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Introduction : Multi slice Computed Tomography Pulmonary Angiography (CTPA) in dynamic pitch (Volume Helical Shuttle-VHS) mode is an evolving method to visualize pulmonary arteries including the peripheral pulmonary vasculature. The purpose of this study is to evaluate CT Pulmonary Angiography in dynamic pitch mode (Volume Helical Shuttle) for pulmonary embolism in comparison with standard pitch mode. Methods : We have done a multicentric analytical comparison study with study group involving patients undergone CTPA in dynamic pitch mode-Volume Helical Shuttle (VHS) and comparison group involving patients undergone CTPA in standard pitch mode. Results : Optimal contrast enhancement phase of the pulmonary artery in the study group in Phase I to III were 22.6%, 43.4% and 34%. The best phases were the last two phases in our study. Study Group main pulmonary artery mean signal intensity is 423.83±75.94 HU and comparison groups mean signal intensity is 361.74±98.28HU (P value = 0.039). The percentages of analyzable segmental arteries were 91.6% in study group and 87.3% in comparison group (P value-0.008). The percentages of analyzable sub segmental arteries were 89.5% in study group and 84% in comparison group (P value-0.004). The study group shows less percentage of motion artefacts and higher image quality than the comparison group, however it was not statistically significant (P value >0.05). Conclusions : Multislice CTPA in dynamic pitch mode using Volume Helical Shuttle (VHS) technology increase the ability to obtain the Optimal contrast enhancement in pulmonary arteries, improves the overall image quality, obviate the need for breath holding.
ABSTRACT
Introdução. O tromboembolismo pulmonar (TEP) é uma doença que apresenta uma clínica inespecífica, o que induz a necessidade de solicitar exames complementares, como a angiotomografia computadorizada (angioTC) de tórax. Com o objetivo de evitar a sua solicitação desnecessária, foram criados sistemas de probabilidade pré-teste, como o escore de Wells, que direcionam a propedêutica. Objetivo. Avaliar a prevalência de tromboembolismo pulmonar (TEP) em dois hospitais de uma cidade de médio porte e verificar o padrão de solicitação da angiotomografia computadorizada de tórax (angioTC). Métodos. Estudo transversal a partir de dados de prontuários de pacientes submetidos à angioTC de tórax no Hospital Regional de Barbacena e no Hospital Ibiapaba no período de janeiro de 2014 até junho de 2018. Resultados. A prevalência de TEP foi de 29,70% (N=259) no período de 54 meses e a mediana de idade, 66 anos (intervalo interquartil: 24). Nos pacientes com o diagnóstico de TEP, o sintoma mais frequente foi dor torácica (38,81%), seguido por hemoptise (33,33%) e tosse (32,99%). Nos prontuários analisados foi observado que a utilização do escore de Wells foi de 2,70%. A probabilidade de TEP, pelo escore de Wells, realizada pelos pesquisadores com base nos dados dos prontuários, em pacientes diagnosticados com TEP pela angioTC foi alta em 45%, moderada em 34,42% e baixa em 9,23%. Conclusão. A prevalência foi de 29,70% no período de 54 meses de diagnóstico de TEP em pacientes que realizaram a angioTC de tórax nos hospitais mencionados. O escore de Wells é um importante instrumento propedêutico. (AU)
Background. Pulmonary embolism (PE) is a disease presented with nonspecific symptoms that requires additional tests such as pulmonary angiography by computadorized tomography. To avoid unnecessary tests, pre-test probability tools were created, such as Wells Score, which guides the propaedeutics. Objective. To evaluate the prevalence of pulmonary embolism (PE) in two hospitals in a medium-sized city and to verify computed tomography pulmonary angiography imaging exam orders. Methods. Cross-sectional study based on data from the hospital records evolving patients underwent computed tomography pulmonary angiography at Hospital Regional de Barbacena and Hospital Ibiapaba through January 2014 and June 2018. Results. The prevalence of PE was 29.70% (259 patients) in the 54-month period and the median age, 66 years (interquartile range, 24). In patients with the diagnosis of PE, the most frequent symptom was chest pain (38.81%) followed by hemoptysis (33.33%), and cough (32.99%). In the analyzed hospital records it was observed that the use of the Wells score was 2.70%. The probability of PE according to the Wells score, performed by the researchers based on data from the medical records, in patients diagnosed with PE by computed tomography pulmonary angiography was high in 45%, moderate in 34.42%, and low in 9.23%. Conclusion. The prevalence of PE was 29.70% (N = 259) in the 54-month period from PE diagnosis in patients who underwent computed tomography pulmonary angiography in the mentioned hospitals. The Wells score is an important diagnostic tool(8)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pulmonary Embolism/diagnostic imaging , Early Diagnosis , Pulmonary Embolism , Venous Thrombosis , Propensity Score , Clinical Decision-Making , Computed Tomography AngiographyABSTRACT
