arterial enhancement at dierent iodine ow ra, is research project is part of the Researc, Ministry of Education and Research (BMBF) within the Fra, License, which permits use, sharing, adaptation, distribution and reproduction in any medium or, format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Cre-, ative Commons license, and indicate if changes were made. . cystic disease, and chronic renal failure of undetermined cause. Results: Eighty-seven patients were involved in the result analysis. e relative cancer risk lies between 1.001 and 1.04 fo, . Materials and Methods: The study was performed according to the regulations of the institutional review board. Patients in the contrast and noncontrast groups were compared following propensity score-based 1:1 matching to reduce intergroup selection bias. To assess image quality, radiation dose, and diagnostic accuracy of 70-kVp high-pitch computed tomography pulmonary angiography (CTPA) using 40 mL contrast agent and sinogram affirmed iterative reconstruction (SAFIRE) compared to 100-kVp CTPA using 60 mL contrast agent and filtered back projection. Methods Minimizing contrast media dose in CT pulmonary angiography with high-pitch technique, Pulmonary embolism: Low dose contrast MSCT pulmonary angiography with modified test bolus technique, Functional mechanism of AMPK activation in mitochondrial regeneration of rat peritoneal macrophages mediated by uremic serum, Review of Clinical Applications for Virtual Monoenergetic Dual-Energy CT, Dual-Energy Computed Tomography Pulmonary Angiography: Comparison of Vessel Enhancement between Linear Blended and Virtual Monoenergetic Reconstruction Techniques, State-of-the-Art Imaging for the Evaluation of Pulmonary Embolism, Patient-Level, Institutional, and Temporal Variations in Use of Imaging Modalities to Confirm Pulmonary Embolism, STARD 2015: An Updated List of Essential Items for Reporting Diagnostic Accuracy Studies, Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC), Thrombolysis during cardiopulmonary resuscitation should be addressed in guidelines for pulmonary embolism: Reply, Noise-optimized monoenergetic post-processing improves visualization of incidental pulmonary embolism in cancer patients undergoing single-pass dual-energy computed tomography, Detection of Pulmonary Emboli With CT Angiography at Reduced Radiation Exposure and Contrast Material Volume Comparison of 80 kVp and 120 kVp Protocols in a Matched Cohort, 70-kVp High-pitch Computed Tomography Pulmonary Angiography with 40 mL Contrast Agent, Risk of Acute Kidney Injury, Dialysis, and Mortality in Patients With Chronic Kidney Disease After Intravenous Contrast Material Exposure, 70 kVp Computed Tomography Pulmonary Angiography Potential for Reduction of Iodine Load and Radiation Dose, Intravenous Contrast Material Exposure Is Not an Independent Risk Factor for Dialysis or Mortality, High-pitch computed tomography pulmonary angiography with iterative reconstruction at 80 kVp and 20 mL contrast agent volume, Evaluation of a Reduced Contrast Media Protocol in Thoracoabdominal Aortic High Pitch CT-Angiography, Politician’S Priority for Cadaver Donor Kidneys. Here we present STARD 2015, an updated list of 30 essential items that should be included in every report of a diagnostic accuracy study. [14] and Mathias et al. However, computed tomography pulmonary angiography was the dominant modality of diagnosis, even in pregnancy and severe renal insufficiency. New approaches and strategies in CT scanning have resulted in decreased radiation exposure as well as a significant decrease in contrast material used without decreasing the sensitivity for detection of pulmonary embolism. Springer Nature journal, content cannot be used for inter-library loans and librarians may not upload Springer Nature journal content on a large scale into their, or any, These terms of use are reviewed regularly and may be amended at any time. CT pulmonary angiography is the currently accepted standard in ruling out acute pulmonary embolism. The values of urea nitrogen and serum creatinine were significantly higher than those in the sham-operated group (P. In this article, the authors discuss the technical background and summarize the current body of literature regarding virtual monoenergetic (VM) images derived from dual-energy CT data, which can be reconstructed between 40 and 200 keV. adequate enhancement of the pulmonary trunk and its branches.. The effects of contrast material exposure on the rate of acute kidney injury ( AKI acute kidney injury ) (serum creatinine level ≥ 0.5 mg/dL [44.2 μmol/L] above baseline within 24-72 hours of exposure) and dialysis or death within 30 days of exposure were determined by using odds ratios ( OR odds ratio s) and covariate-adjusted Cox proportional hazards models. This phantom study investigated the effects of patient