Application and progress of CT pulmonary angiography in diagnosis and treatment of pulmonary embolism

doi:10.3760/cma.j.issn.1007-1245.2023.08.005

Abstract

Abstract:

Pulmonary embolism (PE) is a life-threatening disease. CT pulmonary angiography (CTPA) is a widely available, rapid, and noninvasive technique, can directly display PE, and is the first choice for imaging examination of patients with suspected PE.

Key words:

Pulmonary embolism, CT pulmonary angiography, Application and progress

摘要：

肺栓塞（pulmonary embolism，PE）是一种可危及生命的疾病。CT肺动脉成像（computed tomography pulmonary angiography，CTPA）是一种广泛可用、快速和无创的技术，具有直接显示栓塞的能力，是可疑PE患者的第一选择影像学检查。

关键词:

肺栓塞, CT肺动脉成像, 应用进展

Xu Shijie, Luo Zebin, Chen Xiaodong.

Application and progress of CT pulmonary angiography in diagnosis and treatment of pulmonary embolism [J]. International Medicine and Health Guidance News, 2023, 29(8): 1053-1056.

徐仕杰罗泽斌陈晓东.

CT肺动脉成像在肺栓塞诊治中的应用进展 [J]. 国际医药卫生导报, 2023, 29(8): 1053-1056.