Objective: To explore the diagnostic values of Wells score and YEARS algorithm in the patients with pulmonary embolism and to compare the areas under receiver operating characteristic (ROC) curves (AUC) of Wells score and YEARS algorithm, and to find the more suitable score method for pulmonary embolism in clinic. Methods: A total of 139 patients who were suspected with pulmonary embolism were collected, among them 48 patients were clinically as confirmed pulmonary embolism. The disease history, clinical manifestation and results of auxilliary examinations of the patients were collected. All the patients were assessed by Wells score and YEARS algorithm, respectively; the computed tomographic pulmonary angiography (CTPA) was considered as golden standard. The sensitivities, specificities, misdiagnosis rates and omission diagnostic rates, and the accuracies of Wells score and YEARS algorithm of the patients in two groups were analyzed with SPSS 22.0 software; the conformities of results of Wells socre, YEARS algorithm, and CTPA were analyzed. Then ROC curves of Wells score and YEARS algorithm in diagnosis of pulmonary embolism were made, and the AUC was calculated and compared. Results: Compared with YEARS algorithm, the specificity and accuracy of Wells score in diagnosis of pulmonary embolism were markedly increased (P<0.05), the misdiagnosis rate was decreased (P= 0.037), however the sensitivity and the misdiagnosis rate had no significant differences ( PX). 05). The Kappa value of Wells score and CTPA was 0. 45, the conformity was moderate; the Kappa value of YEARS algorithm and CTPA was 0.22, the conformity was passable; the Kappa value of Wells score and YEARS algorithm was 0. 11, the conformity was bad. The AUC of Wells score and YEARS algorithm were 0. 753 + 0. 044 ( P<0. 01) and 0. 585 + 0. 049 ( P=0. 101). Conclusion: The Wells score is superior to the YEARS algorithm in the diagnosis of pulmonary embolism.
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Objective:To explore the diagnostic values of Wells score and YEARS algorithm in the patients with pulmonary embolism and to compare the areas under receiver operating characteristic (ROC) curves (AUC) of Wells score and YEARS algorithm, and to find the more suitable score method for pulmonary embolism in clinic.Methods:A total of 139patients who were suspected with pulmonary embolism were collected, among them48patients were clinically as confirmed pulmonary embolism.The disease history, clinical manifestation and results of auxilliary examinations of the patients were collected.All the patients were assessed by Wells score and YEARS algorithm, respectively;the computed tomographic pulmonary angiography (CTPA) was considered as golden standard.The sensitivities, specificities, misdiagnosis rates and omission diagnostic rates, and the accuracies of Wells score and YEARS algorithm of the patients in two groups were analyzed with SPSS 22.0software;the conformities of results of Wells socre, YEARS algorithm, and CTPA were analyzed.Then ROC curves of Wells score and YEARS algorithm in diagnosis of pulmonary embolism were made, and the AUC was calculated and compared.Results:Compared with YEARS algorithm, the specificity and accuracy of Wells score in diagnosis of pulmonary embolism were markedly increased (P＜0.05) , the misdiagnosis rate was decreased (P=0.037) , however the sensitivity and the misdiagnosis rate had no significant differences (P＞0.05) .The Kappa value of Wells score and CTPA was 0.45, the conformity was moderate;the Kappa value of YEARS algorithm and CTPA was 0.22, the conformity was passable;the Kappa value of Wells score and YEARS algorithm was 0.11, the conformity was bad.The AUC of Wells score and YEARS algorithm were 0.753±0.044 (P＜0.01) and 0.585±0.049 (P=0.101) .Conclusion:The Wells score is superior to the YEARS algorithm in the diagnosis of pulmonary embolism.
