Semin Vasc Med 2001; 01(2): 195-204
DOI: 10.1055/s-2001-18488
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Second-Generation, Subsecond Multislice Computed-Tomography: Advancing the Role of Helical CT Pulmonary Angiography in Suspected Pulmonary Embolism

Peter M. T. Pattynama, Jan-Willem Kuiper
  • Department of Radiology, Erasmus University Medical Center Rotterdam, The Netherlands
Further Information

Publication History

Publication Date:
16 November 2001 (online)

ABSTRACT

Advancements in computed tomography (CT) have led to the development of noninvasive helical CT of the pulmonary arteries as a diagnostic tool in patients with suspected pulmonary embolism (PE). The first-generation, single-slice CT scanners were capable of acquiring one 3-mm-thick imaging section per second. As a further technical evolution of helical CT, multislice CT scanners now allow simultaneous acquisition of eight slices per second. This increased imaging speed can be used to advantage by scanning the entire thorax with 1-mm-thin imaging sections during a single breath-hold. Because of the increased spatial resolution and increased robustness to motion artifacts of multislice CT, the pulmonary arteries can now be accurately depicted up to the fifth order branches. In comparison with single-slice CT, this holds the promise of better detection of small subsegmental PE and thus, increased accuracy to detect and rule out PE. A few recent management studies suggest that single-slice CT can be used as an accurate cornerstone in the diagnostic work-up of suspected PE-a concept that will be further enhanced with multislice helical CT.

