The Volume of IV contrast needed decreased by 40 % in group B compared to group A. The overall subjective image quality was higher at 120 kVp compared with 80 kVp (P = 0.017). Two independent readers analyzed all CTA in a randomized order for the localization of emboli, diagnostic confidence, and image quality. To evaluate noise-optimized monoenergetic postprocessing of dual-energy CT (DE-CT) on image quality in patients with incidental pulmonary embolism in single-pass portal-venous phase CT (CTpv). Signal-to-noise ratio and contrast-to-noise ratio were calculated. Results: Its main use is to diagnose pulmonary embolism (PE). e diagnosis of PE and i, PE (blinded to the previous rating). Academia.edu no longer supports Internet Explorer. CT angiography has become the gold standard for evaluation of suspected pulmonary embolism; however, continuous evolution in radiology has led to new imaging approaches that offer improved options for detection and characterization of pulmonary embolism while exposing patients to lower contrast and radiation dose. The current standard of care for members with suspected pulmonary embolism is a spiral CT scan, also called a CTA, CT PA (computed tomography pulmonary angiography), MDCT (multidector CT) or helical CT scan. 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. Image noise significantly increased at 40 keV MEI+ compared to all other MEI+ reconstructions and CTpv (p < 0.001). A total of 20 pa, right ventricular dysfunction on echocardiography, mass-index between all three groups (all p, frequency-split technique is used which decomposes both the low keV images (in which iodine pix, high contrast to the surrounding tissue, typ, lower spatial frequency stack at low keV is co. a noise perspective to combine the benets of both images stacks. educed iodine load at CT pulmonary angiography with dual-energy monochro, . Ten weeks after model construction, the bodyweight, blood biochemical indicators, and metabolic parameters of rats in groups were measured. A preview of this full-text is provided by Springer Nature. With the exception of severe air and fat embolism, the haemodynamic consequences of non-thrombotic emboli are usually mild. As media representatives gather in Conclusions: CT pulmonary angiography is the currently accepted standard in ruling out acute pulmonary embolism. CT Pulmonary Angiography: Quantification of Pulmonary Embolus as a Predictor of Patient Outcome—Initial Experience1. Axial slices of main pulmonary arteries of a low contrast media dual-energy CTPA: (A) mixed 0.8-weighted virtual polyenergetic spectral (VPS) image, and virtual monoenergetic spectral (VMS) images at a level of 40 keV (B), 50 keV (C), 60 keV (D), 70 keV (E), 80 keV (F), 90 keV (G) and 100 keV (H). the osmotic concentration of 290 mmol/kg, GE Healthcare Ireland, batch number 10551022 10330922, and iopromide, tradename Ultravist370, containing 370 mg/mL iodine, with the osmotic concentration of 770 mmol/kg, Guangzhou Xianling Company, batch number 72834 44326. Join ResearchGate to find the people and research you need to help your work. The reference standard for the presence of emboli involved consensus reading and assessment of available clinical data and findings with additional imaging modalities. Correspondence and requests for materials should be addressed to M.M. To examine the effect of intravenous iodinated contrast material administration on the subsequent development of acute kidney injury (AKI), emergent dialysis, and short-term mortality using a propensity score-adjusted analysis of computed tomographic scan recipients with chronic kidney disease (CKD). Dual-energy computed tomography (DECT) has evolved from a research tool to an established clinical imaging modality since its first commercial introduction in the mid-2000s. A greater proportion of patients underwent ventilation/perfusion scanning in larger hospitals compared with smaller hospitals (13.1% versus 7.3%, P<0.001). 100 further patients were either examined with a standard CTPA protocol or a standard DE CTPA (32 g iodine). 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. To evaluate the image quality, radiation dose and diagnostic accuracy of 80kVp, high-pitch CT pulmonary angiography (CTPA) with iterative reconstruction using 20 ml of contrast agent. The median number of examinations visually scored concerning pulmonary embolism as good–excellent was 47/47 (range 44–47); adequate 0/47 (0–3) and non-diagnostic 0/47 (range 0–0). 3 The peak of serum creatinine level and the ratio of the increase in the creatinine level of 44.2 μ mol/L or more and the increase of 88.4 μ mol/L or more during three days after angiography and a change in the creatinine level during seven days after angiography were determined. The Ascending aorta average density decreased from 250 HU in group A to 130 HU in group B with P value <.001. CT scanner. All contrast material-enhanced (contrast group) and unenhanced (noncontrast group) abdominal, pelvic, and thoracic computed tomography scans from 2000-2010 were identified. 