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Schüssler A, Lug Q, Kremer N, Harth S, Kriechbaum SD, Richter MJ, Guth S, Wiedenroth CB, Tello K, Steiner D, Seeger W, Krombach GA, Roller FC. Evaluation of diagnostic accuracy of dual-energy computed tomography in patients with chronic thromboembolic pulmonary hypertension compared to V/Q-SPECT and pulmonary angiogram. Front Med (Lausanne) 2023; 10:1194272. [PMID: 37425315 PMCID: PMC10324648 DOI: 10.3389/fmed.2023.1194272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/31/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose The relevance of dual-energy computed tomography (DECT) for the detection of chronic thromboembolic pulmonary hypertension (CTEPH) still lies behind V/Q-SPECT in current clinical guidelines. Therefore, our study aimed to assess the diagnostic accuracy of DECT compared to V/Q-SPECT with invasive pulmonary angiogram (PA) serving as the reference standard. Methods A total of 28 patients (mean age 62.1 years ± 10.6SD; 18 women) with clinically suspected CTEPH were retrospectively included. All patients received DECT with the calculation of iodine maps, V/Q-SPECT, and PA. Results of DECT and V/Q-SPECT were compared, and the percent of agreement, concordance (utilizing Cohen's kappa), and accuracy (kappa2) to PA were calculated. Furthermore, radiation doses were analyzed and compared. Results In total, 18 patients were diagnosed with CTEPH (mean age 62.4 years ± 11.0SD; 10 women) and 10 patients had other diseases. Compared to PA, accuracy and concordance for DECT were superior to V/Q-SPECT in all patients (88.9% vs. 81.3%; k = 0.764 vs. k = 0.607) and in CTEPH patients (82.4% vs. 70.1%; k = 0.694 vs. k = 0.560). Furthermore, the mean radiation dose was significantly lower for DECT vs. V/Q-SPECT (p = 0.0081). Conclusion In our patient cohort, DECT is at least equivalent to V/Q-SPECT in diagnosing CTEPH and has the added advantage of significantly lower radiation doses in combination with simultaneous assessment of lung and heart morphology. Hence, DECT should be the subject of ongoing research, and if our results are further confirmed, it should be implemented in future diagnostic PH algorithms at least on par with V/Q-SPECT.
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Affiliation(s)
- Armin Schüssler
- Department of Diagnostic and Interventional Radiology, Justus-Liebig-University Giessen, Giessen, Germany
- Member of the German Center for Lung Research, Giessen, Germany
| | - Quirin Lug
- Department of Diagnostic and Interventional Radiology, Justus-Liebig-University Giessen, Giessen, Germany
- Member of the German Center for Lung Research, Giessen, Germany
| | - Nils Kremer
- Member of the German Center for Lung Research, Giessen, Germany
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute, Giessen, Germany
| | - Sebastian Harth
- Department of Diagnostic and Interventional Radiology, Justus-Liebig-University Giessen, Giessen, Germany
- Member of the German Center for Lung Research, Giessen, Germany
| | | | - Manuel J. Richter
- Member of the German Center for Lung Research, Giessen, Germany
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute, Giessen, Germany
| | - Stefan Guth
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | | | - Khodr Tello
- Member of the German Center for Lung Research, Giessen, Germany
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute, Giessen, Germany
| | - Dagmar Steiner
- Department of Nuclear Medicine, Justus-Liebig-University Giessen, Giessen, Germany
| | - Werner Seeger
- Member of the German Center for Lung Research, Giessen, Germany
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute, Giessen, Germany
- DZHK (German Centre for Cardiovascular Research), Frankfurt am Main, Germany
| | - Gabriele Anja Krombach
- Department of Diagnostic and Interventional Radiology, Justus-Liebig-University Giessen, Giessen, Germany
- Member of the German Center for Lung Research, Giessen, Germany
| | - Fritz Christian Roller
- Department of Diagnostic and Interventional Radiology, Justus-Liebig-University Giessen, Giessen, Germany
- Member of the German Center for Lung Research, Giessen, Germany
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Malik MK, Wroblewski I, Darki A. Pulmonary Cement Embolism After Vertebroplasty. Cureus 2023; 15:e39194. [PMID: 37332403 PMCID: PMC10276658 DOI: 10.7759/cureus.39194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/20/2023] Open
Abstract
Pulmonary cement embolism (PCE) is a known complication that can occur in the setting of vertebroplasty. The majority of these cases are asymptomatic and found incidentally on imaging. There are no current management recommendations regarding PCE. We present a case of a patient who underwent vertebroplasty complicated by a symptomatic sub-massive PCE.
