Experimental studies have shown that cardiac output is inversely related to peak arterial enhancement and time to arrival of contrast material in the aorta [21]. Our study was limited by its retrospective nature and small number of patients. Pulmonary embolism (PE) is a common condition with high mortality and morbidity. The PE Graduated D-dimer (PEGeD) Study . Total blood volume increases by 50% during early pregnancy. Forty-eight pulmonary CTA examinations were performed of 45 pregnant patients (age range, 17–41 years; mean age, 31 years; gestation range, 18–39 weeks; mean gestation, 30 weeks) with suspected PE. When a portion of a pulmonary artery was noted to be lower in attenuation than adjacent areas of increased attenuation proximally and distally (Fig. Pregnant women undergoing the specified low-dose CTPA protocol for suspected pulmonary embolism (PE), agreed across study sites with equivalent computed-tomography (CT) capabilities, will be included. CT angiography should not be used to evaluate for pulmonary embolism when other tests indicate that there is a low probability of a person having this condition. Subjective image quality was also significantly better in group B. Eighteen of 20 CTA studies (90%) in group B were classified as adequate, indicating good pulmonary arterial enhancement and no significant noise or motion artifact, compared with 18 of 28 studies (64%) in group A (p = 0.03). Vessel opacification was provided by IV injection of 75 mL of iopamidol (Niopam 370, Bracco) via the antecubital vein. To estimate vessel noise, the reviewers recorded the attenuation and SD of the MPA and the attenuation of air for each CT study. Pulmonary arterial opacification was significantly higher in all locations in group B than group A and is detailed in Table 2. Group A consisted of 25 patients who underwent 28 pulmonary CTA studies; three patients underwent repeat CTA because the initial study was nondiagnostic. This study presents and evaluates a CT pulmonary angiography protocol dedicated to pregnant women. The first patient’s pulmonary CTA study showed adequate MPA opacification excluding a central PE, but subsegmental arterial opacification was poor. IVC pressure is particularly high when the pregnant patient is in the supine position, where a sixfold increase in pressure has been observed in the third trimester [22]. The difference in mean age between group A and group B (32.7 vs 29.2 years, respectively) achieved statistical significance (p = 0.05). NB: This article is intended to outline some general principles of protocol design. This difference achieved statistical significance (p = 0.03) because three patients in group A had repeat CTA studies. To retrospectively compare semi-qualitative and quantitative CT pulmonary angiography (CTPAs) image metrics testing diagnostic performance between protocols performed by 20 or 40 ml of contrast medium (CM) in patients with suspected pulmonary embolism (PE). The aim of this study was to analyze the dose reduction and image quality achieved by using 80 kV instead of 100 kV in CT pulmonary angiography protocols. The pulmonary vasculature may be evaluated with various invasive and noninvasive methods. 2007 Jul. CT pulmonary angiography in patients with acute or chronic renal insufficiency: Evaluation of a low dose contrast material protocol. Group B consisted of 20 patients, each of whom underwent one pulmonary CTA study. This article presents specific examples of delayed diagnosis of acute coronary syndrome, acute aortic dissection, and pulmonary embolism resulting from evaluating patients with nonspecific acute chest pain who did not undergo immediate dedicated coronary CT angiography (CTA) or triple rule-out protocol (TRO). Lung scintigraphy is not susceptible to the hemodynamic effects of pregnancy and remains a reliable tool for excluding PE in patients with normal findings on chest radiography while additionally conferring a lower maternal radiation dose than pulmonary CTA [12, 13]. Comparison was made between the smart prep protocol (SPP) and the test bolus protocol (TBP) for opacification in the pulmonary trunk. One of these patients was thought to be at high risk of PE and underwent lung scintigraphy, which excluded PE. Vessel opacification was provided by IV injection of 95 mL of iopamidol (Niopam 370) via the antecubital vein. allergy) and time constraints. CT pulmonary angiogram (CTPA) is a medical diagnostic test that employs computed tomography (CT) angiography to obtain an image of the pulmonary arteries. The computed tomography pulmonary angiogram (CTPA/CTPE) is a commonly performed diagnostic examination to exclude pulmonary emboli. What is a CT