open access

Ahead of print
Review Article
Published online: 2019-08-27
Get Citation

Multimodality cardiovascular imaging in pulmonary embolism

Hyung Yoon Kim, Kye Hun Kim, Jahae Kim, Jong Chun Park
DOI: 10.5603/CJ.a2019.0084
·
Pubmed: 31478557

open access

Ahead of print
Review articles
Published online: 2019-08-27

Abstract

Various imaging modalities include chest computed tomography pulmonary angiography (CTPA), echocardiography, magnetic resonance imaging, and nuclear imaging and each are used for the assessment of varying status of PE. Assessment of thromboembolic burden by chest CTPA is the first step in the diagnosis of PE. Hemodynamic assessment can be achieved by echocardiography and also by chest CTPA. Nuclear imaging is useful in discriminating  CTEPH from APE.

Better perspectives on diagnosis, risk stratification and decision making in PE can be provided by combining multimodality cardiovascular imaging. Here, the advantages or pitfalls of each imaging modality in diagnosis, risk stratification, or management of PE will be discussed.

Abstract

Various imaging modalities include chest computed tomography pulmonary angiography (CTPA), echocardiography, magnetic resonance imaging, and nuclear imaging and each are used for the assessment of varying status of PE. Assessment of thromboembolic burden by chest CTPA is the first step in the diagnosis of PE. Hemodynamic assessment can be achieved by echocardiography and also by chest CTPA. Nuclear imaging is useful in discriminating  CTEPH from APE.

Better perspectives on diagnosis, risk stratification and decision making in PE can be provided by combining multimodality cardiovascular imaging. Here, the advantages or pitfalls of each imaging modality in diagnosis, risk stratification, or management of PE will be discussed.