REFERENCES

  • 1 Rathbun S W, Raskob G E, Whitsett T L. Sensitivity and specificity of helical computed tomography in the diagnosis of pulmonary embolism: a systematic review.  Ann Intern Med . 2000;  132 227-232
  • 2 Mullins M D, Mullins M D, Becker D M, Hagspiel K D, Philbrick J T. The role of spiral volumetric computed tomography in the diagnosis of pulmonary embolism.  Arch Intern Med . 2000;  160 293-298
  • 3 De Monyé W, Pattynama P MT. Contrast-enhanced spiral computed tomography of the pulmonary arteries: an overview.  Semin Thromb Hemostas . 2001;  27 32-39
  • 4 Costello P, Gupta K B. Pulmonary embolism: imaging modalities-V/Q scan, spiral (helical) CT and MRI.  Semin Vasc Med. 2001 In press; 
  • 5 Van Beek J E, Brouwers E M, Song B, Bongaerts A H, Oudkerk M. Lung scintigraphy and helical computed tomography for the diagnosis of pulmonary embolism: a meta-analysis.  Clin Appl Thromb Hemost . 2001;  7 87-92
  • 6 Michiels J J, Pattynama P MT. Exclusion and diagnosis of pulmonary embolism by a rapid ELISA D-dimer test and noninvasive imaging techniques within the context of a clinical model.  Clin Appl Thromb Hemostas . 2000;  6 46-52
  • 7 Harvey R T, Gefter W B, Hrung J M, Langlotz C P. Accuracy of CT angiography versus pulmonary angiography in the diagnosis of acute pulmonary embolism: evaluation of the literature with summary ROC curve analysis.  Acad Radiol . 2000;  7 786-797
  • 8 Klingenbeck-Regn K, Schaller S, Flohr T, Ohnesorge B, Kopp A F, Baum U. Subsecond multislice computed tomography: basics and applications.  Eur J Radiol . 1999;  31 110-124
  • 9 Nieman K, Oudkerk M, Rensing B J. Coronary angiography with multislice computed tomography.  Lancet . 2001;  357 599-603
  • 10 Van Strijen J L M, De Monyé W, Kieft G J, for the ANTELOPE investigators. Diagnosis of pulmonary embolism with spiral CT: a prospective cohort study in 617 patients [abstract OC154].  Thromb Haemost. 2001 In press; 
  • 11 Remy-Jardin M, Baghaie F, Bonnel F, Masson P, Duhamel A, Remy J. Thoracic helical CT: influence of subsecond scan time and thin collimation on evaluation of peripheral pulmonary arteries.  Eur Radiol . 2000;  10 1297-1303
  • 12 Baile E M, King G G, Muller N L. Spiral computed tomography is comparable to angiography for the diagnosis of pulmonary embolism.  Am J Respir Crit Care Med . 2000;  161 1010-1015
  • 13 Ghaye B, Szapiro D, Mastora I. Peripheral pulmonary arteries: how far in the lung does multi-detector row spiral CT allow analysis?.  Radiology . 2001;  219 629-636
  • 14 Stein P D, Henry J W, Gottschalk A. Reassessment of pulmonary angiography for the diagnosis of pulmonary embolism: relation of interpreter agreement to the order of the involved pulmonary arterial branch.  Radiology . 1999;  210 689-691
  • 15 Diffin D C, Leyendecker J R, Johnson S P, Zucker R J, Grebe P J. Effect of anatomic distribution of pulmonary emboli on interobserver agreement in the interpretation of pulmonary angiography.  AJR Am J Roentgenol . 1998;  171 1085-1089
  • 16 Oser R F, Zuckerman D A, Gutierrez F R, Brink J A. Anatomic distribution of pulmonary emboli at pulmonary angiography: implications for cross-sectional imaging.  Radiology . 1996;  199 31-35
  • 17 De Monyé W, Van Strijen J L M, Huisman M V, Kieft G J, Pattynama P MT, for the ANTELOPE group. Suspected pulmonary embolism: prevalence and anatomic distribution in 487 consecutive patients.  Radiology . 2000;  215 184-188
  • 18 Wells P S, Ginsberg J S, Anderson D R. The use of a clinical model to safely manage patients with suspected pulmonary embolism.  Ann Int Med . 1998;  129 997-1005
  • 19 Perrier A, Desmarais S, Miron M J. Non-invasive diagnosis of venous thromboembolism in outpatients.  Lancet . 1999;  353 190-195
  • 20 Van Erkel R A, Van Rossum B A, Bloem J L, Kievit J, Pattynama P MT. Spiral CT angiography for suspected pulmonary embolism: a cost-effectiveness analysis.  Radiology . 1996;  201 29-36
  • 21 Van Rossum B A, Pattynama P MT, Tjin A Ton R E. Spiral CT angiography for pulmonary embolism: validation in 149 patients.  Radiology . 1996;  201 467-470
  • 22 Van Erkel R A, Pattynama P MT. Cost-effective diagnostic algorithms in pulmonary embolism: an updated analysis.  Acad Radiol . 1998;  5(S) 321-327
  • 23 Ferretti G R, Bosson J L, Buffaz P D. Acute pulmonary embolism: role of helical CT in 164 patients with intermediate probability at ventilation-perfusion scintigraphy and normal results at duplex US of the legs.  Radiology . 1997;  205 453-458
  • 24 Garg K, Sieler H, Welsh C H, Johnston R J, Russ P D. Clinical validity of helical CT being interpreted as negative for pulmonary embolism: implications for patient treatment.  AJR Am J Roentgenol . 1999;  172 1627-1631
  • 25 Lomis N N, Yoon H C, Moran A G, Miller F J. Clinical outcomes of patients after a negative spiral CT pulmonary arteriogram in the evaluation of acute pulmonary embolism.  J Vasc Intervent Radiol . 1999;  10 707-712
  • 26 Goodman L R, Lipchik R J, Kuzo R S, Liu Y, McAuliffe T L, O'Brien D J. Subsequent pulmonary embolism: risk after a negative helical CT pulmonary angiogram-prospective comparison with scintigraphy.  Radiology . 2000;  215 535-542
  • 27 Ost D, Rozenshtein A, Saffran L, Snider A. The negative predictive value of spiral computed tomography for the diagnosis of pulmonary embolism in patients with nondiagnostic ventilation-perfusion scans.  Am J Med . 2001;  110 16-21
  • 28 Gottsater A, Berg A, Centergard J, Frennby B, Nirhov N, Nyman U. Clinically suspected pulmonary embolism: is it safe to withhold anticoagulation after a negative spiral CT?.  Eur Radiol . 2001;  11 65-72
  • 29 Van Strijen J L M, De Monyé W, Schiereck J, for the ANTELOPE-investigators. Helical-CT as the primary diagnostic test in suspected pulmonary embolism: a prospective multicenter trial in 500 patients [abstract].  Radiology. 2001 In press; 
  • 30 Van Rossum B A, Pattynama P MT, Mallens W M, Hermans J, Heijerman H G. Can helical CT replace scintigraphy in the diagnostic process in suspected pulmonary embolism? A retrolective-prolective cohort study focusing on total diagnostic yield.  Eur Radiol . 1998;  8 90-96
  • 31 Remy-Jardin M, Remy J, Baghaie F, Fribourg M, Artaud D, Duhamel A. Clinical value of thin collimation in the diagnostic work-up of pulmonary embolism.  AJR Am J Roentgenol . 2000;  175 407-411
  • 32 Mac Gillavry R M, Sanson B J, Büller H R, Brandjes D P, for the ANTELOPE-Study Group. Compression ultrasonography of the leg veins in patients with clinically suspected pulmonary embolism: is a more extensive assessment of compressibility useful?.  Thromb Haemost . 2000;  84 973-976
  • 33 Cham M D, Yankelevitz D F, Shaham D. Deep venous thrombosis: detection by using indirect CT venography. The Pulmonary Angiography-Indirect CT Venography Cooperative Group.  Radiology . 2000;  216 744-751
  • 34 Loud P A, Katz D S, Bruce D A, Klippenstein D L, Grossman Z D. Deep venous thrombosis with suspected pulmonary embolism: detection with combined CT venography and pulmonary angiography.  Radiology . 2001;  219 498-502
  • 35 Duwe K M, Shiau M, Budorick N E, Austin J H, Berkmen Y M. Evaluation of the lower extremity veins in patients with suspected pulmonary embolism: a retrospective comparison of helical CT venography and sonography. 2000 ARRS Executive Council Award I. American Roentgen Ray Society.  AJR Am J Roentgenol . 2000;  175 1525-1531
  • 36 Bounameaux H, Perrier A, Wells P S. Diagnostic strategies for suspected pulmonary embolism among outpatients.  Semin Vasc Med . 2001;  1 189-194
  • 37 Perrier A. Pulmonary embolism: from clinical presentation to clinical probability assessment.  Semin Vasc Med . 2001;  1 147-154
  • 38 De Moerloose P, Desmarais S, Bounameaux H. Contribution of a new, rapid, individual and quantitative automated D-dimer ELISA to exclude pulmonary embolism.  Thromb Haemost . 1996;  75 11-13
  • 39 Kruip M H A J, Slob M J, Van der Heul C, Büller H R. The use of D-dimer concentration and a clinical decision rule in the diagnostic work-up of patients with suspected pulmonary embolism: A prospective management study [abstract].  Neth J Med . 2001;  58 A30
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