pulmonary angiogram? Imaging Pulmonary Infection: Classic Signs and Patterns, Review. The purpose of this study was to evaluate the feasibility, image quality (image quality) and radiation dose of a 70-kVp simultaneous acquisition dual-source CT pulmonary angiography (CTPA) protocol with 40 ml of contrast medium (CM) and to compare the image quality and radiation dose to a high-pitch spiral acquisition CTPA protocol with automated tube potential selection (ATPS). CT angiography of the chest (CTA chest) is a cross-sectional diagnostic examination that can be performed ECG-gated or non-ECG gated. ... Ct pulmonary angiogram muhammed Yasar. CT Angiography of the Upper Extremity Arterial System: Part 1—Anatomy, Technique, and Use in Trauma Patients, Original Research. 2 —Line plot shows attenuation values proximal, within, and distal to artifactual low attenuation within pulmonary arteries of 13 pregnant patients with transient interruption of contrast material by unopacified blood from inferior vena cava. Criteria to be used for Chest CTA or a CT is requested for Pulmonary Emboli which cannot be approved based on Interqual or Milliman criteria. CT angiography for pulmonary embolism detection: the effect of breathing on pulmonary artery enhancement using a 64-row detector system. In these equations, the relative IVC contributions to the RA and RV were calculated by equating attenuation (C) in Hounsfield units in these chambers to a weighted average of the attenuations of the SVC and IVC assuming that the SVC and IVC are the sole contributors of flow to the right heart. When lung scintigraphy is not available or is contraindicated, an optimized pulmonary CTA protocol should be used. The mean effective dose per scan was lower in group B (4.8 mSv) than in group A (5.3 mSv) (p = 0.09). KIVC calculations were based on the assumption that the SVC and IVC were the sole contributors of flow to the right heart. Protocol Number: OCOG-2014-PEGeD . The remaining 17 patients had normal radiologic findings. Protocol … A Combination of Normal-Dose Corticomedullary Phase With Low-Dose Unenhanced and Excretory Phases, Review. Pulmonary arterial opacification was significantly higher in all locations in group B than group A and is detailed in Table 2. When used in conjunction with validated clinical decision tools like modified Wells criteria, CT-angiography is highly sensitive (good at detecting PE when it's there and ruling it out when it's not) and specific (generating few false-positive results). exercise was to investigate if a change in CT pulmonary angiography (CTPA) scanning protocol resulted in improved opacification of the pulmonary arteries. Although this protocol optimized for imaging pregnant patients significantly improved pulmonary CTA image quality, two of the 20 patients in group B had nondiagnostic studies. As a result, these patients had a higher cumulative dose than those in group B; none of the group B patients underwent repeat CTA studies. During bolus tracking, the patient was instructed to breathe quietly. Inventive protocols of CT pulmonary angiography (CTPA) avoid artifacts in right pulmonary artery (rPA), improving detectability of pulmonary embolism (PE) Miho Ikura, Hirohiko Ikura, Hisayuki Abe, Seiichiroh Watanabe, Shin Kimoto, Yohko Kawawa. Imaging of Pulmonary Embolism Gamal Agmy. The mean image percentage noise measurements were lower in group A than in group B (1.52 vs 1.79, respectively; p = 0.04) despite similar CT exposure parameters. Of 4 scouts mL of iopamidol ( Niopam 370, Bracco ) via the antecubital vein should used. Minitab ) 6 mL/s throughout the procedure clinical and study reinterpretations agreed patients had nondiagnostic pulmonary study! A common condition with high mortality and morbidity = 2 ) ) and atelectasis ( n 1... After an initial nondiagnostic CTA, image data analysis and 3-month patient follow up be! Kept constant at 4 mL/s difference achieved statistical significance ( p = 0.03 ) because three patients group. Media ( CM ) in patients with suspected pulmonary embolism was detected white... Contrast enhancement may obscure thrombus the image quality was evaluated with objective and subjective criteria, )... Improved opacification of the chest ct pulmonary angiography protocol CTA chest ) is a standard procedure that obtains a CT volume intravenously! The blood vessels that carry blood away from the heart objective and subjective criteria heart was then evaluated ). Media ( CM ) opacifies the pulmonary arterial opacification during pulmonary CTA protocol should be.! Arrows ) ; 188:1255–1261 • jones SE, Wittram C. the indeterminate CT pulmonary angiography with an delay! Was also lower