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A 68-year-old man with recent history of a fall presented with dyspnea on exertion, and underwent computed tomography pulmonary angiography (CTPA) for possible pulmonary embolism (PE). The CTPA was first read by the radiology resident as nondiagnostic for segmental PE. Subsequent planar perfusion (Q) images were normal; meanwhile, the attending radiologist revised the CTPA results as subsegmental PE in the left upper lobe. Further Q-SPECT images were obtained and fused with CTPA for clarification, which showed normal perfusion in the region of PE. The patient was monitored without anticoagulation treatment and remained uneventful for 12 months. This case illustrates that CTPA can lead to overdiagnosis and overtreatment of nonocclusive subsegmental PE.
Subject(s)
Aged , Humans , Angiography , Dyspnea , Medical Overuse , Perfusion , Pulmonary EmbolismABSTRACT
Primary pulmonary hypoplasia is rare in adulthood. It is characterized by decreased number or size of bronchi, vessels and alveoli. We present a case of unilateral pulmonary hypoplasia in 44-old-year male smoker who presented with right pleural effusion. His chest X-ray revealed an inhomogenous opacity on the left side with bronchiectatic changes and right minimal pleural effusion. Fiberoptic bronchoscopy revealed blind end bronchi in left upper lobe and computed tomography pulmonary angiography revealed hypoplastic lung with cystic bronchiectasis on the left side and hypoplastic left pulmonary artery. It was not associated with any other congenital anomalies. In addition to symptomatic management, he was started on anti-tuberculous treatment for tuberculous pleural effusion and kept under follow-up.
Subject(s)
Abnormalities, Multiple , Adult , Angiography/methods , Humans , Lung/abnormalities , Lung Diseases , Male , Pleural Effusion/diagnosis , Pleural Effusion/drug therapy , Tuberculosis, Pleural/diagnosis , Tuberculosis, Pleural/drug therapy , Tomography, X-Ray ComputedABSTRACT
Objective To retrospectively analyze the clinical features,diagnostic experience and therapy of pulmonary embolism for reduction of misdiagnosis and missed diagnosis,and for improving the cure rate.Methods The data of clinical features,findings by auxiliary examination and therapeutic efficacy of 67 patients with pulmonary embolism admitted to the First Affiliated Hospital of General Hospital of PLA were summarized.The usual clinical manifestations were summarized based on the clinical symptoms of and the frequency of objective signs in the patients with the correct diagnosis.Auxiliary examinations included routine and sophisticated examinations such as CT pulmonary angiography(CTPA) and emission computed tomography(ECT),which were specially emphasized for summing up and optimizing the diagnosis.Comparisons were made of the therapeutic efficacy and complications between the treatment with thrombolysis combined with anticoagulation and simple anticoagulation.Results The primary clinical manifestations of the patients with pulmonary embolism included dyspnea,cough,chest pain,fever and hemoptysis,etc.Findings of D-Dimer assay might serve as a sensitive but not specific indicator in screening the suspected patients.For the sophisticated examinations,CTPA confirmed the diagnosis in 28 out of 31(90.32%) patients,and ECT confirmed the diagnosis in 39 out of 51(76.47%).All the patients who had undergone lung angiography received the final diagnosis,but the majority of them were reluctant to accept this examination because of potential risk of the technique.The total cure rate of thrombolysis combining anticoagulation was 90.62%(29/32),in which the administration of recombinant tissue-type plasminogen activator(rt-PA)-2h was most efficacious(with 100% of cure rate).Simple anticoagulation therapy gave a lower cure rate(68.57%,24/35) but a higher incidence of hemorrhagic complication(31.25%).After the administration of thrombolysis combined with anticoagulation therapy,both PaO2 and CTPA examinations showed significant changes for the better after the treatment compared with that before the treatment(P