an approximately 10% difference in accuracy between the techniques, we would have had to study more than 200 pigs. 2016 Mar-Apr;49(2):75-8. doi: 10.1590/0100-3984.2014.0115. 2–4 CTPA is a standard procedure that obtains a CT volume while intravenously injected iodinated contrast media (CM) opacifies the pulmonary arteries. Differences between angiography and spiral CT were assessed using a two-sided test for equality of proportions (14). However, our study design was not intended for such a comparison. A 14-French (Fr) polyethylene catheter was introduced into the left external jugular vein for later injection of the emboli. Of these, 40 were 4.2 mm in diameter and 46 were 3.8 mm in diameter. CT pulmonary angiogram is a medical diagnostic test that employs computed tomography angiography to obtain an image of the pulmonary arteries. Therefore, the aim of the current study is to compare spiral CT to pulmonary angiography for detection of small pulmonary emboli by using a methacrylate cast of the porcine pulmonary vessels as the independent gold standard. The ventilator was turned off at end-inspiration and spiral CT scans were obtained (∼ 45 s). CT3 scans were reconstructed at 1.5 mm spacing (85 ± 4 sections) and CT1 scans at 0.5 mm spacing (187 ± 9 sections). The pigs were intubated, and ventilated using a tidal volume of 10 to 12 ml/kg and a rate of approximately 12 breaths/ min. Comparison with pulmonary angiography. In chest CT angiogram all the vessels of the chest are seen with the help of x-rays where as in pulmonary angiogram only vessels of the lungs are seen. On two occasions, when two or more emboli impacted in the same vessel, the most distal embolus broke away from the adjacent embolus during corrosion of the lung tissue. Table 2. Diagnosis of pulmonary embolism with spiral CT as a second procedure following scintigraphy. Epub 2018 Aug 10. In this study angiography was performed only after main pulmonary artery injection of contrast material. Fraser, R. G., J. i dont think they are same thing spiral ct is 3D ct and ct angio means you inject contrast and … Because this condition has no specific signs or symptoms its diagnosis relies on imaging techniques. In this paper, the technique, the findings and the role of spiral CT angiography in diagnosis of pulmonary embolism are discussed. Most of the essential methodological standards for comparing 2 tests were met in this report. It is impossible to calculate the specificity (percentage of true negatives) because it is not possible to count the total number of unaffected arteries. The amount and rate of injection of contrast was calculated, according to the formula used for humans in our institution, and adjusted for the pig's weight (0.57 ml/kg and 0.28 ml/kg/s, respectively). Coronal reformatted image demonstrates multiple emboli on pulmonary arteries (D). National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. The two distal emboli (2 and 3) are clearly seen but the posterior embolus (1) is partially hidden by the overlying interlobar artery. Goodman, L. R., J. J. Curtin, M. W. Mewissen, W. D. Foley, R. J. Lipchik, M. R. Crain, K. B. Sagar, and B. D. Collier. The purpose of this study was to investigate whether the severity of acute pulmonary embolism (PE) could be quantitatively assessed with spiral CT angiography (SCTA). vraptopo@caregroup.harvard.edu The aim of this study was to compare contrast-enhanced spiral CT to pulmonary angiography for the detection of subsegmental-sized pulmonary emboli by using a methacrylate cast of porcine pulmonary vessels as an independent gold standard. Also shown, in parenthesis, are the number of false negatives and positives that were in identical locations for both readers. Purpose: To evaluate the accuracy of spiral computed tomography (CT) in the noninvasive diagnosis of pulmonary embolism (PE). Although our results show that spiral CT is comparable to pulmonary angiography for the detection of pulmonary emboli in this porcine model, a number of caveats concerning experimental design should be considered before the results are applied clinically. | [3] Images depicting clots in the pulmonary arterial system are provided below. Gerard SE, Patton TJ, Christensen GE, Bayouth JE, Reinhardt JM. Any errors in the gold standard will always be reported as errors for the technique being compared. Because of this, results from survey studies have shown that physicians are reluctant to order pulmonary angiography, even when it is appropriate (6). The study was approved by the University Animal Experimentation Committee and was carried out according to the Candian guidelines for