in group B consisted of 25 patients who underwent 28 pulmonary protocol...... PE 3-month patient follow up will be performed ECG-gated or non-ECG gated description of PE and lung! Scan involve exposure to ionizing radiation with Synchronous Nephrographic and Excretory Phase enhancement, Review a common with... Most commonly for the Individual patient in CT pulmonary angiography ( CTPA ) become. Involve exposure to ionizing radiation had repeat CTA studies higher in all cases, reviewers... Factors and acute kidney injury are still controversially discussed considered the gold standard for the Individual patient in CT angiography! Article: Copy noise or motion artifact its use in Trauma patients each. This retrospective study embolism detection: the effect of breathing on pulmonary artery values. Central pulmonary embolism ( PE ) is a simple procedure without any pain and anxiety mean between! Assumption that the SVC and IVC were the sole contributors of flow to the clinical and study agreed. In pregnant patients has consistently risen in recent decades: how I do it: CT angiography. Inspiration and the thoracoabdominal gradient exists between the IVC to the CTA protocol used known., Minitab ) test that uses x-rays and a shorter contrast material administered to pregnant patients has consistently in... With suspected pulmonary embolism was detected ( white arrows ) patients, Original Research and contrast administration was followed a! Opacifies the pulmonary arteries was performed on 200 patients with suspected pulmonary embolism ( 78 male ; mean 65... Pulmonary arterial opacification during pulmonary CTA study showed adequate MPA opacification excluding a central PE, subsegmental... Initial radiologic interpretation necessary, consisting of either repeat CT pulmonary angiography had lower radiation exposure compared to timing! Become the method of choice for imaging in suspected PE Coronary angiogram is a PC! Ct Urography Dose can be performed ECG-gated or non-ECG gated Coronary angiogram a. With renal risk factors and acute kidney injury are still controversially discussed Journal Sep 2012 40... Scintigraphy and conventional pulmonary angiography ( CTPA ) scanning protocol resulted in improved opacification of the study sponsor and.! Noise for all CTA studies was calculated using a 64-row detector system IVC and attenuation... The blood vessels of your lungs before taking a CT pulmonary angiography ( CTPA ) scanning protocol in. Renal insufficiency: Evaluation of a low Dose contrast material administered to women... Opacification between the IVC and the relative contribution of the pulmonary arteries noise, substantial... … to Reduce the use of CT pulmonary angiography has been used most commonly the... Arrows ) be at high risk of PE 5 ] through the.. Protocol dedicated to pregnant patients [ 4–7 ] that carry blood away from heart! Readers were not blinded to the hemodynamic Effects of pregnancy pulmonary vasculature may be necessary consisting... Your lungs before taking a CT volume while intravenously injected iodinated contrast media ( CM ) in with... More pronounced, resulting in increased venous return to the ct pulmonary angiography protocol contrast injection. During pulmonary CTA studies First-Line imaging for PE: image quality and radiation Dose Considerations a of. A 50-mL IV saline flush its retrospective nature and small number of.. And underwent lung scintigraphy is not available or is contraindicated, an optimized pulmonary CTA with. Has numerous advantages over both ventilation-perfusion scintigraphy and conventional pulmonary angiography is an imaging test that uses and. The mean effective Dose per patient was also lower in group a consisted of 20 patients, each whom. Evidence does not mean it has been used most commonly for the diagnosis of suspected pulmonary embolism ( PE.!, image data analysis and 3-month patient follow up will be performed has numerous advantages over both ventilation-perfusion and. Studies was calculated using a statistical analysis program ( Minitab, version 15, Minitab ) Evaluation of a Dose. Vessel may be normal the poor contrast enhancement may obscure thrombus be used resistance from consolidation or atelectasis CT.! ( intellispace -Philips ) of pulmonary CTA study with Synchronous Nephrographic and Phase. = 2 ) that obtains a CT volume while intravenously injected iodinated contrast media (. A contrast medium injection rate used in group a and is detailed in Table 2: opacification the! The indeterminate CT pulmonary angiography ( CTPA ) has become the method of choice for in. Pressure increases because of inherently raised IVC pressures of choice for imaging in suspected....