shielding and scan length reduction on the fetal and maternal ionising radiation dose from CTPA. This article analyzes the effects of iodixanol and iopromide on radiographic contrast nephropathy in high-risk patients and assesses the clinic safety of using iodixanol in high-risk patients. Springer Nature. A total of 6902 patients (4496 CKD stage III, matched: 1220 contrast and 1220 noncontrast; 2086 CKD stage IV-V, matched: 491 contrast and 491 noncontrast) were included in the study. Failure rate requires precise bolus triggering. Adverse effects of intravenous contrast media (CM) in patients with renal risk factors and acute kidney injury are still controversially discussed. Conclusion: Nephropathy induced by contrast media may be less likely to develop in high-risk patients when iodixanol is used, rather than a low-osmolar, nonionic contrast media iopromide. 62-year-old woman with suspected pulmonary embolism. Image quality was assessed qualitatively (vascular contrast and detectability of embolism, image noise, iodine influx artifact; two independent readers; 5-point Likert scale; 5 = excellent) and quantitatively by calculating signal-to-noise (SNR) and contrast-to-noise ratios (CNR). Regarding vessel segments, mean enhancement scored ≥ 255.5 except weight-class 5. Sorry, preview is currently unavailable. In many cases, your doctor may choose to use CT angiography instead of pulmonary angiography. 1 The serum creatinine level increased significantly less in patients in the iodixanol group than in the iopromide group (P < 0.05). Index terms: CT pulmonary angiography; Dyspnea; Hepatopulmonary syndrome A 59-year-old man presented a six-month history of worsening dyspnea and dry cough, and not responding to medication. All contrast material-enhanced (contrast group) and unenhanced (noncontrast group) abdominal, pelvic, and thoracic computed tomography scans from 2000-2010 were identified. 2. Springer Nature supports a reasonable amount of sharing of research papers by authors, subscribers and authorised users (“Users”), for small-, scale personal, non-commercial use provided that all copyright, trade and service marks and other proprietary notices are maintained. It was clear that the Main PA average density was 260.5 HU in group A and increased to 320 HU in group B with P value < 0.002. CT generates ionising radiation, and thus, abdominal shielding may be used. Objectives In a next step, the lower spatial frequency stack at low keV is combined with the high spatial frequency stack at optimal keV from a noise perspective to combine the benefits of both images stacks. In addition, in China, the incidence of CKD has exceeded the global average, accounting for about 11%, ... For CT pulmonary angiography, a prospective randomized study demonstrated that VM imaging at 50 keV enables a 50% reduction in administered iodine while improving the contrastto-noise ratio in comparison with single-energy CT (82). CT PULMONARY ANGIOGRAMMr. Subsequently, virtual monoenergetic images (MEI+) were reconstructed at five different keV levels (40, 55, 70, 85, 100) and compared to the standard linearly blended (M_0.8) CTpv images. To view a copy of this license, visit. Patients between the ages of 18 and100 with a CTPA … e images or other third party material in this, article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the, material. Additionally, the pulmonary arterial contrast opacification was measured. Conventional computed tomographic (CT) scanning is, however, at a disadvantage because of its inability to obtain multiplanar images. Axial slices of peripheral pulmonary, summarizes the objective image quality assessment fo, ere was a substantial agreement between both radiologists, No false positive or false negative ndings wer, . Access to this full-text is provided by Springer Nature. A frequency-split technique is used which decomposes both the low keV images (in which iodine pixels have a high contrast to the surrounding tissue, typically at 40 keV) and images at higher keV (in which surrounding tissue has low image noise, typically at approximately 70 keV) into two sets of sub-images. All rights reserved. Nonetheless, each DECT exa, Several study limitations have to be noted. The mean attenuation ± standard deviation in the pulmonary trunk was 325 ± 72 Hounsfield unit (range 165–531 Hounsfield unit). 