use and care of animals. Sensitivity and specificity was therefore 87 … The right external and internal jugular veins were isolated for later insertion of a Swan-Ganz catheter (5-Fr), and a Grollman angiographic catheter, respectively. As a minimally invasive examination, this technique is becoming widely available and has progressively replaced conventional and digital pulmonary angiography as the standard diagnostic imaging modality of the pulmonary … Prolonged resuscitation of metabolic acidosis after trauma is associated with more complications. CT1: as for CT3, except, preparation delay of 12 ± 2 s. Lungs were scanned from the level of the main pulmonary artery to 2 cm cephalad to the posterior costophrenic angle, using a field of view of 24 cm. View larger version (18K) Fig. John Wiley, New York. We studied 16 anesthetized, juvenile pigs and injected colored methacrylate beads (3.8 mm, small; 4.2 mm, large) via the jugular vein. Statistical Methods for Rates and Proportions. These include differences between species that might influence lung anatomy, the use of methacrylate “emboli” rather than thrombi, the ability to ensure apnea throughout the scan, the lack of comparison of CT with selective angiography and magnification, and the per embolus rather than per pig analysis. The introduction of multidetector scanners will minimize this potential limitation. E-mail: American Journal of Respiratory and Critical Care Medicine. Circulation. | The interobserver correlations for diagnosis of subsegmental PE with multidetector spiral CT exceed the reproducibility of selective pulmonary angiography. However, if poor image quality is obtained as a result of motion artifacts while using spiral CT, then pulmonary angiography should be considered. Significance was accepted when p < 0.05. Baile EM, King GG, Müller NL, D'yachkova Y, Coche EE, Paré PD, Mayo JR. Spiral computed tomography is comparable to angiography for the diagnosis of pulmonary embolism. Computed tomography pulmonary angiography (CTPA) is used for diagnosis. The positive predictive value for CT1 was less than that of CT3 (p = 0.014) owing to the greater number of false positive for CT1. The two emboli lost from the cast as well as the five found outside the scanned volume were not included in the analysis. The window width and level were selected by the operator. This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. CT generates ionising radiation, and thus, abdominal shielding may be used. The accuracy of the readers' diagnoses for the three imaging modalities (angiography, CT3, and CT1) was verified. Garg K, Welsh CH, Feyerabend AJ, Subber SW, Russ PD, Johnston RJ, Durham JD, Lynch DA. There was no difference between spiral CT and angiography for detection of subsegmental-sized pulmonary emboli. Am J … Correspondence and requests for reprints should be addressed to Elisabeth M. Baile, UBC Pulmonary Research Laboratory, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6 Canada. Spiral computed tomographic (CT) angiography of the pulmonary circulation has emerged recently as a potential useful diagnostic method for the evaluation of the pulmonary circulation. adequate enhancement of the pulmonary trunk and its branches.. Diagnosis of pulmonary embolism with spiral CT: comparison with pulmonary angiography and scintigraphy. Two sizes of colored emboli were made (large, 4.2 mm diameter, green; small, 3.8 mm diameter, red) using Batson's compound (Polysciences Inc., Warrington, PA), a methacrylate resin. A double-lumen (18-gauge) catheter was introduced into the left internal jugular vein for measurement of central venous pressure and the administration of intravenous fluids and drugs as required. A longer “breath-hold” time was required to acquire the tomographic images (CT3, 22 ± 1.4 s; CT1, 28 ± 2 s) than the angiographic images (< 10 s). Using fluoroscopy, the Swan-Ganz catheter was advanced into the main pulmonary artery for measurement of pulmonary arterial pressure. Angiography is an imaging test that uses x-rays and a special dye to see inside the arteries. Nagle SK, Schiebler ML, Repplinger MD, François CJ, Vigen KK, Yarlagadda R, Grist TM, Reeder SB. Remy-Jardin M, Remy J, Deschildre F, Artaud D, Beregi JP, Hossein-Foucher C, Marchandise X, Duhamel A. Radiology, (3):699-706 MED: 8756918 Contrast-enhanced spiral computed tomography (spiral CT) is a promising new technique for the diagnosis of pulmonary embolism. J Orthop Surg Res. 1998 Jul;208(1):201-8. doi: 10.1148/radiology.208.1.9646814. Strategies that combined spiral CT and ultrasonography were considerably more expensive. On completion of the surgery, emboli were injected and the pigs were transferred to the imaging suites of our institution. Epub 2015 Dec 29. The total number of false positive and false negatives for the two readers for each imaging modality is shown in Table 3. The use of computed tomography (CT) in evaluating PE and pulmonary infarction was first described in 1978. These were assigned as false negatives for spiral CT (52% of all the false negatives attributed to CT3 and CT1). The sensitivity of each technique, as interpreted by each reader, for emboli of different sizes, was calculated by the proportion of true-positive identifications. 