pulmonary embolism diagnosis gold standard

10 Long-term sequelae of pulmonary embolism . Most of the false positive findings were due to contrast agent–related flow artifacts, pulmonary veins, and lymph nodes.Conclusion For digital angiography, radiation dose was calculated according to phantom measurements and adapted to acquisition and fluoroscopy times. Magnetic Resonance Imaging of Neural and Pulmonary Vascular Function: A Dissertation, Automated detection of pulmonary embolism in CT pulmonary angiograms using an AI-powered algorithm, Pulmonary Embolism — a Short- to Long-term Approach, Diagnostic yield of CT pulmonary angiography in the diagnosis of pulmonary embolism: A single center experience, Incidence of transient interruption of contrast (TIC) – A retrospective single-centre analysis in CT pulmonary angiography exams acquired during inspiratory breath-hold with the breathing command: “Please inspire gently!”, Collaboration between interactive three-dimensional visualization and computer aided detection of pulmonary embolism on computed tomography pulmonary angiography views, Follow the minimum monitoring standards; use the pulse oximeter, Tricuspid annular plane of systolic excursion to prognosticate acute pulmonary symptomatic embolism (TAPSEPAPSE study): Tricuspid Plane of Systolic Excursion for the Assessment of Pulmonary Embolism, Missed Pulmonary Embolism on Abdominal CT, Influence of Monoenergetic Images at Different Energy Levels in Dual-Energy Spectral CT on the Accuracy of Computer-Aided Detection for Pulmonary Embolism, Sparse sampling computed tomography (SpSCT) for detection of pulmonary embolism: a feasibility study, Improving the Image Quality in Computed Tomographic Pulmonary Angiography With Dual-Energy Subtraction: A New Application of Spectral Computed Tomography, [CT pulmonary angiography assessment in diagnosis of pulmonary embolism], Current Approach to the Diagnosis of Acute Nonmassive Pulmonary Embolism, Retro Is the Rage! 2015 Jun;22(3):221-9. doi: 10.1007/s10140-014-1265-6. functioning?” is an essential item in the WHO surgical All rights reserved. In this dissertation, I will describe novel MRI techniques for the characterization of neural and pulmonary vascular function in preclinical models of disease. For that reason, your doctor will likely order one or more of the following tests. Our local protocols that comply with the National Institute for Health and Clinical Excellence (NICE) guidelines in the UK appear to be effective in preventing VTE and reducing mortality in trauma and orthopedic patients. pulse oximetry. Most blood clots originally form in one of the deep veins of the legs, thighs, or pelvis; this condition is known as deep vein thrombosis (DVT). 8 Chronic treatment and prevention of recurrence. Attenuation values in the thoracic aorta and in the pulmonary trunk were assessed in duplicate measurements (M1 and M2) and the aorto-pulmonary density ratio was calculated. A completely noninvasive diagnostic algorithm for patients presenting with suspected acute pulmonary embolism is proposed. Of 849 patients in whom a diagnosis of pulmonary-embolism had initially been excluded, 5 (0.6% [95% CI, 0.2% to 1.4%]) developed pulmonary embolism or deep venous thrombosis during follow-up. Measurements: Patients received a diagnosis of pulmonary embolism if they had a high-probability ventilation-perfusion scan, an abnormal result on ultrasonography or pulmonary angiography, or a venous thromboembolic event during follow-up. and a non-invasive blood pressure monitor Clinically apparent pulmonary embolism recurred in 33 patients (8.3 percent), of whom 45 percent died during follow-up. II. The longitudinal relaxation time of HP-He is sensitive to the presence of paramagnetic oxygen. 2020 Sep 7:S2213-333X(20)30466-2. doi: 10.1016/j.jvsv.2020.08.028. There are still concerns with regards to the increased risk of thromboembolic events with the use of TA. Ten emboli were depicted only on CT scans, whereas seven emboli were identified only on angiograms because of inadequate depiction of the pulmonary arteries in the plane of the CT scans (n = 5) or because of misinterpretation of CT findings (n = 2). The diagnosis of pulmonary embolism (PE) can be very elusive and, if missed, may have fatal consequences. Recent advances have clarified that the incidence of CIN is much lower than previously thought, but there are lingering questions. Underlying respiratory disease does not affect the negative predictive value of thin-collimation CT angiography, which appears to be a reliable tool in the work-up in this subgroup of patients with acute PE. The kappa values for Wells Criteria were 0.54 and 0.72 for the trichotomized and dichotomized scorings, respectively. Pulmonary embolism is a potentially fatal disorder. Results The total numbers of CAD-detected PE at 