ct pulmonary angiography protocol

Methods: 2007 Jul. The contrast agent is injected into a vein (not an artery as in conventional angiography), usually in the arm. It is a preferred choice of imaging in the diagnosis of PE due to its minimally invasive nature for the patient, whose only requirement for the scan is an intravenous line. Image quality was evaluated with objective and subjective criteria. Three of 11 CTA studies judged to have transient interruption of the contrast bolus in group A were considered of diagnostic quality at the time of image acquisition and by subjective image quality evaluation, but the mean pulmonary arterial enhancement was classified as poor in two and as adequate in one of these studies. Group B consisted of 20 patients, each of whom underwent one pulmonary CTA study. For scanner/protocol combinations The CT Coronary Angiogram is a simple procedure without any pain and anxiety . Lung volume was quantified employing semi-automated lung software that calculated lung volumes (intellispace -Philips). A focal increase in vascular resistance from consolidation or atelectasis. Intrathoracic pressure decreases on deep inspiration and the thoracoabdominal gradient becomes more pronounced, resulting in increased venous return to the right heart. The increase in cardiac output in pregnancy may lead to decreased peak arterial enhancement and a shorter contrast material arrival time. There was a strong positive relationship between mean pulmonary arterial attenuation and good objective image quality (r = 0.67, p = 0.001). Statistical methods included the Shapiro-Wilk test to confirm normal distribution, Student t test, chi-square test, and Pearson correlation coefficient. Comparison was made between the smart prep protocol (SPP) and the test bolus protocol (TBP) for opacification in the pulmonary trunk. The relative contribution of the IVC to the right heart was then evaluated. Finally, study groups A and B were not similar in size; fewer pulmonary CTA studies were performed of pregnant patients during the second half of the study duration as part of a revised departmental protocol advocating lung scintigraphy as the preferred study in pregnant patients. Transient interruption of the contrast bolus by unopacified blood from the IVC was a causative factor in one case and the second nondiagnostic study was caused by poor peak arterial enhancement. One of these patients was thought to be at high risk of PE and underwent lung scintigraphy, which excluded PE. Same procedure; Clearly show the patho, compressed a. Tot of 4 scouts. The pulmonary vasculature may be evaluated with various invasive and noninvasive methods. Although this difference was not statistically significant, the slightly lower radiation dose in group B may have been due to shallow inspiration and resultant decreased z-axis coverage. The difference in mean age between group A and group B (32.7 vs 29.2 years, respectively) achieved statistical significance (p = 0.05). Group B consisted of 20 patients, each of whom underwent one pulmonary CTA study. Its use in pregnant patients has consistently risen in recent decades . When the threshold of attenuation in the MPA was reached, the patient was instructed to perform shallow held inspiration, after adequate coaching by a technologist encouraging a shallow breath and the avoidance of a Valsalva maneuver. A Combination of Normal-Dose Corticomedullary Phase With Low-Dose Unenhanced and Excretory Phases, Review. There were no reported complications as a result of pulmonary CTA in either group. These data indicate a 143-HU difference in mean opacification between the two groups. exercise was to investigate if a change in CT pulmonary angiography (CTPA) scanning protocol resulted in improved opacification of the pulmonary arteries. These measurements were then combined to calculate mean pulmonary opacification. There was a strong positive relationship between mean pulmonary arterial attenuation and good subjective image quality (r = 0.55, p = 0.001). In group B, two patients had nondiagnostic studies. TABLE 2: Opacification of the Pulmonary Arteries on CT Angiography. A D-dimer assay might be a preferred alternative to test for pulmonary embolism, and that test and a low clinical prediction score on the Wells test or Geneva score can exclude pulmonary embolism as a possibility. Copyright © 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. One study that showed transient interruption of the contrast bolus in group B was considered diagnostic at the time of image acquisition and met both subjective and objective criteria of “good” and “adequate” at study reinterpretation. 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). Readers were not blinded to the CTA protocol used. Pulmonary arterial opacification was significantly higher in all locations in group B than group A and is detailed in Table 2. The relative contribution of the IVC to the right heart was then evaluated. Statistical methods included the Shapiro-Wilk test to confirm normal distribution, Student t test, chi-square test, and Pearson correlation coefficient. Studies analyzing pulmonary CTA of pregnant patients have confirmed that pulmonary arterial opacification is reduced during pregnancy [4, 7, 19, 20] and that transient interruption of the contrast bolus by unopacified blood from the IVC may occur more often in pregnant patients than in the general population [7]. 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). Suspected Pulmonary Embolism: A Management Study . 2–4 CTPA is a standard procedure that obtains a CT volume while intravenously injected iodinated contrast media (CM) opacifies the pulmonary arteries. Cystic Hepatic Lesions: A Review and an Algorithmic Approach, Review. For example, in a recent study of 43 pregnant patients, investigators reported a 19% rate of indeterminate CTA studies using 100–120 mL of contrast medium and held maximal inspiration, with slow breathing used as a trouble-shooting maneuver [20]. Aim: The purpose of this study is to investigate the relationship between contrast media volume and patient lung volume when employing a patient-specific contrast media formula during pulmonary computed tomography angiography (CTA). Comparison was made between the smart prep protocol (SPP) and the test bolus protocol (TBP) for opacification in the pulmonary trunk. KIVC values range from 0 to 1.0; a high KIVC (> 0.8) indicates a larger contribution from the IVC to the right heart relative to the SVC and suggests the presence of transient interruption of the contrast bolus by unopacified blood from the IVC, whereas healthy control subjects have average KIVC values of approximately 0.5 [17]. CTA of the pulmonary arteries was performed on 200 patients with suspected pulmonary … Angiography is an imaging test that uses x-rays and a special dye to see inside the arteries. 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]. Transient interruption of the contrast bolus by unopacified blood from the IVC was a causative factor in one case and the second nondiagnostic study was caused by poor peak arterial enhancement. [Dual-source CT scanners provide high-pitch dual source protocols … 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]. 50 patients with acute/chronic renal failure were examined on a 3 rd generation dual-source CT with an optimized DE CTPA protocol and a low CM injection protocol (5.4 g iodine). 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. Image quality was evaluated with objective and subjective criteria. Pulmonary angiography is an invasive procedure and due to its costs and potential risks is usually reserved for patients in whom more information or certainty of the diagnosis of PE are necessary. Methods: KIVC values range from 0 to 1.0; a high KIVC (> 0.8) indicates a larger contribution from the IVC to the right heart relative to the SVC and suggests the presence of transient interruption of the contrast bolus by unopacified blood from the IVC, whereas healthy control subjects have average KIVC values of approximately 0.5 [17]. Of the CTA studies with the artifact, the average relative IVC contributions (KIVC) to the RA and RV were 84.4% and 84.7%, respectively, whereas the average KIVC values for those CTA studies without the artifact were 46.9% and 52.7% (p < 0.0001), respectively. The adequate group included CTA studies with good pulmonary arterial enhancement and without significant noise or motion artifact. During bolus tracking, the patient was instructed to breathe quietly. 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). We thank the CT radiographers at St. Vincent’s University Hospital—in particular, Susan Collins and Sheena O’Keeffe—and chief physicist Michael Casey for their important contributions to image acquisition and dose calculation in this study. 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