Contrast-enhanced spiral computed tomography (spiral CT) is a promising new technique for the diagnosis of pulmonary embolism. Direct visualisation of the embolus [l], with no more invasion than an intravenous injection of contrast medium, carries obvious and immediate appeal. Strategies Incorporating Spiral CT for the Diagnosis of Acute Pulmonary Embolism* A Cost-effectiveness Analysis D. Ian Paterson, MD; and Kevin Schwartzman, MD, MPH Objective: To assess the cost-effectiveness of spiral CT for the diagnosis of acute pulmonary embolism. CRD COMMENTARY - Selection of comparators Methods: A total of 83 patients with suspected pulmonary embolism were examined using V/Q lung scintigraphy in SPECT technique as well as 4-slice spiral CT. Multislice spiral CT is becoming an increasingly important tool for diagnosing pulmonary embolism. There is still considerable debate about the optimal diagnostic imaging modality for acute pulmonary embolism. Anthony P. Borzotta, MD, Portland, Ore: The authors have attempted to define the role of spiral computed tomography of the chest in the diagnosis of pulmonary embolism in critically ill surgical patients, 77% of whom were victims of trauma. The study was supported by the National Institutes of Health and the National Heart, Lung, and Blood Institute. Spiral volumetric computed tomography (SVCT) has been recognized as a test with potential for use in the diagnosis of pulmonary embolism (PE) since 1992, at which time Remy-Jardin et al 1 employed it in the evaluation of 42 patients. Most patients who are mildly claustrophobic can tolerate this study after Abstract & Commentary Synopsis: Of 11 published investigations of spiral volumetric computed tomography in the diagnosis of pulmonary embolism, none met all 11 standards applied by the authors for studies of diagnostic tests, and only five articles met five standards. Pulmonary embolism: optimization of small pulmonary artery visualization at multi-detector row CT. Radiology. The multi-slice spiral CT image is significantly better than the unprocessed image after being processed by the enhancement algorithm. The purpose of this study was to investigate whether the severity of acute pulmonary embolism (PE) could be quantitatively assessed with spiral CT angiography (SCTA). 2003 May. Now spiral computed tomographic (CT) angiography provides a readily available, noninvasive test for pulmonary embolism. Patel S, Kazerooni EA, Cascade PN. Spiral Volumetric CT to Diagnose Pulmonary Embolism. The use of spiral CT angiography is likely to lead to improved patient outcomes in terms of mortality and also improvements in the cost-effectiveness of the diagnosis of suspected pulmonary embolism. Acute pulmonary emboli were detected with conventional CT,23, 24 but the potential of spiral CT for diagnosing pulmonary emboli became apparent with the introduction of spiral CT, 25 a major advance in CT scanner technology. How good is chest CT at identifying PE? There is still considerable debate about the optimal diagnostic imaging modality for acute pulmonary embolism. In comparison to pulmonary angiography it is less invasive, less expensive, and its use may be more acceptable to physicians ( 7 ). Spiral CT of the pulmonary arteries is a recent modality, that allows reliable visualization of emboli in pulmonary arteries up to fourth-order branches. Abstract: A fully automated method for computerized detection of pulmonary embolism in spiral computed tomography angiography was developed based on volumetric image analysis. Recent investigations reveal a high negative predictive value for spiral CT, further proving its value. In some cases, contrast material is given intravenously during the CT scan to outline the pulmonary arteries. Many departments around the world are performing more and more spiral CT investigations for suspected pulmonary embolism. Design: Computer-based cost-effectiveness analysis. Mild nausea is common when the contrast dye is injected. The detection method is based on segmentation of pulmonary vessels to limit the search space, and analysis of several three-dimensional features inside segmented vessel volume. Many parenchymal, vascular, and other ancillary findings may be observed on both imaging modalities with a highly detailed depiction of abnormalities on multislice CT. CLINICAL PRIORITIES Check the patient for allergy to iodinated dyes. Sensitivities, specificities, and kappa values with spiral CT and scintigraphy were 87%, 95%, and 0.85 and 65%, 94%, and 