Pulmonary embolism (PE) is potentially life threatening condition which requires adequate diagnosis. Since computerized tomography pulmonary angiography (CTPA) described the presence of a clot subjectively, an objecti...Pulmonary embolism (PE) is potentially life threatening condition which requires adequate diagnosis. Since computerized tomography pulmonary angiography (CTPA) described the presence of a clot subjectively, an objective and quantification method to characterize plural parenchymal abnormality, pulmonary vessels and heart is needed (in order to diagnose PE). This study was directed to investigate whether the presence of plural parenchymal findings correlates with the PE and as well, it was designed to answer two basic questions based on CTPA findings done for clinical suspicion of PE: firstly, what are the plural parenchymal abnormalities associated with PE;secondly, correlation of PE with the presence of heart changes and pulmonary vessels measurements. CTPA scans were acquired for 55 patients suspected of having PE and another 50 subjects who were considered as control. The clinical signs and pleuroparenchymal abnormalities, pulmonary artery tree measurements, right ventricle and atrium diameters, Inter ventricular septum width as well as the myocardium thickening were characterized and correlated with PE. The results showed that the PE patients group has more dilated measurements than the normal control subjects. The right ventricle diameter changes were found to be significantly related to the presence of PE at p ≤ 0.001. Significant changes at p ≤ 0.005 were also noticed in the pulmonary trunk diameter as well as the right and left main pulmonary arteries with no significant changes detected in the distal portion of both pulmonary arteries diameters. The common complaints from PE patients were chest pain, shortness of breathing, lower limb swelling, tachycardia and syncope. Consolidation, ground glass opacifications, mosaic, right ventricle morphological changes and pleural effusion were present in the majority of patients undergoing CTPA for the clinical suspicion of PE. CTPA is considered as the diagnostic modality of choice in characterization of pulmonary vessels, atrium and ventricle changes as well as pleura parenchymal abnormalities in patients with or without PE.展开更多
Pulmonary contrast enhanced magnetic resonance angiography(CE-MRA)is useful for the primary diagnosis of pulmonary embolism(PE).Many sites have chosen not to use CE-MRA as a first line of diagnostic tool for PE becaus...Pulmonary contrast enhanced magnetic resonance angiography(CE-MRA)is useful for the primary diagnosis of pulmonary embolism(PE).Many sites have chosen not to use CE-MRA as a first line of diagnostic tool for PE because of the speed and higher efficacy of computerized tomographic angiography(CTA).In this review,we discuss the strengths and weaknesses of CEMRA and the appropriate imaging scenarios for the primary diagnosis of PE derived from our unique multiinstitutional experience in this area.The optimal patient for this test has a low to intermediate suspicion for PE based on clinical decision rules.Patients in extremis are not candidates for this test.Younger women(<35 years of age)and patients with iodinated contrast allergies are best served by using this modality We discuss the history of the use of this test,recent technical innovations,artifacts,direct and indirect findings for PE,ancillary findings,and the effectiveness(patient outcomes)of CE-MRA for the exclusion of PE.Current outcomes data shows that CE-MRA and NM V/Q scans are effective alternative tests to CTA for the primary diagnosis of PE.展开更多
BACKGROUND Underdiagnosis of peripheral arterial disease results in inadequate treatment and more serious consequences.Hence,clinicians have focused on early diagnosis and treatment.AIM To investigate the effectivenes...BACKGROUND Underdiagnosis of peripheral arterial disease results in inadequate treatment and more serious consequences.Hence,clinicians have focused on early diagnosis and treatment.AIM To investigate the effectiveness of the combination of doppler ultrasonography(DUS),three-dimensional dynamic contrast-enhanced magnetic resonance an-giography(CE-MRA),and CT angiography(CTA)in assessing lower extremity arterial disease in diabetes mellitus(DM).METHODS This study retrospectively analyzed the imaging and clinical data of 116 patients diagnosed with DM complicated with lower extremity vascular diseases from January 2021 to June 2023.All patients underwent unilateral or bilateral DUS,CTA,and CE-MRA as well as invasive digital subtraction angiography(DSA).The application values of DUS,CE-MRA,and CTA were compared.RESULTS A total of 152 lower extremity arteries in the 116 patients were graded following the classification of vascular branches.The Kappa values between DUS and DSA were 0.780,0.755,and 0.806 for diagnosing moderate stenosis and 0.484,0.699,and 0.449 for severe stenosis of grade 1 arteries,grade 2 arteries,and grade 3 arteries,respectively.The Kappa values between CE-MRA and DSA were 0.784,0.814,and 0.835 for diagnosing moderate stenosis and 0.694,0.748,and 0.606 for severe stenosis of grade 1 arteries,grade 2 arteries,and grade 3 arteries,respectively.The Kappa values between CTA and DSA were 0.900,0.858,and 0.878 for diagnosing moderate stenosis and 0.882,0.823,and 0.756 for severe stenosis of grade 1 arteries,grade 2 arteries,and grade 3 arteries,respectively.CONCLUSION DUS,CE-MRA,and CTA demonstrated comparable accuracy in diagnosing lower extremity arterial disease in DM,and the consistency between CTA and DSA diagnoses was higher than the other two imaging methods.展开更多
Objective:To describe the clinical fea-tures of a case of ischemic stroke caused by pseudo severe stenosis of vertebral artery(VA).Methods:The clinical history and image data of a 52-year-old man with ischemic stroke ...Objective:To describe the clinical fea-tures of a case of ischemic stroke caused by pseudo severe stenosis of vertebral artery(VA).Methods:The clinical history and image data of a 52-year-old man with ischemic stroke were collected.Results:Computerized tomography angiography(CTA)revealed stenosis of V1 and V4 of the left VA.DSA confirmed that the anterior blood flow recov-ered after stent implantation,and the V4 segment of the left VA was normal without stenosis.Conclusions:It is spec-ulated that the upper stenosis is due to local hemodynamic changes rather than real stenosis.This case suggests that the interpretation of stenosis on CTA should consider cere-bral vascular anatomy and hemodynamic changes.展开更多