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Affiliation(s)
- Muhammad K Malik
- Internal Medicine, Loyola University Medical Center, Maywood, USA
| | | | - Amir Darki
- Cardiology, Loyola University Medical Center, Maywood, USA
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Kalyanasundaram S, Sudarsanam H, Dhas D, Shankar A, Varadan B, Ethiraj D, Rajakumar A, A.C S, Devarajan V, Hakeem AR. Role of Combined CT Pulmonary Angiography and Indirect CT Venography in Diagnosing Venous Thromboembolism in COVID-19 Patients - Experience From an Indian Quaternary Centre. Vasc Endovascular Surg 2023; 57:129-136. [PMID: 36179371 PMCID: PMC9527151 DOI: 10.1177/15385744221131424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To study the role of combined CTPA and indirect CT venogram to diagnose venous thromboembolism (VTE) in patients with COVID-19 pneumonia and to compare the clinical characteristics, laboratory parameters, CT findings and clinical outcomes between the VTE positive and negative groups. METHODS In this retrospective study, 131 patients with COVID-19 pneumonia who underwent CTPA and venogram between August 2020 and January 2021 were included. Relevant demographical, clinical and laboratory data and CT images were collected. Two thoracic radiologists independently reviewed the CTPA and venogram images. RESULTS VTE was identified in 29 patients (22% of the study population). CT venogram identified DVT in 9 patients. No statistical difference was observed between the two groups with respect to age, gender, BMI and presence of comorbidities. There was a significant difference in the hospital stay duration, which is increased in the VTE positive group. The number of patients who were dependent on oxygen and mortality were also high in the positive group. There was statistically significant difference in the mean D-dimer value and the mean Neutrophil/lymphocyte ratio, which were higher in the VTE positive group. CONCLUSION Combined CTPA and venogram can be used as a one-stop investigation for diagnosing PE and DVT of lower limbs in patients with COVID-19 pneumonia. CTPA with venogram should be performed in patients with D-dimer value in the range of 1000 - 1200 μg/L and above to rule out VTE as the hospital stay duration and final outcomes vary between the positive and negative groups.
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Affiliation(s)
- Srinivasan Kalyanasundaram
- Department of Radiology, Dr. Rela Institute and Medical
Centre, Chennai, India,Srinivasan Kalyanasundaram, Department of
Radiology, Dr. Rela Institute and Medical Centre, 7, CLC Works street, 600045,
Chromepet, Chennai, India.
| | - Hemanth Sudarsanam
- Department of Radiology, Dr. Rela Institute and Medical
Centre, Chennai, India
| | - Daspin Dhas
- Department of Radiology, Dr. Rela Institute and Medical
Centre, Chennai, India
| | - Abhinaya Shankar
- Department of Radiology, Dr. Rela Institute and Medical
Centre, Chennai, India
| | - Baskaran Varadan
- Department of Radiology, Dr. Rela Institute and Medical
Centre, Chennai, India
| | - Dillibabu Ethiraj
- Department of Radio-diagnosis, Vardhman Mahavir Medical College
and Safdarjung Hospital, New Delhi, India
| | - Akila Rajakumar
- Department of Liver Intensive Care
and Anaesthesia, Dr. Rela Institute and Medical
Centre, Chennai, India
| | - Sathya A.C
- Department of Anaesthesia and ICU, Dr. Rela Institute and Medical
Centre, Chennai, India
| | - Vidya Devarajan
- Department of Infectious Diseases, Dr. Rela Institute and Medical
Centre, Chennai, India
| | - Abdul Rahman Hakeem
- Department of HB & Liver
Transplant Surgery, St James’s University
Hospital, Leeds, UK
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Chan K, Ioannidis S, Coghlan JG, Hall M, Schreiber BE. Pulmonary Arterial Hypertension With Abnormal V/Q Single-Photon Emission Computed Tomography. JACC Cardiovasc Imaging 2017; 11:1487-1493. [PMID: 29055626 DOI: 10.1016/j.jcmg.2017.07.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study aimed to evaluate the incidence and clinical outcomes of abnormal ventilation/perfusion (V/Q) single-photon emission computed tomography (SPECT) without thromboembolism, especially in patients with group I pulmonary arterial hypertension (PAH). BACKGROUND American Heart Association/American College of Cardiology and European Society of Cardiology guidelines recommend V/Q scan for screening for chronic thromboembolic pulmonary hypertension. The significance of patients with abnormal V/Q SPECT findings but no thromboembolism demonstrated in further investigations remained unclear. A distinct pattern of global patchy changes not typical of thromboembolism is recognized, but guidelines for reporting these in the context of PAH are lacking. METHODS A total of 136 patients who underwent V/Q SPECT and right-sided heart catheterization showing mean pulmonary arterial pressure ≥25 mm Hg were included. V/Q SPECT findings were reported using European Association of Nuclear Medicine criteria for pulmonary embolism followed by computed tomography pulmonary angiography screening for positive thromboembolism and further invasive pulmonary angiography for distal thromboembolism. The abnormal V/Q SPECT images were further analyzed according to perfusion pattern into focal or global perfusion defects. RESULTS V/Q SPECT showed thromboembolic disease in 44 patients, but 19 of these patients had no thromboembolism demonstrated by pulmonary angiography. Among these patients, 15 of 19 (78.9%) had group I PAH, and the majority had diffuse, patchy perfusion defects. After redefining V/Q SPECT images according to the perfusion pattern, those patients with global perfusion defects had higher mean pulmonary arterial pressure compared with patients with focal perfusion defects and normal scans (mean difference +13.9 and +6.2 mm Hg, respectively; p = 0.0002), as well as higher pulmonary vascular resistance (mean difference +316.6 and +226.3 absolute resistance units, respectively; p = 0.004). Among patients with PAH, global perfusion defects were associated with higher all-cause mortality with a hazard ratio of 5.63 (95% confidence interval: 1.11 to 28.5) compared with patients with focal or no perfusion abnormalities. CONCLUSIONS There is a high incidence of abnormal V/Q SPECT scans in nonthromboembolic PAH. Further studies are needed to investigate the poor outcome associated with abnormal V/Q SPECT findings in the context of PAH.
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Affiliation(s)
- Kenneth Chan
- Royal Free NHS Foundation Trust, London, United Kingdom; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | | | | | - Margaret Hall
- Royal Free NHS Foundation Trust, London, United Kingdom
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