40-80 keV were 48, 67, 63, 87, 106, 115, 138, 157, and 226. Anticoagulation was not started when results of CT were negative for PE or indicated an alternative diagnosis that explained the clinical signs and symptoms, or when results on serial compression ultrasonography were normal. This site needs JavaScript to work properly. Rationale and objectives: We included 57 patients, on whom a CDUS was performed. The purpose of this study is to evaluate a series of missed pulmonary emboli (PE) identified on abdominal CT and to describe their characteristics and the clinical scenario. Eighteen patients (12 men and six women; average age, 58.8 years) were identified as having missed PE on abdominal CT. The presence of two or more co-morbidities was significantly associated with the incidence of mortality (unadjusted odds ratio (OR) = 3.52, 95% confidence interval (CI) (1.34, 18.99), P = 0.034). In a slight majority of the cases, the reviewing radiologists judged the contrast bolus as good. CR with < 10 years since finishing training were more likely to consider CTPA the gold standard, OR 2.0 (1.1-3.9). The sensitivity of dual-section helical CT was 90%, and the specificity was 94%. Emergency departments at four tertiary care hospitals in Canada. We prospectively followed 399 patients with pulmonary embolism diagnosed by lung scanning and pulmonary angiography, who were enrolled in a multicenter diagnostic trial. Patients: 930 consecutive patients with suspected pulmonary embolism. Imaging specific for pulmonary embolism: 1. Other less invasive techniques, including lung scintigraphy and imaging studies of leg veins, have a less than optimal diagnostic performance. Of this group 67,000 (11 per cent) die within one hour of the event before definitive diagnosis and management, and 563,000 (89 per cent) survive the event for at least one hour so that there may be sufficient opportunity for diagnosis and therapy. Further technological progress has strengthened its diagnostic impact leading to an essential role in clinical practice. It is now considered to be the gold standard for diagnosis and risk stratification of pulmonary embolism, as it has a very high sensitivity and specificity. K Values, sensitivities, and specificities were determined. Acad Radiol. For the diagnosis of subsegmental pulmonary emboli at multi-detector row CT, the use of 1-mm section widths results in substantially higher detection rates and greater agreement between different readers than the use of thicker sections. When Wells Criteria were trichotomized into low pretest probability (n=59, 44%), moderate pretest probability (n=61, 46%), or high pretest probability (n=14, 10%),the pulmonary embolism prevalence was 2%, 15%, and 43%, respectively. -, AJR Am J Roentgenol. • Sparse sampling CT is a novel hardware solution with which less projection images are acquired. Exposure was performed with an anthropomorphic phantom with thermoluminescent dosimeters for four-detector row CT without the dose-modulation program and 16-detector row CT without and with the dose-modulation program with standard protocols for pulmonary CT angiography (120 kV, 144 mAs, four and 16 detector rows with 1.00- and 0.75-mm section thickness, respectively). Serial compression ultrasonography has limited additional value. 11 Non-thrombotic pulmonary embolism. Materials and methods: However, in the 163,000 early survivors in whom a diagnosis is made and appropriate therapy is unstituted, the survival rate is 92 per cent and the mortality is only 8 per cent. Clinical data collected included oncology status, chemotherapy regimen, site of tumor, and location of PE. In our subset of patients, helical CT was only 63% sensitive. Purpose: various national levels of the developing nations.1 Since quality of the diagnostic process largely determines quality of care, overcoming deficiencies in standards, methodology, and funding deserves high priority. #### Summary points All reports of chest CT scans performed during a 12-month period were searched for keywords indicative of PE. For decades, the catheterization study known as the pulmonary angiogram was the gold standard for diagnosing a pulmonary embolus, but this test has now been supplanted by the CT scan. 2-SpSCT and 4-SpSCT showed higher values for sensitivity, specificity, accuracy, and the area under the curve at all DL compared with FS. In 1982, the per-capita dose was estimated to be 0.54 mSv and the collective dose 124,000 person-Sv. contrast administration. The proportions of coincidental PE were 3.3% of patients with progressive cancer, 2.5% of patients with stable cancer, 0.7% of patients with no evidence of cancer posttreatment, and 1.0% of nononcological patients. The time of year may affect the occurrence of VTE, with a higher incidence in the winter than in the summer. Clinical pretest probability