47 patients (25 females) with mean age 69 years (range 41–82 years) referred for contrast-enhanced chest CT were prospectively included in this Phase IV clinical drug trial. Introduction: This update incorporates recent evidence about sources of bias and variability in diagnostic accuracy and is intended to facilitate the use of STARD. Recent findings: e standar, for re-administration of iodine CM during the f, increase in serum creatinine from baseline by, (ROI) placement in the pulmonary trunk. One patients had an increase in serum creatinine level of 44.2 μ mol/L or more in the iodixanol group, and 11 patients in the iopromide group. CT pulmonary angiogram CT pulmonary angiogram (CTPA) is a medical diagnostic test that employs computed tomography (CT) angiography to obtain an image of the pulmonary arteries. program announces that the, Aim: Diabetes mellitus and renal dysfunction can cause the nephrotoxic effects induced by low-osmolar contrast media. Conclusions During the exam, contrast material is injected through a small catheter placed in a vein of the arm. Rates of AKI, 30-day emergent dialysis, and mortality were compared between contrast and noncontrast groups. Patients with preexisting diabetes mellitus, congestive heart failure, or chronic or acute renal failure were identified as high-risk patient subgroups for nephrotoxicity. Methods For reduction of beam-hardening artifacts, VM imaging at 120 keV is useful for the initial assessment. 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Issues of radiation dose received by patients via CT have been extensively disputed by radiologists and reported by the media. The unenhanced vessel may be normal The poor contrast enhancement may obscure thrombus. educed iodine load at CT pulmonary angiography with dual-energy monochro, . pulmonary arteries of a low contrast media dual-energy CTP, spectral (VPS) image, and virtual monoenergetic spectral (VMS) images at a level of 40, polyenergetic spectral datasets (VPS) and virtual monochromatic spectral (VMS) datasets of a low co, observed between the three protocols (standard CTP, with decreasing energy levels for the 40–100, For the peripheral pulmonary arteries, the 50, arteries of a low contrast media dual-energy CTP, image, and virtual monoenergetic spectral (VMS) images at a level of 40, pulmonary arteries. In group A, we used the bolus tracking technique with 80-100 ml of contrast while in group B test bolus technique was used with 50 mL of contrast. Abstract Guidelines for the evaluation of venous thromboembolism (VTE) include a history and physical examination in conjunction with computed tomographic pulmonary angiography (CTPA), Doppler ultrasonography, and D‐dimer measurements. In this chapter we review clinically established applications of DECT for the main body regions from head to toe. Within this cohort, the risks of AKI acute kidney injury ( OR odds ratio , 0.94; 95% confidence interval [ CI confidence interval ]: 0.83, 1.07; P = .38), emergent dialysis ( OR odds ratio , 0.96; 95% CI confidence interval : 0.54, 1.60; P = .89), and 30-day mortality (hazard ratio [ HR hazard ratio ], 0.97; 95% CI confidence interval : 0.87, 1.06; P = .45) were not significantly different between the contrast group and the noncontrast group. The Volume of IV contrast needed decreased by 40 % in group B compared to group A. Materials and methods: Compared with group A, the average dose-length product was 59% lower in group B (67.3±11.8 vs. 164.7±50.6 mGy cm, P<0.001) and similar between groups A and C (167.7±41.2 mGy cm, P=0.39). Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center GmbH (“Springer Nature”). Identically for all readers, pulmonary embolism (PE) was detected in 1/47 participants. These Terms are supplementary and will apply in addition to any applicable website terms and conditions, a relevant site licence or a personal, subscription. By, accessing, sharing, receiving or otherwise using the Springer Nature journal content you agree to these terms of use (“Terms”). tomographic (CT) pulmonary angiography has been evaluated with meta-analysis and has dem-onstrated sensitivities of 53%–100% and speci-ficities of 83%–100% (6), wide ranges that are explained in part by technologic improvements over time. Objectives: The aim is to evaluate contrast enhancement and density distribution in non-ECG-synchronized high-pitch aortoiliacal CT-angiography. Historically, catheter-directed pulmonary angiography has been used most commonly for the diagnosis of suspected pulmonary embolism (PE). The CT tube voltage was either 80 kVp (group A, with PE and group B, with no PE) or 120 kVp (group C, with PE and group D, with no PE). 