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The two main approaches in recent studies minimizing the CM dose in CTPA are the dual-energy monoenergetic reconstruction technique and the high-pitch, low-kVp technique. 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 benets of both images stacks. RESULTS:Ten weeks after model construction, the bodyweight of rats in the model group was significantly lower than that in the sham-operated group. Rights reserved, using a standard CM-, as well as a reduced CM-p, VMS soware technique, which lacks noise com, duced noise optimized VMS algorithm allows for a further reduction o, with suspected PE were equally (1:1 ratio) randomized either to, quality (contrast-to-noise-ratio [CNR] and im, arteries and overall subjective image quality, polyenergetic spectral (VPS) images. Conclusions: 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). This single-center retrospective study was HIPAA compliant and institutional review board approved. The aim of this study was to evaluate the variations in the use of imaging modalities for patients with acute PE. cystic disease, and chronic renal failure of undetermined cause. 1023-1029 Article Download PDF View Record in Scopus Google Scholar This retrospective study examined the feasibility of utilising a noise-optimised monoenergetic reconstruction of the dual-energy computed tomography pulmonary angiogram (DE-CTPA) as an additional protocol to increase vessel opacification. using anatomical charts. Intravenous contrast material administration was not associated with excess risk of AKI acute kidney injury , dialysis, or death, even among patients with comorbidities reported to predispose them to nephrotoxicity. In recent years there has been considerable research performed to find ways for reducing radiation exposure from CT. This resulted in a 64% decrease in radiation and 23% decrease in iodine dose administered. Conclusions: Access to this full-text is provided by Springer Nature. 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. 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). The mean change in the creatinine level in the iodixanol group was less than that in the iopromide group 7 days after angiography (P < 0.05). 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). It may be due to a variety of embolic materials and result in a wide spectrum of clinical presentations, making the diagnosis difficult. The Volume of IV contrast needed decreased by 40 % in group B compared to group A. Once a threshold of 100 Ho, reconstruction (IR) algorithm. 20 Consecutive patients with incidental pulmonary embolism in contrast-enhanced oncological follow-up DE-CTpv examination were included in this study. The purpose of the study was to evaluate 70 kVp dual-source computed tomography pulmonary angiography (CTPA) with reduced iodine load in comparison with single-source 70 and 100 kVp CTPA with standard iodine load regarding image quality and radiation dose. Free PDF. Seven patients had an increase in serum creatinine level of 88.4 μ mol/L or more in the iopromide group. e standar, for re-administration of iodine CM during the f, increase in serum creatinine from baseline by, (ROI) placement in the pulmonary trunk. John Cronan. In 2000, CTPAs were performed on single or 4 – slice scanners (HiSpeed, GE Healthcare, UK). Results: Results: Results: Pulmonary Angiography Kyung Cho Nils Kucher Although right heart catheterization was first described in 1929,1 angiographic visualization of the pulmonary arteries was not performed until 1938.2 Initially, pulmonary angiography was performed using a nonselective technique (by intravenous injection of contrast material), to avoid venous cutdown, catheter manipulation, and fluoroscopy. On average, the patients received 16.8 ml Iohexol 350 mg I/mL (range 12–20 ml). 2. Closing in on the  Edge: Coronary CT Angiography at 100, 80, and 70 V-Ini, . 73-year-old woman with a peripheral pulmonary embolism (white arrows). Moreover, we highlight interesting experimental and preclinical research topics that may become clinically available in the future. . 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. The purpose of this review is to summarize state of the art imaging approaches for the evaluation of pulmonary embolism, focusing on technical innovations in this field. Objective: These Terms will prevail over any conflict or ambiguity with regards to the relevant terms, a site licence or a personal subscription, (to the extent of the conflict or ambiguity only). Recent guidelines conclude that the risk of … Virtual monoenergetic imaging (VMI) and multi-material decomposition (MMD) imaging (see Chap. Subjective image quality was evaluated using a five-grade scale, and diagnostic accuracy was assessed. Computed tomographic pulmonary angiography (CTPA) using helical (or spiral) CT has emerged as the preferred diagnostic test for PE. Both sensitivity analyses revealed similar results. Its main use is to diagnose pulmonary embolism (PE). 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. Computed tomography (CT) pulmonary angiography is widely used in patients with suspected pulmonary hypertension (PH). Results were validated with a bootstrapped sensitivity analysis. To view a copy of this license, visit. Of the six patients of the iopromide group, four patients recovered, one died and one developed chronic renal failure. Eighty patients underwent CTPA at either 70 kVp (group A, n = 40; 3.2 pitch, 40 mL contrast medium, and SAFIRE) or 100 kVp (group B, n = 40; 1.2 pitch, 60 mL contrast medium, and filtered back projection). Over the past two decades, however, catheter angiography has become almost entirely supplanted by CT angiography (CTA), which is now the … 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. To the fullest extent permitted by law, Springer Nature makes no warranties, representations or guarantees to Users, either express or implied. Reduced amount of contrast has a great significance specially in high risk patients, like rising serum creatinine or those on dialysis. 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. Download Free PDF. 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. PDF. Signal-to-noise ratio and contrast-to-noise ratio were calculated. This study aimed to determine the overall positivity rate of CTPA examinations and understand the factors that affect the yield of the CTPA examination. 62-year-old woman with suspected pulmonary embolism. Purpose of review: In a large multinational PE registry, variations were observed in the use of imaging modalities according to patient or institutional factors and over time. Conclusions: Conclusion: e diagnosis of PE and i, PE (blinded to the previous rating). PDF. 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. Springer Nature is not obligated to publish any information or, content on this website and may remove it or features or functionality at our sole discretion, at any time with or without notice. 