Descending aortic intramural hematoma with pulmonary embolism: A case report / 中国胸心血管外科临床杂志

@#Aortic intramural hematoma and pulmonary embolism are two rapidly progressive and life-threatening diseases. A 65-year-old male patient with descending aortic intramural hematoma and pulmonary embolism underwent pulmonary embolectomy and descending aortic stent-graft placement, with good postoperative results.

Application value of dual-energy CT perfusion imaging in acute pulmonary embolism examination / 中国辐射卫生

Objective To analyze the pulmonary perfusion defect index (PPDI) of dual-energy computed tomography (CT) and pulmonary artery obstruction index (PAOI) of conventional CT angiography, and to investigate the clinical application value of dual-energy CT perfusion imaging in the examination of patients with acute pulmonary embolism. Methods A retrospective study was conducted on 21 patients diagnosed with acute pulmonary embolism in Weifang People's Hospital from January 1, 2022 to December 31, 2022. PPDI, PAOI, and maximum plasma D-dimer concentration (mg/L) were calculated. According to the 2019 ESC Guidelines, the patients were divided into low-risk group (n = 8) and medium-risk group (n = 12). The Mann-Whitney U test was used for between-group comparisons. The Spearman’s rank correlation coefficient was used to analyze the correlations between PAOI, PPDI, and plasma D-dimer concentration. Results The PPDI, PAOI, and D-dimer values in the low-risk group were 3.33 (2.09, 4.58), 5.00 (3.13, 5.00), and 0.67 (0.52, 0.79), respectively. The PPDI, PAOI, and D-dimer values in the middle-risk group were 8.34 (5.42, 12.50), 12.50 (8.13, 15.00), and 1.18 (0.86, 2.87), respectively. The Z-values of comparison between the two groups were −3.092, −3.650, and −3.318, respectively (all P < 0.05). There were significant differences in PPDI, PAOI, and D-dimer between the low-risk and middle-risk groups (P < 0.05). Positive correlations were observed between PPDI and PAOI, between PPDI and D-dimer, and between PAOI and D-dimer (rs = 0.869, 0.918, 0.909, all P < 0.05). Conclusion Both PPDI and PAOI can be used for the clinical examination of patients with acute pulmonary embolism and evaluation of the severity of the disease. Compared with conventional CT, dual-energy CT perfusion imaging is more efficient in the diagnosis of acute pulmonary embolism, and facilitates accurate clinical treatment.

Study of the value of SPECT lung perfusion imaging in optimizing lung cancer radiotherapy plan for lung function protection / 中华放射肿瘤学杂志

Objective:To evaluate the application value of SPECT lung perfusion imaging in guiding radiotherapy path, optimizing the radiotherapy plan for lung cancer and protecting lung function during radiotherapy for locally advanced non-small cell lung cancer.Methods:In this study, 84 patients with stage Ⅲ non-resectable non-small cell lung cancer were randomly divided into the control group ( n=44) and observation group ( n=40). In the control group, radiotherapy plan based on conventional CT images was delivered, and two plans based on the lung function information suggested by conventional CT and SPECT lung perfusion imaging: P1 and P2 were given in the observation group. All patients in the observation group were finally treated according to the P2 plan. The incidence of radiation pneumonitis, and changes in lung function before and after radiotherapy were statistically compared between two groups. The dose-volume parameters of P1 and P2 were statistically compared. Results:After the plan was optimized, the incidence of radiation pneumonitis in the observation group was significantly reduced and the decline of lung function was significantly improved (both P≤0.001). The functional dose parameters were significantly improved in the P2 plans (both P<0.05), whereas the irradiation dose of organs at risk did not significantly change ( P>0.05). Conclusion:SPECT lung perfusion imaging optimizes the intensity-modulated radiotherapy plan, which can reduce the functional lung dose and increase the tumor radiotherapy dose without increasing the irradiation dose of other organs at risk.