1992 Nov. 185(2):381-7. 1988. Table 1. Pulmonary angiograms were carried out using commercially available Digital Subtraction Angiography (CAS 2000; Toshiba, Tokyo, Japan), and a 40.6-cm image intensifier. In many studies spiral CT has been compared with angiography for the diagnosis of pulmonary emboli, but neither has been compared with an independent gold standard (2, 3, 8– 11). https://ja.ma/2MABHL8 After embolization spiral CT (3 mm and 1 mm collimation), and pulmonary angiography were performed. (D) Embolus 1 is easily seen on spiral CT (1-mm collimation). 1,2 Since the 1990s, CT pulmonary angiography (CTPA) has become the method of choice for imaging in suspected PE. A nuclear medicine utilizing a gamma camera, V/Q imaging involves injecting both a radioactive tracer and having the patient inhale radioactive gas. Purpose: NIH The images were read in random order. Victor F. Tapson, MD, FCCP, Duke University Medical Center March, 2005 Review: Moores LK, Jackson WL Jr, Shorr AF, Jackson JL.Meta-Analysis: Outcomes in Patients with Suspected Pulmonary Embolism Managed with Computed Tomographic Pulmonary Angiography. There was no difference in positive predictive values between CT3, CT1, and angiography (p = 0.25, p = 0.23, respectively). 2D axial images show presence of thrombus in the main pulmonary arteries with extension to the segmental and subsegmental pulmonary arterial braches on both sides resulting in filling defects (A-C). Images were reviewed on a workstation at mediastinal settings (window 350 Hounsfield units [HU], level 35 HU) and lung settings (window 1,500 HU, level −750 HU). To illustrate the effect of using a potentially inaccurate gold standard, the data for spiral CT were also analyzed as if angiography were the gold standard. A CT coronary angiogram also enables radiologists to examine blood vessel walls, which the catheterization procedure does not. If the methacrylate emboli did not completely interrupt blood flow through the vessels in which they lodged then they might be easier to identify using CT rather than angiography. To compare the accuracy of techniques to detect pulmonary emboli, an analysis by subject rather than, or in addition to, by embolus would be desirable. In eight of the pigs pulmonary angiography was done before spiral CT and in the other eight spiral CT was done first. Positive predictive values and 95% confidence intervals for 3 mm and 1 mm collimation CT and angiography, respectively, were: 94% (86 to 94%), 81% (73 to 88%), and 88% (80 to 93%). Spiral computed tomographic (CT) angiography of the pulmonary circulation has emerged recently as a potential useful diagnostic method for the evaluation of the pulmonary circulation. For example, if angiography is used as the gold standard then no false positive or negatives can be attributed to it. Although CT1 was more sensitive than CT3, its positive predictive value was less than CT3 or angiography owing to a greater prevalence of false positives. Spiral CT Angiography for Acute PE: Where Do We Stand? Radiology. Materials and methods: A prospective study was performed in 75 patients who were evaluated with spiral CT and pulmonary angiography of each lung to detect central PE; 25 of the patients also underwent ventilation-perfusion (V-P) scanning. Findings from both studies were positive in 39 patients. CT findings of 188 central emboli corresponded exactly to those of angiography. Diagnosing PE Is V/Q Imaging a Better Choice, Especially for Younger Women? Complications and validity of pulmonary angiography in acute pulmonary embolism. Would you like email updates of new search results? We conclude that spiral CT is comparable to angiography for detection of pulmonary emboli. Victor F. Tapson, MD, FCCP, Duke University Medical Center March, 2005 Review: Moores LK, Jackson WL Jr, Shorr AF, Jackson JL.Meta-Analysis: Outcomes in Patients with Suspected Pulmonary Embolism Managed with Computed Tomographic Pulmonary Angiography. 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