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Detection of Pulmonary Embolism on CT-Angiography Using Contrast Attenuation of Pulmonary Veins
, 2, 3, 1, 1, 1, 14
Affiliations- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
- Department of Radiology, Cantonal Hospital Baden, Im Ergel 1, 5404 Baden, Switzerland
- Division of Magnetic Resonance Imaging, Silesian Center for Heart Diseases, Zabrze, Poland, Marii Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
- Department of Diagnostic, Interventional and Paediatric Radiology, INSELGROUP, Radiology Division SLS, University of Bern, Tiefenaustrasse 112, 3004 Bern, Switzerland
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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.
Keywords
Pulmonary Embolism Detection, CT-Pulmonary Angiography, Enhancement and Perfusion of Pulmonary Veins
About this articleTitle
Detection of Pulmonary Embolism on CT-Angiography Using Contrast Attenuation of Pulmonary Veins
Journal
Issue
Article type
Research paper
Pages
1-9
Published online
2021-06-01
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1343
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1056
DOI
Bibliographic record
Acta Angiologica 2021;27(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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