References

[1] Blachere H, Latrabe V, Montaudon M, et al. Pulmonary embolism revealed on helical CT angiography: comparison with ventilation-perfusion radionuclide lung scanning [J]. AJR Am J Roentgenol, 2000, 174(4): 1041-1047. DOI: 10.2214/ajr.174.4.1741041.
[2] 陈爱萍,于红,肖湘生.肺栓塞的影像学研究进展及临床诊断策略[J].国际医学临床放射学分册,2007,30(5):309-312, 337. DOI: 10.3784/j.issn.1674-1897.2007.05.006.
[3] Wildberger JE, Mahnken AH, Das M, et al. CT imaging in acute pulmonary embolism: diagnostic strategies [J]. Eur Radiol, 2005, 15(5): 919-929. DOI: 10.1007/s00330-005-2643-y.
[4] Stein PD, Fowler SE, Goodman LR, et al. Multidetector computed tomography for acute pulmonary embolism [J]. N Engl J Med, 2006, 354(22): 2317-2327. DOI: 10.1056/NEJMoa052367.
[5] Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) [J]. Eur Heart J, 2008, 29(18): 2276-2315. DOI: 10.1093/eurheartj/ehn310.
[6] Qanadli SD, Hajjam ME, Mesurolle B, et al. Pulmonary embolism detection: prospective evaluation of dual-section helical CT versus selective pulmonary arteriography in 157 patients [J]. Radiology, 2000, 217(2): 447-455. DOI: 10.1148/radiology.217.2.r00nv01447.
[7] Cronin P, Weg JG, Kazerooni EA. The role of multidetector computed tomography angiography for the diagnosis of pulmonary embolism [J]. Semin Nucl Med, 2008, 38(6): 418-431. DOI: 10.1053/j.semnuclmed.2008.07.002.
[8] Remy-Jardin M, Pistolesi M, Goodman LR, et al. Management of suspected acute pulmonary embolism in the era of CT angiography: a statement from the Fleischner Society [J]. Radiology, 2007, 245(2):315-329. DOI: 10.1148/radiol.2452070397.
[9] Mos IC, Klok FA, Kroft LJ, et al. Safety of ruling out acute pulmonary embolism by normal computed tomography pulmonary angiography in patients with an indication for computed tomography: systematic review and meta-analysis [J]. J Thromb Haemost, 2009, 7(9):1491-1498. DOI: 10.1111/j.1538-7836.2009.03518.x.
[10] Aribas A, Keskin S, Akilli H, et al. The use of axial diameters and CT obstruction scores for determining echocardiographic right ventricular dysfunction in patients with acute pulmonary embolism [J]. Jpn J Radiol, 2014, 32(8): 451-460. DOI: 10.1007/s11604-014-0327-8.
[11] Cozzi D, Moroni C, Cavigli E, et al. Prognostic value of CT pulmonary angiography parameters in acute pulmonary embolism [J]. Radiol Med, 2021, 126(8):1030-1036. DOI: 10.1007/s11547-021-01364-6.
[12] Cho SU, Cho YD, Choi SH, et al. Assessing the severity of pulmonary embolism among patients in the emergency department: utility of RV/LV diameter ratio [J]. PLoS One, 2020, 15(11): e0242340. DOI: 10.1371/journal.pone.0242340.
[13] Ayöz S, Erol S, Kul M, et al. Using RV/LV ratio and cardiac biomarkers to define the risk of mortality from pulmonary embolism [J]. Tuberk Toraks, 2021, 69(3): 297-306. DOI: 10.5578/tt.20219701.
[14] Lyhne MD, Schultz JG, MacMahon PJ, et al. Septal bowing and pulmonary artery diameter on computed tomography pulmonary angiography are associated with short-term outcomes in patients with acute pulmonary embolism [J]. Emerg Radiol, 2019, 26(6):623-630. DOI: 10.1007/s10140-019-01709-9.
[15] Shayganfar A, Hajiahmadi S, Astaraki M, et al. The assessment of acute pulmonary embolism severity using CT angiography features [J]. Int J Emerg Med, 2020, 13(1):15. DOI: 10.1186/s12245-020-00272-2.
[16] Meinel FG, Nance JW, Schoepf UJ, et al. Predictive value of computed tomography in acute pulmonary embolism: systematic review and meta-analysis [J]. Am J Med, 2015, 128(7):747-59.e2. DOI: 10.1016/j.amjmed.2015.01.023.
[17] 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 [J]. AJR Am J Roentgenol, 2001, 176(6):1415-1420. DOI: 10.2214/ajr.176.6.1761415.
[18] 黑建忠,马小平,王国礼.CT肺动脉阻塞指数评估急性肺栓塞患者病情程度及预后的价值[J].宁夏医学杂志,2021,43(7):652-654. DOI:10.13621/j.1001-5949. 2021. 07.0652.
[19] Faghihi Langroudi T, Sheikh M, Naderian M, et al. The association between the pulmonary arterial obstruction index and atrial size in patients with acute pulmonary embolism [J]. Radiol Res Pract, 2019: 6025931. DOI: 10.1155/2019/6025931.
[20] Praveen Kumar BS, Rajasekhar D, Vanajakshamma V. Study of clinical, radiological and echocardiographic features and correlation of Qanadli CT index with RV dysfunction and outcomes in pulmonary embolism [J]. Indian Heart J, 2014, 66(6): 629-634. DOI: 10.1016/j.ihj.2014.10.405.
[21] Zhou HT, Yan WY, Zhao DL, et al. CT pulmonary angiogram for assessing the treatment outcome of acute pulmonary embolism [J]. Echocardiography, 2018, 35(3): 396-400. DOI: 10.1111/echo.13766.
[22] Goo HW, Goo JM. Dual-energy CT: new horizon in medical imaging [J]. Korean J Radiol, 2017, 18(4):555-569. DOI: 10.3348/kjr.2017.18.4.555.
[23] Thieme SF, Johnson TR, Lee C, et al. Dual-energy CT for the assessment of contrast material distribution in the pulmonary parenchyma [J]. AJR Am J Roentgenol, 2009, 193(1): 144-149. DOI: 10.2214/AJR.08.1653.
[24] Weidman EK, Plodkowski AJ, Halpenny DF, et al. Dual-energy CT angiography for detection of pulmonary emboli: incremental benefit of iodine maps [J]. Radiology, 2018, 289(2): 546-553. DOI: 10.1148/radiol.2018180594.
[25] Apfaltrer P, Bachmann V, Meyer M, et al. Prognostic value of perfusion defect volume at dual energy CTA in patients with pulmonary embolism: correlation with CTA obstruction scores, CT parameters of right ventricular dysfunction and adverse clinical outcome [J]. Eur J Radiol, 2012, 81(11): 3592-3597. DOI: 10.1016/j.ejrad. 2012.02.008.
[26] Kong WF, Wang YT, Yin LL, et al. Clinical risk stratification of acute pulmonary embolism: comparing the usefulness of CTA obstruction score and pulmonary perfusion defect score with dual-energy CT [J]. Int J Cardiovasc Imaging, 2017, 33(12): 2039-2047. DOI: 10.1007/s10554-017- 1188-x.
[27] 杨熙斌,姜永宏.双能量CT对肺栓塞溶栓治疗疗效的评估[J].临床放射学杂志,2019,38(9):1642-1647.
[28] Kröger JR, Hickethier T, Pahn G, et al. Influence of spectral detector CT based monoenergetic images on the computer-aided detection of pulmonary artery embolism [J]. Eur J Radiol, 2017, 95: 242-248. DOI: 10.1016/j.ejrad.2017.08.034.
[29] Silva M, Milanese G, Cobelli R, et al. CT angiography for pulmonary embolism in the emergency department: investigation of a protocol by 20 ml of high-concentration contrast medium [J]. Radiol Med, 2020, 125(2):137-144. DOI: 10.1007/s11547-019-01098-6.
[30] Özkan H, Osman O, Şahin S, et al. A novel method for pulmonary embolism detection in CTA images [J]. Comput Methods Programs Biomed, 2014, 113(3):757-766. DOI: 10.1016/j.cmpb.2013.12.014.
[31] 高歌,马帅,王霄英. 计算机辅助诊断在医学影像诊断中的基本原理和应用进展[J]. 放射学实践,2016,31(12):1127-1129. DOI:10.13609/j.cnki.1000-0313.2016.12.004.
[32] Schoepf UJ, Schneider AC, Das M, et al. Pulmonary embolism: computer-aided detection at multidetector row spiral computed tomography [J]. J Thorac Imaging, 2007, 22(4): 319-323. DOI: 10.1097/RTI.0b013e31815842a9.