Value of dual-input perfusion of 320 row CT on the efficacy evaluation of small cell lung cancer / 肿瘤研究与临床

Objective To discuss the value of dual-input perfusion of 320 row CT on the efficacy evaluation of small cell lung cancer (SCLC).Methods A total of 18 patients with SCLC confirmed by pathology who received cisplatin plus etoposide chemotherapy between June 2016 and June 2018 in the 8th Medical Center of Chinese PLA General Hospital were collected.All patients received 320 row CT perfusion scan at 3 time points before chemotherapy,after 2 cycles and 4 cycles of chemotherapy.Tumor size,perfusion pseudo color map and bronchial arterial blood flow (BF),pulmonary flow (PF) and perfusion index (PI) were obtained.The efficacy and adverse reactions were evaluated.The single factor analysis was used to make the group comparison.Pearson test was used to make correlation analysis.Results Two patients after 2 cycles of chemotherapy had complete remission (CR),another 2 patients after 4 cycles of chemotherapy had CR,and 3 patients of the above 4 cases with CR had abundant BF;after 4 cycles of chemotherapy,7 cases had partial remission (PR),6 cases had stable disease (SD),1 patient had progression of disease (PD).Dual-input perfusion of 320 row CT showed that 10 cases had the tumor area ＜ 15 cm2 and 8 cased had the tumor area ＞15 cm2 before the treatment.There was a negative correlation between PI and the tumor area (r =-0.694,P =0.026) on patients with the tumor area ＜ 15 cm2 before the treatment,and no correlation was found in patients with tumor area ＞15 cm2 (P ＞ 0.05).One case had Ⅳ degree of bone marrow suppression,and obvious adverse reactions were not seen in the rest of the patients.Conclusion Dual-input perfusion of 320 row CT based on the simple imaging can make an accurate quantitative judgement of the effect of SCLC according to perfusion parameter,which provides a new basis for curative effect evaluation on SCLC.

Two Cases of Pulmonary Embolectomy Using Retrograde Pulmonary Perfusion for Acute Pulmonary Thromboembolism / 日本心臓血管外科学会雑誌

Pulmonary thromboembolism (PTE) is a life-threatening disease, and in severe cases is required surgical treatment. Emergency pulmonary embolectomy using retrograde pulmonary perfusion (RPP) as an adjunct was successfully performed in 2 patients suffering from massive acute PTE. After removal of the pulmonary thrombus via incision of the pulmonary artery trunk, RPP via the right upper pulmonary vein was performed, which enabled the removal of residual thrombotic material and air from the peripheral branches of pulmonary arteries.

Evaluating efficacy of pulmonary thromboendarterectomy in treatment of chronic thromboembolic pulmonary hypertension using pulmonary perfusion tomography / 中国医学影像技术

Objective To evaluate the efficacy of pulmonary thromboendarterectomy (PTE) in treatment of chronic thromboembolic pulmonary hypertension (CTEPH) using 99Tcm-macroaggregated albumin (99 Tcm-MAA) pulmonary perfusion tomography.Methods Sixteen patients with CTEPH underwent 99Tcm-MAA pulmonary perfusion tomography before and 6-12 months after PTE.The perfusion defects and improvement both in pulmonary lobe and segment were observed pre-and post-PTE.Percentage of perfusion defect scores (PPDs％) were calculated and the change of systolic pulmonary artery pressure (SPAP) measured by echocardiography was also recorded.Results The postoperative SPAP was significantly lower than that before surgery ([36.56±8.47] mmHg vs [90.52±14.55] mmHg,t=14.14,P＜0.001).Before PTE,perfusion abnormalities were identified in 86 (86/96,89.58％) pulmonary lobes of 16 patients.In all of the 86 abnormal lobes,21 (21/86,24.42％) became normal,and the remaining 65 (65/86,75.58％) were improved after PTE.Perfusion defects were confirmed in 230 (230/304,75.66％) pulmonary segments of 16 patients before surgery.In all of the 230 abnormal segments,73 (73/230,31.74％) became normal,74 (74/230,32.17％) were improved and 83 (83/230,36.09％) remained unchanged after PTE.The mean PPDs％ decreased from (56.79±14.54)％ pre PTE to (28.20±15.24)％ at 6 12 months after PTE.The PPDs％ was positively correlated with homochronous SPAP (r=0.68,P＜0.001).Conclusion PTE can significantly reduce SPAP and improve the pulmonary perfusion in CTEPH patients.Pulmonary perfusion imaging can evaluate the curative effect of PTE.