serves as the root of any diagnostic approach. • In the current study, a dose reduction of 87.5% (corresponding to a mean effective dose of 0.38 mSv) for CTPA could be achieved while maintaining excellent diagnostic performance. CTA-CTV was inconclusive in 87 of 824 patients because the image quality of either CTA or CTV was poor. For a pulmonary angiogram, dye is injected through a catheter placed into the pulmonary artery so that blood clots can be visualized on an X-ray. Only 1 (0.1% [CI, 0.0% to 0.7%]) of these 759 patients developed thromboembolic events during follow-up. We performed a retrospective review of the complete medical records from a population-based inception cohort of 2218 patients who resided within Olmsted County, Minnesota, and had an incident deep vein thrombosis or pulmonary embolism during the 25-year period from 1966 through 1990. While most patients accrue low radiation-induced cancer risks, a subgroup is potentially at higher risk due to recurrent CT imaging. Active cancer. Study objective: The literature suggests that the D-dimer is useful in patients suspected of having pulmonary embolism and who have a low pretest probability of disease. The gold standard diagnostic test for pulmonary embolism has historically been interventional pulmonary angiography. Previous DVT or PE. Historically, the gold standard for the imaging of PE has been pulmonary angiography. The DESI 3 got the highest CNR and the DESI 1 got the second highest CNR. This study received internal review board approval and was Health Insurance Portability and Accountability Act compliant. CT exposures were estimated to produce 0.7% of total expected baseline cancer incidence and 1% of total cancer mortality. With 16-detector row CT and a dose-modulation program, radiation dose is decreased during PE work-up. In the third part of this dissertation, we present results of the application of hyperpolarized helium (HP-He) in the characterization of new model of experimental pulmonary ischemia. Two cohorts of patients undergoing CT for suspected PE with either single-detector CT (3-mm collimation and pitch of 1.7) or MDCT (2-mm collimation and pitch of 1) scanners were prospectively observed and compared using predefined criteria for evidence of subsequent thromboembolic disease during the 6 months after the acquisition of their initial scan. This was a multicenter, retrospective, and secondary analysis of consecutive patients in three academic emergency departments. The requirement for informed consent was waived. standardised scoring system. Sudarski S, Haubenreisser H, Henzler T, Reischauer C, Kolokythas O, Matoori S, Herzog BA, Schönberg SO, Gutzeit A. PLoS One. Setting: Emergency departments at four tertiary care hospitals in Canada. Ultrasonography, computed tomography with angiography, magnetic resonance angiography, ventilation perfusion lung scanning, and SPECT ventilation-perfusion lung imaging are discussed. No patients in this group died of fatal PE, 1 patient developed nonfatal PE, and venous thromboembolism occurred in 0.4% of these patients (95% CI, 0% to 2.2%). If CT results were normal or inconclusive, compression ultrasonography was performed on the same day as CT and repeated on days 4 and 7 if findings on the first compression ultrasonography were normal. radiologist with a powerful tool with which to image the lung. Chest CTPA, especially multidetector CT, has proven to be superior or equal to PA angiography, even detecting smaller filling defects. The immunoturbidimetric and rapid enzyme-linked immunosorbent assay d -dimer assays had similar sensitivities (94%) and specificities (45% versus 46%). Morbidity and mortality that result from PE can be reduced significantly if appropriate treatment is initiated early; this makes timely diagnosis imperative. The CT scans were obtained during one 24-sec or two 12-sec breath-holds. For each set of images, each subsegmental artery was independently graded by three radiologists as open, containing emboli, or indeterminate. Computed tomographic pulmonary angiography with dual-energy subtraction technique is feasible. By 2005, the estimated number of procedures had increased to about 19.6 million. Epub 2019 May 9. Dual-section helical CT can replace pulmonary arteriography for the direct demonstration of PE in a majority of patients. Pulmonary infiltrate suggesting pneumonia was the most common non-PE finding. Within a 35-month period, 485 consecutive patients with clinical symptoms of acute PE underwent SCTA of the pulmonary arteries. Exams with clinical questions other than PE were excluded from the analysis (n = 34). Variation in the utilization and positivity rates of CT pulmonary angiography among emergency physicians at a tertiary academic emergency department. Because the gold standard test is no longer performed, the reference … In addition, in certain scenarios, radiologists in endemic areas were less likely to over-manage than their counterparts in nonendemic regions. Among patients with PE, patients who also underwent an enhanced abdominal CT within 3 months were assessed for missed PE. In the final part of this dissertation, I will present results of a new method to measure pulmonary blood volume (PBV) using proton based MRI. To evaluate the performance of an AI-powered algorithm for the automatic detection of pulmonary embolism (PE) on chest computed tomography pulmonary angiograms (CTPAs) on a large dataset.Methods Characteristics with evidence of association with recommendation (defined as P<0.10) were included in the multiple-variable analysis. We validate our method using a model of hypoxic pulmonary vasoconstriction in rats. Measures of diagnostic performance were calculated on a per patient and a per finding level.ResultsThe algorithm correctly identified 215 of 232 exams positive for pulmonary embolism (sensitivity 92.7%; 95% confidence interval [CI] 88.3–95.5%) and 1178 of 1233 exams negative for pulmonary embolism (specificity 95.5%; 95% CI 94.2–96.6%). 2005 Apr;184(4):1231-5 To compare radiation dose delivered at four- and 16-detector row computed tomography (CT) with a dose-modulation program and that delivered at digital angiography for evaluation of pulmonary embolism (PE). Results: A filling defect or vessel occlusion is diagnostic of pulmonary embolism. In this review, we discuss the utility of these imaging techniques in the diagnosis … The predictive value of either CTA or CTA-CTV is high with a concordant clinical assessment, but additional testing is necessary when the clinical probability is inconsistent with the imaging results. Results: Computed tomography identified PE in 124 of 510 patients (24.3%) and an alternative diagnosis in 130 patients (25.5%); CT scans were normal in 248 patients (48.6%). In those patients not receiving TA, 6 had a DVT and 4 had a PE, a total of 10 (2.6%). Introduction Subsegmental pulmonary (SSP) embolism is of uncertain clinical significance [1,2], as suggested by the discrepancy between the results of studies comparing a diagnostic test for pulmonary embolism (PE) and those of outcome studies in which patient managementis decided based on … All consecutive adult patients who had, The chest radiograph remains the first imaging modality for the approach to diffuse infiltrative lung disease (DILD), but, 23 years after its introduction, high-resolution CT (HRCT) is still considered the best imaging tool for the evaluation of the pulmonary interstitium and to diagnose and assess DILD. The lungs were divided into three zones: central, middle, and peripheral. The combination of these tests, based on the pretest probability of disease, can be used in a Bayesian fashion to make accurate treatment decisions. Venous thromboembolic events are one of the main causes of mortality among hospitalized patients with COVID-19 pneumonia. Clipboard, Search History, and several other advanced features are temporarily unavailable. A backward selection process was used applying a significance level of 0.05. Only 1 (0.1% [Cl, 0.0% to 0.7%]) of these 759 patients developed thromboembolic events during follow-up. Angiograms, interpreted on the basis of consensus readings, resulted in an unchallenged diagnosis in 96%. Physicians first used a clinical model to determine patients' pretest probability of pulmonary embolism and then performed a D -dimer test. To assess the occurrence of transient interruption of contrast (TIC) phenomenon in pulmonary computed tomography angiography (CTPA) exams performed in inspiratory breath-hold after patients were told to inspire gently. Two surveys were designed, one for chest radiologists and one for interventional radiologists. To read the full-text of this research, you can request a copy directly from the authors. Statistical analysis was performed to determine associations between responses, years of experience, location in an endemic region of granulomatous disease, and setting of practice. The risks of pulmonary angiography were sufficiently low to justify it as a diagnostic tool in the appropriate clinical setting. Magnetic resonance angiography is in the early stages of investigation. The abdominal CT on which PE was overlooked was obtained for a variety of reasons, most commonly because of abdominal pain or to follow up a preexisting condition. Results of measurements of the HP-He relaxation time in both normal and ischemic animals are presented. Epub 2010 Oct 8. BMC Med. There was no difference between spiral CT and angiography for detection of subsegmental-sized pulmonary emboli. The largest pulmonary arterial branch in which PE was detected was recorded. All patients underwent dual-section helical CT (2.7-mm effective section