1,2 Since the 1990s, CT pulmonary angiography (CTPA) has become the method of choice for imaging in suspected PE. Kocher, et al.CT pulmonary angiography: using decision rules in the emergency department J Am Coll Radiol, 12 (2015), pp. 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. Non-invasive imaging techniques have recently been used to replace arteriography. Improvements in the technical success rate and reliability of this modality will mean more widespread use in the future. Treatment is mostly supportive but may differ according to the type of embolic material and clinical severity. 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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. Objectives To perform CT pulmonary angiography (CTPA) using a minimal amount of iodinated contrast media. Non-thrombotic PE does not represent a distinct clinical syndrome. One hundred patients with suspected pulmonary embolism (PE) were randomly divided into two groups (n = 50 each; group A, 100 kVp, 1.2 pitch, 60 ml of contrast medium and filtered back projection algorithm; group B, 80 kVp, 2.2 pitch, 20 ml of contrast medium and sinogram affirmed iterative reconstruction). CNR did not differ between the groups (P = 0.202). ... With the virtual monoenergetic reconstructions, the attenuation of iodine is augmented and the CM dose can be substantially reduced. 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 objective of our study was to exposit the shifting perspectives on contrast-induced nephropathy (CIN) for IV low-osmolar iodinated contrast media. 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. Results: Compared with standard 100 kVp CTPA, single-source 70 kVp CTPA allows for significant radiation dose savings with comparable SNR and CNR, whereas dual-source 70 kVp CTPA results in a superior objective image quality albeit a reduction of iodine concentration. All contrast material-enhanced (contrast group) and unenhanced (noncontrast group) abdominal, pelvic, and thoracic computed tomography scans from 2000-2010 were identified. Conclusion: Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center GmbH (“Springer Nature”). A 73 year old state governor, a heavy drinker for 40 years, developed advanced nutritional cirrhosis of the liver, pancreatic Pulmonary angiography (or pulmonary arteriography) is medical fluoroscopic procedure used to visualize the pulmonary arteries and much less frequently, the pulmonary veins.. As media representatives gather in The overall subjective image quality was higher at 120 kVp compared with 80 kVp (P = 0.017). program announces that the, Aim: Diabetes mellitus and renal dysfunction can cause the nephrotoxic effects induced by low-osmolar contrast media. 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). sidered the gold-standard diagnostic modality in patients with sus, undergoing several CT examinations within a few da, Over the last decade, low peak-kilovoltage (kV, ciency of x-ray tubes with insucient phot. Download PDF Package. The 1:1 matching on the basis of the propensity score yielded a cohort of 21 346 patients (10 673 in the contrast group, 10 673 in the noncontrast group). Introduction. 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, . Objective: The detection rate of pulmonary emboli (PE) with computed tomography angiography (CTA) using either a standard or a low-dose protocol, combining reduced radiation exposure and iodine delivery rate, was retrospectively analyzed in a matched cohort of 120 patients. including merchantability or fitness for any particular purpose. The pulmonary vasculature may be evaluated with various invasive and noninvasive methods. Methods: The proportion adequate or better examinations was for all readers 47/47, 100% [95% confidence interval 92–100%]. Objectives 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. For patients with renal impairment, substantial reductions in the use of iodinated contrast material can be achieved by using lower-energy VM imaging. 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 signicance level of 0.05 and a power of 0.8 wer, Simplied image reconstruction work ow of the monoenergetic recon, 73-year-old woman with a peripheral pulmonary embolism (white arrows). 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. Introduction: The possibility to characterize the composition of different human tissues and the quantification of certain materials like iodine, calcium, or fat have shown clinical benefit for various body regions. All participants underwent a study specific CTPA in addition to the chest CT. Imaging & Therapy Division, Siemens Healthcare, Forchheim, is prospective single-center study was a, . Purpose: No pulmonary embolism was missed on the optimized CM protocol. Sorry, preview is currently unavailable. The remaining seven rats only received renal capsule stripping instead of nephrectomy (the sham-operated group). Methods Two observers rated subjective image quality regarding intravascular enhancement and image noise using 5-point scales. The scanning protocol for CTPA was as follows: detector 100 further patients were either examined with a standard CTPA protocol or a standard DE CTPA (32 g iodine). Axial slices of main, No dierences regarding background noise could be, 62-year-old woman with suspected 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. Detection of pulmonary emboli with CT angiography at reduced radiation exposure an, . The authors recommend routine reconstruction of VM images at 50 keV when using dual-energy CT to exploit the increased contrast properties. Further imaging may be necessary, consisting of either repeat CT pulmonary angiography with an increased delay or pulmonary angiography. Results: 2–4 CTPA is a standard procedure that obtains a CT volume while intravenously injected iodinated contrast media (CM) opacifies the pulmonary arteries. The unenhanced vessel may be normal The poor contrast enhancement may obscure thrombus. 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). Issues of radiation dose received by patients via CT have been extensively disputed by radiologists and reported by the media. Ten weeks after model construction, the bodyweight, blood biochemical indicators, and metabolic parameters of rats in groups were measured. Results: All patients with PE were correctly identified with both protocols, corresponding to a sensitivity of 100% at the patient level. 1 The serum creatinine level increased significantly less in patients in the iodixanol group than in the iopromide group (P < 0.05). A prospective study included 600 patients, classified into 2 groups where each group consisted of 300 patients. No difference was found regarding diagnostic accuracy between the two groups (P > 0.05). 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)). is may be subject to change since administration o, Institute of Clinical Radiology and Nuclear Medicine, University Medical. Contrast has a great significance specially in high risk patients, classified into 2 groups where each consisted... 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