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. 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. ... With the virtual monoenergetic reconstructions, the attenuation of iodine is augmented and the CM dose can be substantially reduced. CT is widely used as an integral part of diagnostic evaluation of patients with suspected SSc-PAH. using anatomical charts. Rationale and objectives: Diagnostic CTPA with 17 ml contrast media is possible in non-obese patients using low kVp, high pitch and carefully designed contrast media administration. Methods: 1 There are iodixanol, tradename Visipaque320, containing 320 g/ L iodine, with, Objective: Using the data from Registro Informatizado Enfermedad TromboEmbolica (RIETE), a prospective international registry of patients with venous thromboembolism (March 2001-January 2019), we explored the imaging modalities used in patients with acute PE. An exploratory objective of this study was t, All technical and personal data were removed from the images, A two-sided binominal test with a signicance level of 0.05 and a power of 0.8 wer, Simplied image reconstruction work ow of the monoenergetic recon, 73-year-old woman with a peripheral pulmonary embolism (white arrows). However, the diagnostic and prognostic significance remains unclear. Computed tomography pulmonary angiography (CTPA) is used for diagnosis. Recent advances have clarified that the incidence of CIN is much lower than previously. SNR and CNR calculations were highest at 40 keV MEI+ followed by 55 keV and CTpv with significant differences to high keV MEI+ (85-100). 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. Purpose: Four groups of 30 patients each, with a body weight of less than 100 kg and receiving pulmonary CTA were matched by age (range, 21-87 years), gender (female/male, 48/72), weight (range, 41-99 kg), and cross sectional area of the chest (range, 468-885 cm(2)). Methods Here we present STARD 2015, an updated list of 30 essential items that should be included in every report of a diagnostic accuracy study. No pulmonary embolism was missed on the optimized CM protocol. The field of pulmonary embolism imaging has demonstrated continuous evolution in both development of novel techniques and improvement in current technologies, resulting in better detection, decreased radiation exposure, and enhanced functional information beyond morphologic characterization of the pulmonary vasculature. Results: Eighty-seven patients were involved in the result analysis. Imaging & Therapy Division, Siemens Healthcare, Forchheim, is prospective single-center study was a, . This level of enhancement, combined with an optimal contrast-to-noise ratio (CNR), allows the distinction of central PE from enlarged hilar and mediastinal lymph nodes, as well as other vascular structures, and provides sufficient contrast enhancement within the peripheral pulmonary arteries [7. METHODS:Twenty-two male Sprague-Dawley (SD) rats were included as experimental subjects. Chest diameter, dose-length product, intravascular signal attenuation, image noise, signal to noise ratio (SNR), and contrast to noise ratio (CNR) were compared. Nonetheless, each DECT exa, Several study limitations have to be noted. 50 patients with acute/chronic renal failure were examined on a 3rd generation dual-source CT with an optimized DE CTPA protocol and a low CM injection protocol (5.4 g iodine). These Terms are supplementary and will apply in addition to any applicable website terms and conditions, a relevant site licence or a personal, subscription. For reduction of beam-hardening artifacts, VM imaging at 120 keV is useful for the initial assessment. Axial slices of peripheral pulmonary arteries of a low contrast media dual-energy CTPA: (A) mixed 0.8-weighted virtual polyenergetic spectral (VPS) image, and virtual monoenergetic spectral (VMS) images at a level of 40 keV (B), 50 keV (C), 60 keV (D), 70 keV (E), 80 keV (F), 90 keV (G) and 100 keV (H). Axial slices of main, No dierences regarding background noise could be, 62-year-old woman with suspected pulmonary embolism. Image quality, diagnostic accuracy and radiation dose were evaluated and compared. Methods: Conclusions: Optimal opacification of the pulmonary vasculature is a fundamental factor of a diagnostic quality computed tomography pulmonary angiogram (CTPA). is may be subject to change since administration o, Institute of Clinical Radiology and Nuclear Medicine, University Medical. Moving beyond planar ventilation/perfusion (V/Q) scintigraphy, nuclear imaging offers several new approaches, including the use of single photon emission computed tomography (SPECT) and SPECT/CT resulting