thickness) and selective pulmonary arteriography within 12 hours of each other. Conclusion: The part of the study involving patients (seven women, four men; mean age, 62 years +/- 16 [standard deviation]; range, 41-85 years) was approved by the institutional review board. J Thromb Haemost. A retrospective case notes analysis was performed. -. When CT or compression ultrasonography results were positive for thromboembolism, anticoagulation was started. During pulmonary CT angiography, mean radiation dose delivered at middle of chest was 21.5, 19.5, and 18.2 mGy for four-detector row CT and for 16-detector row CT without and with dose-modulation program, respectively. Via SpSCT, a dose reduction down to a 12.5% dose level (corresponding to a mean effective dose of 0.38 mSv in the current study) for CTPA is possible while maintaining high image quality and full diagnostic confidence. To determine diagnostic accuracy of four-channel multi-detector row computed tomography (CT) in emergency room and inpatient populations suspected of having acute pulmonary embolism (PE) who prospectively underwent both CT and pulmonary arteriography (PA). A prospective study was performed in 75 patients who were evaluated with spiral CT and pulmonary angiography of each lung to detect central PE; 25 of the patients also underwent ventilation-perfusion (V-P) scanning. P ulmonary embolism (PE) is the third most common cause of cardiovascular death after myocardial infarction and stroke, with an estimated annual incidence in the United States of 69-205 cases per 100,000 personyears [1, ... P ulmonary embolism (PE) is the third most common cause of cardiovascular death after myocardial infarction and stroke, with an estimated annual incidence in the United States of 69-205 cases per 100,000 personyears [1,2]. 2014 Mar 4;12:39. doi: 10.1186/1741-7015-12-39. The Challenges in Assessing Contrast-Induced Nephropathy: Where Are We Now? Catheter-tip fragmentation of the embolus occasionally is accomplished successfully. If pulmonary embolism is not excluded, contrast-enhanced computed tomographic pulmonary angiography (CT angiography) in combination with venous phase imaging (CT venography), is recommended by most PIOPED II investigators, although CT angiography plus clinical assessment is an option. Findings from both studies were positive in 39 patients. Results: 701 patients underwent primary THR and TKR over the 2-year period. If the physician maintains a high level of suspicion, the diagnosis (or its exclusion) usually becomes clarified. The aim of this study was to assess whether the use of pre-operative TA increased the incidence of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) in Total Hip Replacement (THR) and Total Knee Replacement (TKR). One hundred sixty-one health care professionals consented to participate in this study, which had ethical board approval. The annual incidence of pulmonary embolism in the United States is probably in excess of 630,000. IR with < 10 years since finishing training were less likely to consider CTPA the gold standard, OR 0.45 (0.2-0.9). kappa Values, sensitivities, and specificities were determined. Contrast material column in the pulmonary arteries was significantly more homogeneous at multi-detector row CT. Each patient underwent a point‐of‐care sonogram where a TAPSE measurement was obtained, followed by computed tomography pulmonary angiogram. 2019 Jan 17;14(1):e0210473. To determine the effectiveness and safety of using helical CT of the pulmonary arteries as the primary diagnostic test in patients with suspected PE. kappa values were 0.71 and 0.83 for CT and PA, respectively, and were not significantly different between modalities. The AI prototype algorithm we tested has a high degree of diagnostic accuracy for the detection of PE on CTPAs. CT findings of 188 central emboli corresponded exactly to those of angiography. Due to its invasive nature, however, many physicians reserve the procedure for a diagnosis that is imperative (for example, before administering potentially hazardous thrombolytics). Radiologists who had been in practice for longer periods of time were less likely to select the appropriate management, as were radiologists who practiced outside the United States. CT is one of the most reliable and effective methods in the diagnosis is PE, with the advantage of being extremely fast and providing alternative diagnoses. Patients for whom the diagnosis was considered excluded were followed up for 3 months for the development of thromboembolic events. Most deaths were due to underlying diseases. Diagnostic investigations collect information to clarify patients' health status, using personal characteristics, symptoms, signs, history, physical examination, laboratory tests, and additional facilities.

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