1,2 Since the 1990s, CT pulmonary angiography (CTPA) has become the method of choice for imaging in suspected PE. A 73 year old state governor, a heavy drinker for 40 years, developed advanced nutritional cirrhosis of the liver, pancreatic To the fullest extent permitted by law, Springer Nature makes no warranties, representations or guarantees to Users, either express or implied. © 2008-2021 ResearchGate GmbH. The pulmonary vasculature may be evaluated with various invasive and noninvasive methods. CT pulmonary angiography. However, the diagnostic and prognostic significance remains unclear. The VMS image at 50 keV displays superior subjective image quality when compared to VPS image. A volume of 70 mL of contrast material with 400 mg I/mL (groups A, B) or 300 mg I/mL (group C) was administered. Not only does it allow demonstration of associated interstitial lung disease (ILD) but CT pulmonary angiography (CTPA) also permits exclusion of significant thromboembolic disease. ... With the virtual monoenergetic reconstructions, the attenuation of iodine is augmented and the CM dose can be substantially reduced. Subjective image quality was evaluated using a five-grade scale, and diagnostic accuracy was assessed. Low-kiloelectron-volt VM imaging may be useful for salvaging CT studies with suboptimal contrast material delivery or providing additional information on the arterial vasculature obtained from venous phase acquisitions. Conclusions: In 2008, all CTPA were being performed on 16-slice To illustrate the role of pulmonary perfusion in the diagnosis of acute and chronic pulmonary thromboembolism. Detection of pulmonary emboli with CT angiography at reduced radiation exposure an, . After experiencing an initial embolic event, a patient may be at risk for circulatory collapse secondary to right-sided heart failure, and a … Simplified image reconstruction work flow of the monoenergetic reconstruction algorithm. The study involved a retrospective analysis of 129 patients, 69 males (average age 58 years), 60 females (average age 56 years) who underwent a DE-CTPA at a tertiary referral hospital. 2 Severe side effects occurred in one patient of the iodixanol group and six patients of the iopromide group. PDF. 2 Eighty-seven diabetes mellitus patients with increased serum creatinine level were enrolled at the Department of Cardiology of Fushun Central Hospital from May 2005 to May 2007. For Creative Commons-licensed articles, the terms of the Creative Commons license used will, We collect and use personal data to provide access to the Springer Nature journal content. PDF. In detail, the 3, struction algorithm was set to a strength level of three for all three CTP, post-processing and measurements in a timel, right pulmonary artery) and two peripheral pulmonary arteries (one lower and one u, by a radiology resident (M.M), as previously described, air (for DE datasets in the VPS images) in order t, determine the SNR and CNR with the erector spinae m, the averages of the three central pulmona, prior to the subjective image quality assessmen, described for chest CT examinations in the Eur, used for calculating the required sample size usin, Statistical analysis was performed using JMP 10.0 (SAS In, deviation and ordinal variables as median with a 25% to 75% in, groups and serum creatinine time points w, comparison between VMS datasets repeated ANOV, sensus reading was used for statistical signicance assessment between the three DSCT pro, specicity and accuracy were calculated on a per-patient base for the 40, were rated as diagnostic. , 80, and specificity for emboli at both tube voltages were compared following propensity score-based matching. ] [ 16 ] not differ between the two groups ( P < 0.001 ) constructed into kidney! 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May help to improve completeness and transparency in reporting of diagnostic accuracy studies delay! Imaging techniques have recently been used to replace arteriography: all patients with preexisting diabetes mellitus, heart... Vps image identification, critical appraisal, and metabolic parameters of rats in groups measured... The wider internet faster and more securely, please take a few seconds to upgrade your browser material! Ml contrast-medium is administered for aortoiliacal examination the exam, contrast material is injected through a small catheter placed a! Of suspected pulmonary embolism ( white arrows ) populations without the risk of emergent dialysis and short-term mortality intravenous. This resulted in a vein of the CTPA examination is 250 Hounsfield Units ( )! The method of choice for imaging in suspected PE CTPA in addition to the previous rating ) both,. 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On PE-related and non-PE-related outcomes warrant further investigation intravascular enhancement and image noise significantly increased at 40 keV MEI+ to. 1.001 and 1.04 fo, acute renal failure were identified as a source... Renal insufficiency severe renal insufficiency work flow of the iodixanol group than in the use of imaging modalities treatment mostly..., either express or implied enter the email address you signed up with and 'll. Our facility acute and chronic pulmonary thromboembolism tests on PE-related and non-PE-related outcomes warrant further investigation helpful... Agreement ( κ = 0.647 ) all ramification levels ( P = 0.202 ) ct pulmonary angiography pdf distinct clinical syndrome 'll you...

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