Get Citation

Keywords

pulmonary embolism, imaging

About this article
Title

Multimodality cardiovascular imaging in pulmonary embolism

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Review Article

Published online

2019-08-27

DOI

10.5603/CJ.a2019.0084

Pubmed

31478557

Keywords

pulmonary embolism
imaging

Authors

Hyung Yoon Kim
Kye Hun Kim
Jahae Kim
Jong Chun Park

References (63)
  1. Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data. Arch Intern Med. 2003; 163(14): 1711–1717.
  2. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999; 353(9162): 1386–1389.
  3. Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014; 35(43): 3033–3069.
  4. Vonk Noordegraaf A, Westerhof BE, Westerhof N. The Relationship Between the Right Ventricle and its Load in Pulmonary Hypertension. J Am Coll Cardiol. 2017; 69(2): 236–243.
  5. Kim NH, Delcroix M, Jais X, et al. Chronic thromboembolic pulmonary hypertension. Eur Respir J. 2019; 53(1).
  6. Kucher N, Rossi E, De Rosa M, et al. Prognostic role of echocardiography among patients with acute pulmonary embolism and a systolic arterial pressure of 90 mm Hg or higher. Arch Intern Med. 2005; 165(15): 1777–1781.
  7. Kucher N, Luder CM, Dörnhöfer T, et al. Novel management strategy for patients with suspected pulmonary embolism. Eur Heart J. 2003; 24(4): 366–376.
  8. McConnell MV, Solomon SD, Rayan ME, et al. Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism. Am J Cardiol. 1996; 78(4): 469–473.
  9. Platz E, Hassanein AH, Shah A, et al. Regional right ventricular strain pattern in patients with acute pulmonary embolism. Echocardiography. 2012; 29(4): 464–470.
  10. Casazza F, Bongarzoni A, Capozi A, et al. Regional right ventricular dysfunction in acute pulmonary embolism and right ventricular infarction. Eur J Echocardiogr. 2005; 6(1): 11–14.
  11. Seo HS, Lee H. Assessment of right ventricular function in pulmonary hypertension with multimodality imaging. J Cardiovasc Imaging. 2018; 26(4): 189–200.
  12. Lee JH, Park JH, Park KI, et al. A comparison of different techniques of two-dimensional speckle-tracking strain measurements of right ventricular systolic function in patients with acute pulmonary embolism. J Cardiovasc Ultrasound. 2014; 22(2): 65–71.
  13. Pruszczyk P, Goliszek S, Lichodziejewska B, et al. Prognostic value of echocardiography in normotensive patients with acute pulmonary embolism. JACC Cardiovasc Imaging. 2014; 7(6): 553–560.
  14. Lee JH, Park JH. Role of echocardiography in patients with acute pulmonary thromboembolism. J Cardiovasc Ultrasound. 2008; 16(1): 9–16.
  15. Roberts JD, Forfia PR. Diagnosis and assessment of pulmonary vascular disease by Doppler echocardiography. Pulm Circ. 2011; 1(2): 160–181.
  16. Stein PD, Fowler SE, Goodman LR, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med. 2006; 354(22): 2317–2327.
  17. Park JR, Chang SA, Jang SYi, et al. Evaluation of right ventricular dysfunction and prediction of clinical outcomes in acute pulmonary embolism by chest computed tomography: comparisons with echocardiography. Int J Cardiovasc Imaging. 2012; 28(4): 979–987.
  18. He H, Stein MW, Zalta B, et al. Computed tomography evaluation of right heart dysfunction in patients with acute pulmonary embolism. J Comput Assist Tomogr. 2006; 30(2): 262–266.
  19. Coutance G, Cauderlier E, Ehtisham J, et al. The prognostic value of markers of right ventricular dysfunction in pulmonary embolism: a meta-analysis. Crit Care. 2011; 15(2): R103.
  20. Becattini C, Agnelli G, Vedovati MC, et al. Multidetector computed tomography for acute pulmonary embolism: diagnosis and risk stratification in a single test. Eur Heart J. 2011; 32(13): 1657–1663.
  21. Seon HJu, Kim KH, Lee WS, et al. Usefulness of computed tomographic pulmonary angiography in the risk stratification of acute pulmonary thromboembolism. Comparison with cardiac biomarkers. Circ J. 2011; 75(2): 428–436.
  22. Schoepf UJ, Kucher N, Kipfmueller F, et al. Right ventricular enlargement on chest computed tomography: a predictor of early death in acute pulmonary embolism. Circulation. 2004; 110(20): 3276–3280.
  23. van der Meer RW, Pattynama PMT, van Strijen MJL, et al. Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism. Radiology. 2005; 235(3): 798–803.
  24. Miller GA, Sutton GC, Kerr IH, et al. Comparison of streptokinase and heparin in treatment of isolated acute massive pulmonary embolism. Br Med J. 1971; 2(5763): 681–684.
  25. Qanadli SD, El Hajjam M, Vieillard-Baron A, et al. New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. AJR Am J Roentgenol. 2001; 176(6): 1415–1420.
  26. Mastora I, Remy-Jardin M, Masson P, et al. Severity of acute pulmonary embolism: evaluation of a new spiral CT angiographic score in correlation with echocardiographic data. Eur Radiol. 2003; 13(1): 29–35.
  27. Walsh P, Greenspan R, Simon M, et al. An angiographic severity index for pulmonary embolism. Circulation. 1973; 47(suppl2).
  28. Bankier AA, Janata K, Fleischmann D, et al. Severity assessment of acute pulmonary embolism with spiral CT: evaluation of two modified angiographic scores and comparison with clinical data. J Thorac Imaging. 1997; 12(2): 150–158.
  29. Collomb D, Paramelle PJ, Calaque O, et al. Severity assessment of acute pulmonary embolism: evaluation using helical CT. Eur Radiol. 2003; 13(7): 1508–1514.
  30. Araoz PA, Gotway MB, Trowbridge RL, et al. Helical CT pulmonary angiography predictors of in-hospital morbidity and mortality in patients with acute pulmonary embolism. J Thorac Imaging. 2003; 18(4): 207–216.
  31. Ghaye B, Ghuysen A, Willems V, et al. Severe pulmonary embolism:pulmonary artery clot load scores and cardiovascular parameters as predictors of mortality. Radiology. 2006; 239(3): 884–891.
  32. Vedovati MC, Germini F, Agnelli G, et al. Prognostic role of embolic burden assessed at computed tomography angiography in patients with acute pulmonary embolism: systematic review and meta-analysis. J Thromb Haemost. 2013; 11(12): 2092–2102.