0.61, respectively. The accuracy of this examination is exceedingly high, so it should become the first-line test for pulmonary embolism. Although pulmonary angiography is the "gold standard" for diagnosing pulmonary embolism (PE), this technique carries some risks and is not always. A considerable advantage of CT over both V/Q scintigraphy and pulmonary angiography is the ability to depict other conditions that clinically mimic pulmonary embolism, such as acute pneumonia, lung abscess (Figs. Despite these limitations, several studies have now documented that, in patients with suspected pulmonary embolism, it is safe to withhold anticoagulation therapy if a spiral computed tomography exam of the pulmonary arteries is negative and no lower extremity venous thrombosis is present. However, in many instances, a chest radiograph is usually performed as a first-line examination. The first part of this study retrospectively compared the discriminatory power of spiral CT versus clinical findings in 112 consecutive patients referred with chest pain or dyspnoea. Results: Pulmonary embolism: A total of 1741 pulmonary arteries were found, of which 407 (23.37%) showed different degrees of embolism, mainly in the pulmonary artery and pulmonary artery. Remy-Jardin M, Remy J, Deschildre F, et al. Abstract. For this reason, patients are usually kept NPO for 4 hours before the test. The Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II study was designed to assess the validity of contrast-enhanced spiral CT in the diagnosis of acute PE. Hence, the aim of our study was a balanced comparison between V/Q lung scintigraphy and CT angiography using advanced imaging techniques for both modalities. However, the accuracy of pulmonary angiography has never been evaluated against an independent gold standard. If imaging is deemed necessary from an initial clinical evaluation such as d-dimer testing, options include nuclear medicine scanning, catheter pulmonary angiography, and spiral CT. Subclinical myocardial injury and right ventricular dysfunction, assessed by biomarkers, echocardiography or spiral computed tomography, also have been shown to be associated with an increased risk of an adverse outcome in patients with pulmonary embolism … Download Citation | Spiral CT for Pulmonary Embolism | Radiologic imaging for pulmonary embolism has been problematic. Initial results were promising, with sensitivity and specificity reported as 100% and 96%, respectively. The current standard of care for members with suspected pulmonary embolism is a spiral CT scan, also called a CTA, CT PA (computed tomography pulmonary angiography), MDCT (multidector CT) or helical CT scan. Background: Spiral computed tomography (CT) has emerged as a potentially conclusive diagnostic test to exclude pulmonary embolism (PE) in patients with … CT pulmonary angiogram (CTPA) is a medical diagnostic test that employs computed tomography (CT) angiography to obtain an image of the pulmonary arteries.Its main use is to diagnose pulmonary embolism (PE). Diagnosis of pulmonary embolism with spiral CT: comparison with pulmonary angiography and scintigraphy. 227(2):455-60. . 26 With conventional CT, the patient lies on a scanner table that is intermittently advanced. Summary. This paper reviews the technical aspects, typical findings and diagnostic pitfalls of this recent technique. Spiral CT and scintigraphic scans of four patients with embolism did not show embolism. Spiral computer tomography (CT) has become a widely accepted clinical tool in the diagnosis of acute pulmonary embolism. Thirty-six consecutive patients without underlying cardiopulmonary disease and high clinical suspicion of PE underwent prospectively thin-collimation SCTA and echocardiography at the time of the initial … CONCLUSION: In cases of pulmonary embolism, sensitivity of spiral CT is greater than that of scintigraphy. Design of PIOPED II The use of spiral computed tomography (CT) for the diagnosis of pulmonary embolism has been compared to angiography, the current gold standard. It is a preferred choice of imaging in the diagnosis of PE due to its minimally invasive nature for the patient, whose only requirement for the scan is an intravenous line. NEJM Journal Watch reviews over 250 scientific and medical journals to present important clinical … Bob: Pulmonary embolism (PE) accounts for 300,000 deaths per year.Because the signs and symptoms are inconsistent, the diagnosis is often missed. 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