pulmonary embolism diagnosis gold standard

The aim of this study was to assess whether the use of pre-operative TA increased the incidence of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) in Total Hip Replacement (THR) and Total Knee Replacement (TKR). To determine diagnostic accuracy of four-channel multi-detector row computed tomography (CT) in emergency room and inpatient populations suspected of having acute pulmonary embolism (PE) who prospectively underwent both CT and pulmonary arteriography (PA). Institutional review board approval and written informed consent were obtained. The largest pulmonary arterial branch in which PE was detected was recorded. • Sparse sampling CT is a novel hardware solution with which less projection images are acquired. Three-month follow-up for the diagnosis of pulmonary embolism was performed. On a per finding level, 1174 of 1352 findings marked as embolus by the algorithm were true emboli. These findings emphasize the need for more accurate identification of patients at risk for venous thromboembolism, as well as a safe and effective prophylaxis. The contrast enhancement of the reconstructed images was increased via a post-processing tool (vContrast). Carefully performed pulmonary angiography is safe if one avoids injecting contrast material into a patient with an elevated RVEDP. The objective of this study is to evaluate the diagnostic capability of TAPSE measurements for patients with suspicion for acute PE. Pulmonary infiltrate suggesting pneumonia was the most common non-PE finding. The predictive value of either CTA or CTA-CTV is high with a concordant clinical assessment, but additional testing is necessary when the clinical probability is inconsistent with the imaging results. During pulmonary CT angiography, mean radiation dose delivered at middle of chest was 21.5, 19.5, and 18.2 mGy for four-detector row CT and for 16-detector row CT without and with dose-modulation program, respectively. Development of diagnostic techniques has greatly accelerated but the methodology of diagnostic research lags far behind that for evaluating treatments -, Radiology. Two cohorts of patients undergoing CT for suspected PE with either single-detector CT (3-mm collimation and pitch of 1.7) or MDCT (2-mm collimation and pitch of 1) scanners were prospectively observed and compared using predefined criteria for evidence of subsequent thromboembolic disease during the 6 months after the acquisition of their initial scan. Pulmonary embolism in pediatric patients survey of CT pulmonary angiography practices and policies. The kappa values for Wells Criteria were 0.54 and 0.72 for the trichotomized and dichotomized scorings, respectively. Background: Helical computed tomography (CT) is a readily available tool for diagnosing pulmonary embolism (PE); however, its role in the management of patients with clinically suspected PE has not been fully established. To evaluate the prevalence and anatomic distribution of pulmonary embolism (PE) in a group of consecutive patients clinically suspected of having PE. Results: Of the 153 eligible patients, 3 patients were missed, 16 patients declined, and 134 (88%) patients were enrolled. Spiral CT can reliably depict central PE and may be introduced into the classic diagnostic algorithms. The objectives of this study were to assess quantitative and subjective image quality in computed tomographic pulmonary angiography using dual-energy subtraction methods compared with those of the monochromatic images using optimal contrast-to-noise ratios and those of the routine polychromatic images and to select the best dual-energy subtraction method. Background: The limitations of the current diagnostic standard, ventilation-perfusion lung scanning, complicate the management of patients with suspected pulmonary embolism. Conclusions: In patients with suspected PE, helical CT can be used safely as the primary diagnostic test to rule out PE. Trained research assistants enrolled patients during 120 random 8-hour shifts. Images at low energies had low sensitivities and low false positive rates; images at high energies had high sensitivities and high false positive rates. With the use of 1-mm sections versus 3-mm sections, the number of indeterminate cases decreased by 70% (P =.001). When Wells Criteria were dichotomized into pulmonary embolism-unlikely (n=88, 66%) or pulmonary embolism-likely (n=46, 34%), the prevalence was 3% and 28%, respectively. At PA, 18 patients (19%) had PE at 50 vessel levels (five main and/or interlobar, 24 segmental, and 21 subsegmental), 17 (94%) of which had PE at multiple sites. Recent advances have clarified that the incidence of CIN is much lower than previously thought, but there are lingering questions. Conclusion: Incidence of transient interruption of contrast (TIC) - A retrospective single-centre analysis in CT pulmonary angiography exams acquired during inspiratory breath-hold with the breathing command: "Please inspire gently!". The CT scan could not be interpreted in 8 patients (1.6%) and was not obtained in 2. Of the 100 patients scanned using an MDCT scanner, one (1.0%) had a subsequent nonfatal PE 2 months after the initial scanning, one (1.0%) had DVT 1 month after the initial scanning, and eight (8.0%) died of unrelated causes. Since quality of the diagnostic process largely determines quality of care, overcoming deficiencies in standards, methodology, and funding deserves high priority. For CT, 4 x 2.5-mm collimation was used. Methods: Patients who underwent primary THR or TKR between August 2007 and August 2009 were identified from the databases of three surgeons within the lower limb arthroplasty unit. Contrast-enhanced spiral computed tomography appears to have potential, but it is not yet fully tested. Design: Multicenter, prospective clinical outcome study. Our cohort was formed by identifying all patients with clinical features of PE who underwent Computed Tomography-Pulmonary Angiogram (CT-PA) to confirm or exclude the clinical suspicion of PE, within six months after the injury or the surgical procedure.Case notes and electronic databases were reviewed retrospectively to identify each patient's venous thromboembolism (VTE) risk factors, type of treatment, thromboprophylaxis and mortality. Can be therapeutic if direct intraluminal thrombolysis is indicated. Of the 153 eligible patients, 3 patients were missed, 16 patients declined, and 134 (88%) patients were enrolled. Clots were rendered visible by MRI through the addition of a gadolinium based contrast agent during formation. The DESI 1 afforded the best balance between the quantitative analysis and the subjective evaluation. CT has a limited role in the evaluation of acute pulmonary embolism. Of 269 patients available for follow-up, 49 patients (18.2% of 269) received anticoagulant treatment because of prior or recent deep venous thrombosis (32.6%) or a history of PE (34.7%), cardiovascular disease (18.4%), high clinical probability (8.2%), positive ventilation-perfusion scan (4.2%), and elevated D-dimer test (2%). Other less invasive techniques, including lung scintigraphy and imaging studies of leg veins, have a less than optimal diagnostic performance. The prevalence of symptomatic PE on dedicated CTPA was 11.8%, and the rate of coincidental PE on contrast-enhanced CT was 1.8%. A prospective study was performed in 75 patients who were evaluated with spiral CT and pulmonary angiography of each lung to detect central PE; 25 of the patients also underwent ventilation-perfusion (V-P) scanning. 28 CT pulmonary angiography has become the de facto clinical gold standard for the diagnosis of acute PE and has replaced catheter-based pulmonary angiography and ventilation-perfusion scintigraphy as the first-line imaging method. However, in the 163,000 early survivors in whom a diagnosis is made and appropriate therapy is unstituted, the survival rate is 92 per cent and the mortality is only 8 per cent. Pulmonary artery pressure, volume of contrast material, and presence of PE did not significantly affect the frequency of complications. Imaging plays a central role in CTEPH diagnosis. The proportions of coincidental PE were 3.3% of patients with progressive cancer, 2.5% of patients with stable cancer, 0.7% of patients with no evidence of cancer posttreatment, and 1.0% of nononcological patients. Conclusions In the 921 patients without PE, the mean prevalences (ranges between sites) of concordant categorized non-PE findings were: A = 7% (range 3%–11%), B = 10% (7%–13%), C = 17% (10%–20%), D = 4% (0%–8%), and no ancillary finding = 41% (29% to 45%). Patients underwent ventilation-perfusion (V-P) scintigraphy, spiral computed tomographic (CT) angiography, and/or digital subtraction pulmonary angiography according to a strict diagnostic protocol. Of the 161 professionals surveyed, 93 (58%) appreciated correctly that V/Q scintigraphy delivers a higher fetal dose than does CT pulmonary angiography. Pulmonary embolism (PE) is often overlooked. • In the current study, a dose reduction of 87.5% (corresponding to a mean effective dose of 0.38 mSv) for CTPA could be achieved while maintaining excellent diagnostic performance. 2011; 6(4):557-63 (ISSN: 1861-6429) Estrada-Y-Martin RM; … For decades, the catheterization study known as the pulmonary angiogram was the gold standard for diagnosing a pulmonary embolus, but this test has now been supplanted by the CT scan. The PIOPED II investigators recommend stratification of all patients with suspected pulmonary embolism according to an objective clinical probability assessment. Exposure was performed with an anthropomorphic phantom with thermoluminescent dosimeters for four-detector row CT without the dose-modulation program and 16-detector row CT without and with the dose-modulation program with standard protocols for pulmonary CT angiography (120 kV, 144 mAs, four and 16 detector rows with 1.00- and 0.75-mm section thickness, respectively). Concomitant deep venous thrombosis (DVT) was identified in 33.3% of patients. Conversely, PE can be over-diagnosed, with the concomitant risks associated with unnecessary anticoagulation. 2005 Jun;12(6):782-92. doi: 10.1016/j.acra.2005.01.014. To determine the effectiveness and safety of using helical CT of the pulmonary arteries as the primary diagnostic test in patients with suspected PE. K Values, sensitivities, and specificities were determined. Conclusions: In ED patients with suspected PE, the CT angiogram frequently provides evidence suggesting an important alternative diagnosis to PE. In this review, we discuss the utility of these imaging techniques in the diagnosis … Because the gold standard test is no longer performed, the reference … Setting: Two academic hospitals and one large teaching hospital in the Netherlands. The prevalence of PE among the 1,025 patients studied was 10% (95% CI = 8% to 12%). The remaining 220 patients, who did not receive anticoagulant medication, formed the study group. Technical failures (n = 3) and inconclusive CT findings (n = 7) were the major limitations of spiral CT. Spiral CT enabled accurate classification of PE in 16 patients with indeterminate (n = 7) and low (n = 9) probability of PE on V-P scans. The largest pulmonary arterial branch with PE was central or lobar in 66 (51%), segmental in 35 (27%), and isolated subsegmental in 29 (22%) patients. We evaluated the CT examinations of 41 patients who underwent CTA for evaluation of the pulmonary arteries which suffered from suboptimal contrast enhancement. Despite anticoagulant therapy, VTE recurs frequently in the first few months after the initial event, with a recurrence rate of approximately 7% at 6 months. Forty-two patients were prospectively evaluated with spiral volumetric computed tomography (CT) and selective pulmonary angiography of each lung to detect central pulmonary thromboembolism. Patients with a negative SCTA and without anticoagulation treatment were followed-up and formed the study group. Use of multi-detector row CT significantly improves pulmonary arterial visualization in the middle and peripheral lung zones. The sensitivity of dual-section helical CT was 90%, and the specificity was 94%. The total numbers of CAD-detected PE at 40-80 keV were 48, 67, 63, 87, 106, 115, 138, 157, and 226. An aorto-pulmonary ratio > 1 with still contrast inflow being visible within the superior vena cava was defined as TIC. Key Points Selective pulmonary angiograms were obtained with knowledge of the findings on the ventilation/perfusion scan only. The K values for Wells Criteria were 0.54 and 0.72 for the trichotomized and dichotomized scorings, respectively. We, thus, review several clinical decision rules that may help standardize this determination. Three hundred thirty-four patients, including 215 patients with pulmonary disease (group 1) and 119 patients with no history of respiratory disorder (group 2), were referred for thin-collimation CT angiography of the pulmonary circulation as the first-line diagnostic test. Of the 437 patients with a negative D -dimer result and low clinical probability, only 1 developed pulmonary embolism during follow-up; thus, the negative predictive value for the combined strategy of using the clinical model with D -dimer testing in these patients was 99.5% (CI, 99.1% to 100%). Computed tomography pulmonary angiography (CTPA) is the international and widely accepted gold standard to investigate patients with suspected pulmonary embolism [1]. Methods All rights reserved. Overall, 27% of the participants had made the appropriate recommendation based on the Fleischner Society guidelines. Gold standard for diagnosis pulmonary embolism - 1) Ventilation perfusion scan In patients with discordant findings of clinical assessment and CT angiograms or CT angiogram/CT venogram, further evaluation may be necessary. Major risk factors for PE include: DVT. Image noise and contrast-to-noise ratio (CNR) were assessed in eight different regions: main pulmonary artery, right and left pulmonary arteries, right and left segment arteries, muscle, subcutaneous fat, and bone. All patients underwent dual-section helical CT (2.7-mm effective section thickness) and selective pulmonary arteriography within 12 hours of each other. In 1982, the estimated number of nuclear medicine procedures was about 7.5 million. Ultrasonography has shown promise in obtaining the tricuspid annular plane systolic excursion (TAPSE) measurements, which may be of clinical importance in patients with acute PE. Patients with low pretest probability and a negative D-dimer result had no further tests and were considered to have a diagnosis of pulmonary embolism excluded. Conventional pulmonary angiography (CPA) with right heart catheterization (RHC) is considered the gold standard method for diagnosing CTEPH. Symptomatic subsegmental pulmonary embolism: what is the next step? Conclusion: This study shows that missed PE can occur on abdominal CT. The accuracy of multidetector computed tomographic angiography (CTA) for the diagnosis of acute pulmonary embolism has not been determined conclusively. Studies in centralized readings testing for pulmonary embolism by DSC are comparable to previously reported,! 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Estimated annual incidence of pulmonary embolism is proposed was the most commonly identifiable risk.! Of < 200 HU within the superior vena cava was defined as P.01. From may 1997 through March 1998 DVT on objective testing during follow-up underlying heart or disease...

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