The agreement analysis between perfusion deficient score derived from dual-energy CT perfusion imaging and obstruction score derived from pulmonary CT angiography / 实用放射学杂志

Objective To evaluate the agreement between perfusion deficient score derived from dual-energy CT perfusion imaging and obstruction score derived from pulmonary CT angiography in patients with pulmonary embolism.Methods 40 patients who sus-pected PE excluded basic lung disease accepted the dual-energy CT scanning.The data was post-processed on Siemens workstation to obtain the CTA and PBV images.The quality of images was evaluated by radiology quality control center.Two doctors observed ima-ges and obtain the data of obstruction score and perfusion deficient score,then the data were analysed with analysis of variance.The correlation between obstruction score and perfusion deficient score from different doctors were analyzed with Person and Bland-Alt-man methods.Results Perfusion deficient score had a moderate correlation with obstruction score (doctor 1:r=0.560 5,P=0.000 2;doctor 2:r=0.585 1,P=0.000 1).Perfusion deficient score and obstruction score from different doctors had a strong correlation(Perfusion deficient score :r=0.968 9,P=0.000 0;obstruction score:r=0.973 3,P=0.000 0).Perfusion deficient score and obstruction score from same doctor showed significantly different (doctor 1:8.025,95% CI:6.247~ 9.803 ;doctor 2:7.475,95% CI:5.670~9.280),but perfusion deficient score or obstruction score from different doctors showed no obviously difference(perfusion deficient score:0.400,95%CI:-0.106~0.906;obstruction score:-0.150,95% CI:-0.594~0.294).The ICC between perfusion deficient score and obstruc-tion score from same doctor was low (doctor 1:ICC=0.061 7±0.157 5;doctor 2:ICC=0.153 1±0.154 4),but the ICC of perfusion deficient score or obstruction score from different doctors was high (perfusion deficient score:ICC=0.964 6±0.010 9;obstruction score:ICC=0.972 7±0.008 4).Conclusion The pulmonary CT angiography and perfusion blood volume images were both derived from dual-energy CT scanning,which showed the scope of pul-monary embolism at different angles.CTA and PBV were two different examination methods, and could not replaced each other.

Assessment of Perfusion Pattern and Extent of Perfusion Defect on Dual-Energy CT Angiography: Correlations between the Causes of Pulmonary Hypertension and Vascular Parameters

OBJECTIVE: To assess perfusion patterns on a dual-energy pulmonary CT angiography (DECTA) of pulmonary hypertension (PHT) with variable causes and to assess whether the extent of perfusion defect can be used in the severity assessment of PHT. MATERIALS AND METHODS: Between March 2007 and February 2011, DECTA scans of 62 consecutive patients (24 men, 38 women; mean age, 58.5 +/- 17.3 [standard deviation] years; range, 19-87 years) with PHT were retrospectively included with following inclusion criteria; 1) absence of acute pulmonary thromboembolism, 2) maximal velocity of tricuspid regurgitation jet (TR Vmax) above 3 m/s on echocardiography performed within one week of the DECTA study. Perfusion patterns of iodine map were divided into normal (NL), diffuse heterogeneously decreased (DH), multifocal geographic and multiple peripheral wedging patterns. The extent of perfusion defects (PD), the diameter of main pulmonary artery (MPA) and the ratio of ascending aorta diameter/MPA (aortopulmonary ratio, APR) were measured. Pearson correlation analysis was performed between TR Vmax on echocardiography and CT imaging parameters. RESULTS: Common perfusion patterns of primary PHT were DH (n = 15) and NL (n = 12). The perfusion patterns of secondary PHT were variable. On the correlation analysis, in primary PHT, TR Vmax significantly correlated with PD, MPA and APR (r = 0.52, r = 0.40, r = -0.50, respectively, all p < 0.05). In secondary PHT, TR Vmax significantly correlated with PD and MPA (r = 0.38, r = 0.53, respectively, all p < 0.05). CONCLUSION: Different perfusion patterns are observed on DECTA of PHT according to the causes. PD and MPA are significantly correlated with the TR Vmax.

The clinical value of the decfion of percentage of pulmonary perfusion defect scores for pulmonary embolism / 中国基层医药