in superior diagnostic performance and a decrease in nondiagnostic studies, potentially surpassing the diagnostic capabilities of computed tomography pulmonary angiography. Background: Fifteen rats were constructed into chronic kidney disease models (the model group). Average SNR and CNR were significantly higher for group C (21.5±4.7 and 19.0±4.5, respectively) compared with groups A (18.3±3.5 and 15.8±3.4, respectively) and B (17.3±5.8 and 15.6±5.5, respectively; all Ps≤0.001). Conclusion: Subjective image quality was evaluated using a five-grade scale, and diagnostic accuracy was assessed. To illustrate the role of pulmonary perfusion in the diagnosis of acute and chronic pulmonary thromboembolism. ORIGINAL ARTICLE A retrospective comparison of smart prep and test bolus multi-detector CT pulmonary angiography protocols Tara Suckling1, Tony Smith2 & Warren Reed3 1Medical Imaging Department, Tamworth Rural Referral Hospital, Tamworth, New South Wales, Australia 2University Department of Rural Health, The University of Newcastle, Tamworth, New South Wales, Australia We performed a retrospective analysis to evaluate the diagnostic yield of CTPA at our facility. a call of encouragement from the President of the United States. The number of end-stage renal disease patients in the world was increasing year by year. 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. Patients with preexisting diabetes mellitus, congestive heart failure, or chronic or acute renal failure were identified as high-risk patient subgroups for nephrotoxicity. Results: Contrast-to-noise ratio (CNR) for the pulmonary trunk was calculated. Closing in on the Edge: Coronary CT Angiography at 100, 80, and 70 V-Ini, . Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center GmbH (“Springer Nature”). Conclusions Conventional pulmonary angiography is a minimally invasive procedure performed most frequently by an interventional radiologist or interventional cardiologist.This form of angiography has the added … © 2008-2021 ResearchGate GmbH. Main pulmonary arteries at 50 keV and peripheral pulmonary arteries at 40 keV datasets provided the highest contrast-to-noise-ratio (CNR) for both the standard DE CTPA and the optimized protocol, with significantly higher CNR values for the standard DE CTPA protocol (p < 0.05). Intravenous contrast material administration was not associated with an increased risk of AKI, emergent dialysis, and short-term mortality in a cohort of patients with diminished renal function. Results CT pulmonary angiography. Radiology, 2004. cystic disease, and chronic renal failure of undetermined cause. DE CTPA utilizing image reconstruction at 40/50 keV allowed for a reduction of 84% in iodine load while maintaining CNR, which is especially important in patients with acute/chronic renal failure. The aim of this study was to investigate whether dual-energy (DE) pulmonary CT angiography (CTPA) in combination with a noise optimized virtual monoenergetic imaging algorithm allows for a reduction of CM. In addition, no signicant in, is allows the selection of ideal photon energy levels with regard to the evaluation o, Depending on the DECT technique used, recent studies adv, CNR of the pulmonary arteries for dual source and fast kV, monoenergetic algorithm with a re-developed noi, debate in everyday clinical routine, altho, 12% of all hospital-acquired acute renal failur, days, as well as a potential dose dependency between intravenous CM and AKI r, methods of reducing potential contrast media ind, this study might be a valid option for high-risk pa, Several studies have evaluated low contras, protocol. Low-contrast agent dose dual-energy CT monochroma, . There are two principal approaches for performing a CTPA of high diagnostic quality: Objective CT pulmonary angiography (CTPA) is one of the most commonly ordered CT imaging tests. To determine the risk of emergent dialysis and short-term mortality following intravenous iodinated contrast material exposure. Meanwhile, the expression of the M1 phenotype marker protein in peritoneal macrophages was determined. Side effects were observed. The attenuation of the pulmonary trunk measured in Hounsfield units (HU) between the equivalent axial slices of the LB120 data set and the VMI+40 data set underwent statistical analysis via a Wilcoxon paired-sample test. Over the past two decades, however, catheter angiography has become almost entirely supplanted by CT angiography (CTA), which is now the … In 84.2% (n = 4074), diagnostic quality is delivered. dual-source CT angiography in children with co, images from a dual-energy examination to impr. Computed MEI+ at low keV levels allow for improved vessel contrast and visualisation of incidental pulmonary embolism in patients with portal-venous phase CT scans by substantially increasing CNR and SNR. In patients with acute or chronic renal insufficiency, Meyer et al. Historically, catheter-directed pulmonary angiography has been used most commonly for the diagnosis of suspected pulmonary embolism (PE). The average score was increased by 35 % (from 1.75 in group A to 2.8 in group B with P value < .001). OBJECTIVE:To investigate the effects of AMPK activation on mitochondrial inhibition by uremic serum through the AMPK-activated rat peritoneal macrophages stimulated by uremic serum, thereby providing a reference for the clinical treatment of chronic kidney disease. MSCTPA using test bolus method reduces the amount of the contrast used with better opacification of the pulmonary artery and its sub segmental branches in addition to reduced artifact. 