文摘Pulmonary embolism (PE) is potentially life threatening condition which requires adequate diagnosis. Since computerized tomography pulmonary angiography (CTPA) described the presence of a clot subjectively, an objective and quantification method to characterize plural parenchymal abnormality, pulmonary vessels and heart is needed (in order to diagnose PE). This study was directed to investigate whether the presence of plural parenchymal findings correlates with the PE and as well, it was designed to answer two basic questions based on CTPA findings done for clinical suspicion of PE: firstly, what are the plural parenchymal abnormalities associated with PE;secondly, correlation of PE with the presence of heart changes and pulmonary vessels measurements. CTPA scans were acquired for 55 patients suspected of having PE and another 50 subjects who were considered as control. The clinical signs and pleuroparenchymal abnormalities, pulmonary artery tree measurements, right ventricle and atrium diameters, Inter ventricular septum width as well as the myocardium thickening were characterized and correlated with PE. The results showed that the PE patients group has more dilated measurements than the normal control subjects. The right ventricle diameter changes were found to be significantly related to the presence of PE at p ≤ 0.001. Significant changes at p ≤ 0.005 were also noticed in the pulmonary trunk diameter as well as the right and left main pulmonary arteries with no significant changes detected in the distal portion of both pulmonary arteries diameters. The common complaints from PE patients were chest pain, shortness of breathing, lower limb swelling, tachycardia and syncope. Consolidation, ground glass opacifications, mosaic, right ventricle morphological changes and pleural effusion were present in the majority of patients undergoing CTPA for the clinical suspicion of PE. CTPA is considered as the diagnostic modality of choice in characterization of pulmonary vessels, atrium and ventricle changes as well as pleura parenchymal abnormalities in patients with or without PE.
基金research support of the Department of Radiology,UW-Madison and GE Healthcare
文摘Pulmonary contrast enhanced magnetic resonance angiography(CE-MRA)is useful for the primary diagnosis of pulmonary embolism(PE).Many sites have chosen not to use CE-MRA as a first line of diagnostic tool for PE because of the speed and higher efficacy of computerized tomographic angiography(CTA).In this review,we discuss the strengths and weaknesses of CEMRA and the appropriate imaging scenarios for the primary diagnosis of PE derived from our unique multiinstitutional experience in this area.The optimal patient for this test has a low to intermediate suspicion for PE based on clinical decision rules.Patients in extremis are not candidates for this test.Younger women(<35 years of age)and patients with iodinated contrast allergies are best served by using this modality We discuss the history of the use of this test,recent technical innovations,artifacts,direct and indirect findings for PE,ancillary findings,and the effectiveness(patient outcomes)of CE-MRA for the exclusion of PE.Current outcomes data shows that CE-MRA and NM V/Q scans are effective alternative tests to CTA for the primary diagnosis of PE.
文摘BACKGROUND Underdiagnosis of peripheral arterial disease results in inadequate treatment and more serious consequences.Hence,clinicians have focused on early diagnosis and treatment.AIM To investigate the effectiveness of the combination of doppler ultrasonography(DUS),three-dimensional dynamic contrast-enhanced magnetic resonance an-giography(CE-MRA),and CT angiography(CTA)in assessing lower extremity arterial disease in diabetes mellitus(DM).METHODS This study retrospectively analyzed the imaging and clinical data of 116 patients diagnosed with DM complicated with lower extremity vascular diseases from January 2021 to June 2023.All patients underwent unilateral or bilateral DUS,CTA,and CE-MRA as well as invasive digital subtraction angiography(DSA).The application values of DUS,CE-MRA,and CTA were compared.RESULTS A total of 152 lower extremity arteries in the 116 patients were graded following the classification of vascular branches.The Kappa values between DUS and DSA were 0.780,0.755,and 0.806 for diagnosing moderate stenosis and 0.484,0.699,and 0.449 for severe stenosis of grade 1 arteries,grade 2 arteries,and grade 3 arteries,respectively.The Kappa values between CE-MRA and DSA were 0.784,0.814,and 0.835 for diagnosing moderate stenosis and 0.694,0.748,and 0.606 for severe stenosis of grade 1 arteries,grade 2 arteries,and grade 3 arteries,respectively.The Kappa values between CTA and DSA were 0.900,0.858,and 0.878 for diagnosing moderate stenosis and 0.882,0.823,and 0.756 for severe stenosis of grade 1 arteries,grade 2 arteries,and grade 3 arteries,respectively.CONCLUSION DUS,CE-MRA,and CTA demonstrated comparable accuracy in diagnosing lower extremity arterial disease in DM,and the consistency between CTA and DSA diagnoses was higher than the other two imaging methods.
基金National Natural Science Foundation of China(82071468,82271507)。
文摘Objective:To describe the clinical fea-tures of a case of ischemic stroke caused by pseudo severe stenosis of vertebral artery(VA).Methods:The clinical history and image data of a 52-year-old man with ischemic stroke were collected.Results:Computerized tomography angiography(CTA)revealed stenosis of V1 and V4 of the left VA.DSA confirmed that the anterior blood flow recov-ered after stent implantation,and the V4 segment of the left VA was normal without stenosis.Conclusions:It is spec-ulated that the upper stenosis is due to local hemodynamic changes rather than real stenosis.This case suggests that the interpretation of stenosis on CTA should consider cere-bral vascular anatomy and hemodynamic changes.
