open access

Vol 1, No 1 (2021)
Research paper
Published online: 2021-06-01
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Detection of Pulmonary Embolism on CT-Angiography Using Contrast Attenuation of Pulmonary Veins

Dorothee Hausmann, Ahmed Maher, Dominik Aleksander Sieroń, Adrian Thomas Huber, Verena Carola Obmann, Lukas Ebner, Andreas Christe
DOI: 10.5603/AA.2021.0001
·
Acta Angiologica 2021;1(1):1-9.

open access

Vol 1, No 1 (2021)
Original papers
Published online: 2021-06-01

Abstract

Background: In areas of pulmonary embolism (PE), the enhancement of pulmonary veins on computed tomography pulmonary angiography (CTPA) should be decreased due to reduced arterial perfusion. Purpose: The purpose of this study was to investigate the accuracy of contrast density measurements (differences) in all pulmonary veins and the left atrium for the prediction of PE. Materials and Methods: 75 patients with PE and 22 patients without PE on CTPA were included. 4 readers measured the enhancement of the blood in the pulmonary vein immediately before the entrance to the left atrium, right after the aperture, in the center of the left atrium, in the pulmonary trunk and in the aorta. Enhancement of the pulmonary veins with and without upstream PE, and ROC curves with HU thresholds for optimal sensitivity and specificity for PE were calculated. Results: More PEs were found in the right and lower lobes. PE-affected lobes demonstrated 13.8+/-45 HU less enhancement in the pulmonary vein, compared to a paired non-affected pulmonary vein of the same patient (P < 0.0001). On average, non-affected pulmonary veins demonstrated no difference in enhancement compared to each other: 0.2 +/-21 HU. The optimal cutoff level in the ROC curve analysis for PE affection proved to be decreasing enhancement in the pulmonary vein of more than 10 HU, compared to the atrium. Conclusion: Decreasing enhancement in the pulmonary vein of more than 10 HU compared to the atrium could provide additional information and confidence in the diagnosis of PE.

Abstract

Background: In areas of pulmonary embolism (PE), the enhancement of pulmonary veins on computed tomography pulmonary angiography (CTPA) should be decreased due to reduced arterial perfusion. Purpose: The purpose of this study was to investigate the accuracy of contrast density measurements (differences) in all pulmonary veins and the left atrium for the prediction of PE. Materials and Methods: 75 patients with PE and 22 patients without PE on CTPA were included. 4 readers measured the enhancement of the blood in the pulmonary vein immediately before the entrance to the left atrium, right after the aperture, in the center of the left atrium, in the pulmonary trunk and in the aorta. Enhancement of the pulmonary veins with and without upstream PE, and ROC curves with HU thresholds for optimal sensitivity and specificity for PE were calculated. Results: More PEs were found in the right and lower lobes. PE-affected lobes demonstrated 13.8+/-45 HU less enhancement in the pulmonary vein, compared to a paired non-affected pulmonary vein of the same patient (P < 0.0001). On average, non-affected pulmonary veins demonstrated no difference in enhancement compared to each other: 0.2 +/-21 HU. The optimal cutoff level in the ROC curve analysis for PE affection proved to be decreasing enhancement in the pulmonary vein of more than 10 HU, compared to the atrium. Conclusion: Decreasing enhancement in the pulmonary vein of more than 10 HU compared to the atrium could provide additional information and confidence in the diagnosis of PE.

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Keywords

Pulmonary Embolism Detection, CT-Pulmonary Angiography, Enhancement and Perfusion of Pulmonary Veins

About this article
Title

Detection of Pulmonary Embolism on CT-Angiography Using Contrast Attenuation of Pulmonary Veins

Journal

Acta Angiologica

Issue

Vol 1, No 1 (2021)

Article type

Research paper

Pages

1-9

Published online

2021-06-01

DOI

10.5603/AA.2021.0001

Bibliographic record

Acta Angiologica 2021;1(1):1-9.

Keywords

Pulmonary Embolism Detection
CT-Pulmonary Angiography
Enhancement and Perfusion of Pulmonary Veins

Authors

Dorothee Hausmann
Ahmed Maher
Dominik Aleksander Sieroń
Adrian Thomas Huber
Verena Carola Obmann
Lukas Ebner
Andreas Christe

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