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 signicance assessment between the three DSCT pro, specicity and accuracy were calculated on a per-patient base for the 40, were rated as diagnostic. 1,2 Since the 1990s, CT pulmonary angiography (CTPA) has become the method of choice for imaging in suspected PE. This study aims to prove that the test bolus technique provides a better selective imaging study of the pulmonary arterial system in comparison to the automatic bolus-tracking technique. A prospective study included 600 patients, classified into 2 groups where each group consisted of 300 patients. The aim of this study was to (a) build a diagnostic CT model and (b) test its prognostic significance. The introduction of dual-energy CT has resulted in the ability to add functional and prognostic information beyond the morphologic assessment of the pulmonary arteries and potentially offer improved image quality without additional radiation burden. Computed tomography (CT) pulmonary angiography is widely used in patients with suspected pulmonary hypertension (PH). The aim of this study was to evaluate the variations in the use of imaging modalities for patients with acute PE. 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. The mean attenuation ± standard deviation in the pulmonary trunk was 325 ± 72 Hounsfield unit (range 165–531 Hounsfield unit). After propensity score adjustment, rates of AKI, emergent dialysis, and mortality were not significantly higher in the contrast group than in the noncontrast group in either CKD subgroup (CKD stage III: OR, 0.65-1.00; P<.001-.99 and CKD stage IV-V: OR, 0.93-2.33; P=.22-.99). (email: Content courtesy of Springer Nature, terms of use apply. the hospital’s conference room, the chief transplant surgeon explains the intended operations to the television news audience, Patients were subdivided into CKD stage III (baseline estimated glomerular filtration rate, 30-59 mL/min per 1.73 m(2)) and CKD stage IV-V (baseline estimated glomerular filtration rate, <30 mL/min per 1.73 m(2)) subgroups and separately underwent propensity score generation, stratification, and 1:1 matching. . 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. Treatment is mostly supportive but may differ according to the type of embolic material and clinical severity. 4841 slices with mean density 280.0 ± 63 HU are analyzed. Linear blended 120 kilovoltage (kV) images (LB120) dual-energy (DE) data sets (50% 100 kV and 50% 140 kV) were compared to noise-optimised virtual monoenergetic image reconstruction (VMI+) at 40 kiloelectron volts (VMI+40). Although patients who developed AKI acute kidney injury had higher rates of dialysis and mortality, contrast material exposure was not an independent risk factor for either outcome for dialysis ( OR odds ratio , 0.89; 95% CI confidence interval : 0.40, 2.01; P = .78) or for mortality ( HR hazard ratio , 1.03; 95% CI confidence interval : 0.82, 1.32; P = .63), even among patients with compromised renal function or predisposing comorbidities. VMI+40 (1161.500 HU) yielded a statistically significant increase in median attenuation within the pulmonary trunk compared to the LB120 (304.400 HU), with a median difference between monoenergetic reconstruction and standard dual energy of data sets of 827.5 HU (P < .001). However, computed tomography pulmonary angiography was the dominant modality of diagnosis, even in pregnancy and severe renal insufficiency. The proportion adequate or better examinations was for all readers 47/47, 100% [95% confidence interval 92–100%]. To perform CT pulmonary angiography (CTPA) using a minimal amount of iodinated contrast media. Method: PDF. All participants underwent a study specific CTPA in addition to the chest CT. MDCT angiography of the pulmonary arteries: inuence of body weight, body mass index, and scan length on, This article is licensed under a Creative Commons Attribution 4.0 International, http://creativecommons.org/licenses/by/4.0/. To view a copy of this license, visit. Introduction. Purpose: 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). 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