Objective To investigate the clinical value of the decfion of percentage of pulmonary perfusion defect score (PPDS％) in patients with pulmonary embolism (PE).Methods A retrospective study was carried out on PPDs％ data of patients(n =36) with clinical confirmed PE.The patients were divided into three levels:low (PPDS％ ＜30％),medial (30％ ≤PPDS％ ＜50％) and high (PPDS％ ≥50％) risk groups,according to the standard of PPDs％ diagnosis.the PPDS％ and the incidence rate of the clinical adverse events were compared in mild,moderate and severe risk PE.The therapeutic results were compared with the PPDS％ changes.Results The mild,moderate and severe risk patients with PE were 15 cases,13 cases and 8 cases respectively,according to the standard of PPDS％ diagnosis.16 cases,12 cases and 8 cases respectively,according to the standard of 2008 ESC APE diagnosis and treatment guidelines.The uniform rate was 94.4％ for two methods,the uniform rate was 100.0％ in which high risk of PE.The PPDS％ of PE was (46.2 ± 4.6) ％ before treatment.The data was significantly higher than that post treatment (31.6％ ± 1.8％) (t =17.38,P ＜ 0.01).The scores of low,medial and high risk patients were (25.9 ± 3.9) ％,(45.6 ± 4.3) ％ and (58.4 ± 4.9) ％ (t =6.18,P ＜ 0.01),respectively.The mild,moderate and severe risk PE according to the PPDS％ standard with clinical adverse events for were 1 cases (6.5％),3 cases (23.0％) and 5 cases (62.5 ％) respectively,with a significant difference (x2 =8.71,P ＜ 0.05).Conclusion PPDS％ could be used as an important reference index for risk stratification of diagnosis,evaluating therapeutic efficiency and predicting the prognosis in patients with PE.

Clinical research on combination of dose-volume histogram parameters with pulmonary perfusion imaging to predict the radiation pneumonitis / 肿瘤研究与临床

Objective To evaluate the lung exposure dose-volume (DVH) parameters and other indicators of lung perfusion imaging before and after three-dimensional conformal or intensity modulated radiation therapy for lung cancer patients,and combined with clinical factors,to explore relationship with radiation pneumonitis occurred.Methods 18 patients were selected for data analysis.Lung perfusion scintigraphy was detected before and after three-dimensional conformal or intensity modulated radiation therapy for lung cancer.Lung perfusion changes were compared before and after irradiation.Evaluation of radiation pneumonitis was assessed by the Radiation Therapy Oncology Group (RTOG) acute radiation pneumonitis standard.After the CT and SPECT lung perfusion images were transferred to Varian,the Eclipse 3D treatment planning system,image fusion after dose curve projected onto the SPECT images,and the DVH was converted into a f-DVH diagram.Analysis of pulmonary perfusion imaging changes before and after radiotherapy combined with lung irradiation dose volume parameters and radiation pneumonitis.Results In the whole group,33.3 ％ (6/18) cases occurred more than 2 radiation pneumonitis.Before and after radiotherapy,the damage to the lung perfusion was more than 2 radiation pneumonitis incidence [62.5 ％ (5/8)],and impaired pulmonary perfusion improvement was 10.0 ％ (1/10).DVH parameters to V5 severe RP forecasted high accuracy.In curve for each patient,boundary values of V5,V10 and V20 were 53 ％,41％ and 27 ％.Before and after radiotherapy it was found that lung perfusion changes and the whole lung V5 portfolio were the strongest predictors for radiation pneumonitis after radiotherapy.Conclusion Pulmonary perfusion imaging in patients with lung cancer is able to reflect changes in the function of ipsilateral lung perfusion before and after radiotherapy.Changes in the ipsilateral lung perfusion detected before and after radiotherapy combined with V5 are expected to serve as indicators to predict radiation pneumonitis.

Clinical Value of Radionuclide Pulmonary Perfusion Imaging in Diagnosing Acute Pulmonary Embolism / 实用放射学杂志

Objective To evaluate the clinical value of radionuclide pulmonary perfusion imaging in diagnosing acute pulmonary embolism.Methods Radioactive pulmonary perfusion imaging was performed in 25 patients clinically suspected for acute pulmonary embolism,meanwhile,imaging of deep veins of lower limb was taken.Results Multiple segments of abnormal blood perfusion were found in 23 of 25 patients,among them,radioactivity defects were found in 41 segments,radioactivity rarefied areas were found in 84 segments.Deep venous thrombosis was detected in 6 patients.Conclusion Radionuclide pulmonary perfusion imaging is a non-invasive and effective method in diagnosing acute pulmonary embolism.

Anti-hemoptic drugs: II. action of emetine on the pulmonary circulation

1. The actions of emetine on the heart and pulmonary circulation were studied in a total of 45 anesthetized dogs2. Emetine was shown to lower both systemic and pulmonic blood pressures when injected intravenously in doses from 0.05 to 7.5 mg./Kg. The mechanism by which this hypotension was brought appeared to be solely by cardiac depression. No significant direct vasodilating action was demonstrated3. The applicability and dangers of emetine as an antihemoptic agent were discussed. (Summary)