  33. Renard B, Remy-Jardin M, Santangelo T, et al. Dual-energy CT angiography of chronic thromboembolic disease: can it help recognize links between the severity of pulmonary arterial obstruction and perfusion defects? Eur J Radiol. 2011; 79(3): 467–472.
  34. Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016; 37(1): 67–119.
  35. Reichelt A, Hoeper MM, Galanski M, et al. Chronic thromboembolic pulmonary hypertension: evaluation with 64-detector row CT versus digital substraction angiography. Eur J Radiol. 2009; 71(1): 49–54.
  36. Wittram C, Kalra MK, Maher MM, et al. Acute and chronic pulmonary emboli: angiography-CT correlation. AJR Am J Roentgenol. 2006; 186(6 Suppl 2): S421–S429.
  37. Hasegawa I, Boiselle PM, Hatabu H. Bronchial artery dilatation on MDCT scans of patients with acute pulmonary embolism: comparison with chronic or recurrent pulmonary embolism. AJR Am J Roentgenol. 2004; 182(1): 67–72.
  38. Anderson DR, Barnes DC. Computerized tomographic pulmonary angiography versus ventilation perfusion lung scanning for the diagnosis of pulmonary embolism. Curr Opin Pulm Med. 2009; 15(5): 425–429.
  39. Sostman HD, Miniati M, Gottschalk A, et al. Sensitivity and specificity of perfusion scintigraphy combined with chest radiography for acute pulmonary embolism in PIOPED II. J Nucl Med. 2008; 49(11): 1741–1748.
  40. Roach PJ, Schembri GP, Bailey DL. V/Q scanning using SPECT and SPECT/CT. J Nucl Med. 2013; 54(9): 1588–1596.
  41. Roach PJ, Bailey DL, Harris BE. Enhancing lung scintigraphy with single-photon emission computed tomography. Semin Nucl Med. 2008; 38(6): 441–449.
  42. Gutte H, Mortensen J, Jensen CV, et al. Detection of pulmonary embolism with combined ventilation-perfusion SPECT and low-dose CT: head-to-head comparison with multidetector CT angiography. J Nucl Med. 2009; 50(12): 1987–1992.
  43. Bajc M, Neilly JB, Miniati M, et al. EANM guidelines for ventilation/perfusion scintigraphy : Part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography. Eur J Nucl Med Mol Imaging. 2009; 36(8): 1356–1370.
  44. Kalb B, Sharma P, Tigges S, et al. MR imaging of pulmonary embolism: diagnostic accuracy of contrast-enhanced 3D MR pulmonary angiography, contrast-enhanced low-flip angle 3D GRE, and nonenhanced free-induction FISP sequences. Radiology. 2012; 263(1): 271–278.
  45. Kreitner KFJ, Ley S, Kauczor HU, et al. Chronic thromboembolic pulmonary hypertension: pre- and postoperative assessment with breath-hold MR imaging techniques. Radiology. 2004; 232(2): 535–543.
  46. Kawakubo M, Akamine H, Yamasaki Y, et al. Three-dimensional phase contrast magnetic resonance imaging validated to assess pulmonary artery flow in patients with chronic thromboembolic pulmonary hypertension. Radiol Phys Technol. 2017; 10(2): 249–255.
  47. Ota H, Sugimura K, Miura M, et al. Four-dimensional flow magnetic resonance imaging visualizes drastic change in vortex flow in the main pulmonary artery after percutaneous transluminal pulmonary angioplasty in a patient with chronic thromboembolic pulmonary hypertension. Eur Heart J. 2015; 36(25): 1630.
  48. Huisman MV, Klok FA. Magnetic resonance imaging for diagnosis of acute pulmonary embolism: not yet a suitable alternative to CT-PA. J Thromb Haemost. 2012; 10(5): 741–742.
  49. Ley S, Grünig E, Kiely DG, et al. Computed tomography and magnetic resonance imaging of pulmonary hypertension: Pulmonary vessels and right ventricle. J Magn Reson Imaging. 2010; 32(6): 1313–1324.
  50. Kreitner KF, Kunz RP, Ley S, et al. Chronic thromboembolic pulmonary hypertension - assessment by magnetic resonance imaging. Eur Radiol. 2007; 17(1): 11–21.
  51. Reiter U, Reiter G, Fuchsjäger M. MR phase-contrast imaging in pulmonary hypertension. Br J Radiol. 2016; 89(1063): 20150995.
  52. Dalen J, Brooks H, Johnson L, et al. Pulmonary angiography in acute pulmonary embolism: Indications, techniques, and results in 367 patients. Am Heart J. 1971; 81(2): 175–185.
  53. Kim NH, Delcroix M, Jais X, et al. Chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol. 2013; 62(25 Suppl): D92–D99.
  54. Kataoka M, Inami T, Kawakami T, et al. Balloon pulmonary angioplasty (percutaneous transluminal pulmonary angioplasty) for chronic thromboembolic pulmonary hypertension: a japanese perspective. JACC Cardiovasc Interv. 2019; 12(14): 1382–1388.
  55. Da Costa Rodrigues J, Alzuphar S, Combescure C, et al. Diagnostic characteristics of lower limb venous compression ultrasonography in suspected pulmonary embolism: a meta-analysis. J Thromb Haemost. 2016; 14(9): 1765–1772.
  56. Righini M, Le Gal G, Aujesky D, et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial. Lancet. 2008; 371(9621): 1343–1352.
  57. Elias A, Colombier D, Victor G, et al. Diagnostic performance of complete lower limb venous ultrasound in patients with clinically suspected acute pulmonary embolism. Thromb Haemost. 2004; 91(1): 187–195.
  58. Righini M, Le Gal G, Aujesky D, et al. Complete venous ultrasound in outpatients with suspected pulmonary embolism. J Thromb Haemost. 2009; 7(3): 406–412.
  59. Wan T, Skeith L, Karovitch A, et al. Guidance for the diagnosis of pulmonary embolism during pregnancy: Consensus and controversies. Thromb Res. 2017; 157: 23–28.
  60. Chan WS, Rey E, Kent NE, et al. Venous thromboembolism and antithrombotic therapy in pregnancy. J Obstet Gynaecol Can. 2014; 36(6): 527–553.
  61. Pleszewski B, Chartrand-Lefebvre C, Qanadli SD, et al. Gadolinium-enhanced pulmonary magnetic resonance angiography in the diagnosis of acute pulmonary embolism: a prospective study on 48 patients. Clin Imaging. 2006; 30(3): 166–172.
  62. Thomsen HS. Nephrogenic systemic fibrosis: a serious adverse reaction to gadolinium - 1997-2006-2016. Part 1. Acta Radiol. 2016; 57(5): 515–520.
  63. Miniati M, Sostman HD, Gottschalk A, et al. Perfusion lung scintigraphy for the diagnosis of pulmonary embolism: a reappraisal and review of the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis methods. Semin Nucl Med. 2008; 38(6): 450–461.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl