The clinical application of combined dualenergy CT pulmonary angiography and indirect venography

Objective To assess the usefulness of combined dual-energy CT pulmonary angiography (DE-CTPA) and indirect CT venography(CTV) in the diagnosis of venous thromboembolism(VTE). Methods Forty-nine patients with leg swelling suspected of pulmonary embolism(PE) underwent both DE-CTPA combined with CTV and lower     

Combined CT pulmonary angiography and venography for diagnosis of pulmonary embolism and deep vein thrombosis: radiation dose.

A major concern about combined pulmonary CT angiography (PCTA) and CT venography (CTV) refers to the additional radiation exposure to the patient. The purpose of this paper is to analyze the organ dose, the effective dose, and the gonadal dose of combined PCTA and CTV. Effective dose and gonadal dose in PCTA and CTV were calculated. Also measured was the organ doses with thermoluminescence dosimeters in six patients who underwent combined PCTA/CTV. The risk from the effective dose and gonadal dose in combined PCTA/CTV is low. Nevertheless, additional CTV increases the gonadal dose by a significant factor and use of this procedure should be limited in younger patients.     

Computed tomography pulmonary angiography and venography: diagnostic and prognostic properties

Computed tomography pulmonary angiography (CTPA) is now an established test in the diagnosis of suspected pulmonary embolism (PE). Some may argue that it has become the "one-stop" center for diagnosis and prognosis of acute PE and deep vein thrombosis (DVT). Current literature shows CTPA to be reliable and accurate. Management studies have shown patient outcomes are excellent when CTPA is used in the diagnostic algorithm. The addition of computed tomography venography (CTV) increases the sensitivity, which may be worth the added radiation in certain patient populations. Although measures of right heart function, pulmonary artery pressures, and clot burden via CTPA need to be standardized and further validated prospectively, this test may also play a prominent role in determining short-term outcomes in patients with established acute PE.     

Traumatic pulmonary pseudocysts: CT findings

Traumatic pulmonary pseudocyst constitutes an uncommon, though well recognized, manifestation of closed chest trauma. It is usually encountered in young patients, whose compliant chest wall permits the transmission of great compressive forces to the lung parenchyma and the laceration of the latter. Traumatic pulmonary pseudocyst is usually detected during the imaging evaluation of multi-injured patients with the use of computed tomography, as it is often not apparent in the initial supine anteroposterior chest radiographs. We present 5 cases of trauma patients, in whom we detected the presence of multiple traumatic pulmonary pseudocysts during the imaging evaluation of blunt chest trauma with the use of computed tomography.     

Rare presentation of pseudosequestration in childhood: CT and CT angiography findings

Anomalous systemic arterial supply to the lungs with normal bronchial branching and pulmonary arterial supply is an unusual variant of the sequestration spectrum. Pseudosequestration is referred as the combination of systemic arterial supply to lung with normal bronchial connection. Thorax computed tomography (CT) and CT angiography are non‐invasive and useful techniques in making the definitive diagnosis. Herein, we report two paediatric patients with anomalous systemic arterial supply to normal basal segments of the lower lobes.     

Methotrexate-induced pulmonary injury: serial CT findings

We describe serial computed tomographic (CT) findings of methotrexate (MTX)-induced pulmonary injury. MATERIALS AND METHODS: The cases of 8 patients (3 men and 5 women; mean age 58.6 years, range 16 to 75 years) of clinically diagnosed MTX-induced pulmonary injury were reviewed. Six patients had rheumatoid arthritis, 1 had lupus erythematosus profundus, and 1 had juvenile rheumatoid arthritis. CT findings on admission and at follow-up were evaluated. RESULTS: The most common CT features were diffuse and patchy bilateral ground-glass opacity with (n = 3) or without reticulation (n = 4) and consolidation (n = 1). These opacities showed no predilection for any particular lung zone in 6 patients but did show dependent predilection in 1 patient and upper lobe predilection in 1. Diffuse centrilobular ill-defined nodules were noted in 1 patient, which disappeared on follow-up. During the average post-treatment follow-up period of 31.0 days (range 3 to 76 days), the opacities quickly improved after treatment in 6 patients; however, in 2 patients with pre-existing interstitial pneumonitis the opacities were refractory. CONCLUSION: CT features of MTX-induced pulmonary injury were variable and included diffuse parenchymal opacification, reticular opacities, and centrilobular nodules. These opacities usually responded quickly to treatment; however, those patients with lung fibrosis at presentation may have worse prognosis.     

Congenital pulmonary lymphangiectasia: CT and pathologic findings

Congenital pulmonary lymphangiectasia is a rare disease characterized by dilation of lymphatic channels without lymphatic proliferation. The disease is seen almost exclusively in infancy and early childhood. The authors report 2 cases of pulmonary lymphangiectasia. The patients were a 12- and a 25-year-old male who presented with progressive dyspnea and hemoptysis. The diagnosis was confirmed by open lung biopsy. The radiographic findings consisted of bilateral reticular changes, peribronchial cuffing, and bilateral pleural effusions. High-resolution CT demonstrated extensive bilateral septal and peribronchovascular interstitial thickening, areas of ground-glass attenuation, and bilateral pleural effusions. The histologic findings consisted of ectatic and tortuous lymphatic channels in the interlobular septa, bronchovascular sheaths, and pleura.     

CT findings of pulmonary hypertension]

For the treatment for pulmonary hypertension (PH), the differential diagnosis of its causal diseases is essential. To determine whether X-ray CT is useful for differentiating PH, we reviewed CT findings of 53 patients (18 men and 35 women, mean age of 44.9) given a diagnosis of PH, consisting of 25 with primary pulmonary hypertension (PPH), 18 with chronic pulmonary embolism (cPE), 6 with Eisenmenger syndrome, 5 cases of collagen diseases, 2 of acute PE, and 1 of cor pulmonale. The intrapulmonary distribution of CT findings (ground glass opacity [GGO], mosaic attenuation, striation and/or infiltration, and interlobular septal thickening) were reviewed and scored on a 4-point scale (grade 0: no findings, 1: involving one third of the lung, 2: involving one-two thirds, and 3: diffuse distribution) by two radiologists who reached a consensus. PPH showed preferentially diffuse distribution of GGO as compared with cPE (p<0.05). However, there was no apparent relationship between the pulmonary vascular resistance and the distribution of GGO in PPH cases. The mosaic attenuation pattern was more frequent in cPE (43%) than PPH (12% ; p<0.05). Striation and/or infiltration was observed in 36% of cPE, but only 4% of PPH. Interlobular septal thickening was seen in 16% of PPH, and 0% in cPE. Evaluation of CT findings is useful to differentiate PH.     

Pulmonary infarction: spectrum of findings on multidetector helical CT

OBJECTIVE: Despite the dual blood supply to the lung, acute pulmonary embolism (PE) can lead to a spectrum of ischemic injury to the lung resulting in infarction and hemorrhage. In this series we systematically describe the spectrum of CT findings and clinical correlates of pulmonary infarction in patients with PE. METHODS: We retrospectively identified 24 consecutive adults with pulmonary infarction on multidetector CT between July 2002 and March 2004. There were 13 women and 11 men, with a mean age of 59 years. The cases were identified by review of 74 consecutive CTs demonstrating PE. Each CT was evaluated by 2 of 3 reviewers in consensus for presence and characteristics of peripheral parenchymal opacities and extent of PE. Peripheral opacities were evaluated for degree of enhancement, internal air lucencies, and contour. The presence of adjacent vessels and linear strands were noted. At the end of interpreting each case, the reviewers determined whether or not an infarct was present based on the constellation of previously described imaging features. The extent of pulmonary vascular obstruction was graded using the CT clot burden scoring system. Each chart was reviewed for predisposing factors for PE and infarction, presenting clinical symptoms/signs, and co-existing pulmonary or cardiac conditions. RESULTS: Thirty-two percent (24/74) of patients with PE had pulmonary infarction. Thirty-three percent (8/24) of patients had more than 1 infarct. Seventy-three percent (27/37) of infarcts were in the lower lobes. The CT findings of pulmonary infarction included: focal decrease in parenchymal enhancement in 95% (35/37), broad pleural base in 65% (24/37), truncated apex in 57% (21/37), convex border in 46% (17/37), internal air lucencies in 32% (12/37), linear stranding from the apex toward the hilum in 24% (9/37), and a thickened vessel leading to the apex of the infarct in 14% (5/37). There was a trend toward a higher mean clot burden (12.3 vs. 10.5) between the patients with PE with and without infarction. Ninety-six percent (23/24) of patients with pulmonary infarction had predisposing factors for infarction, including PE involving more than 1 lobe (n = 21), malignancy (n = 5), and heart failure (n = 3). Pleuritic chest pain was significantly more frequent in patients with infarction (P = 0.0064). CONCLUSION: Pulmonary infarction occurred in nearly 1/3 of patients with PE in this series. The infarcts were peripheral parenchymal opacities characterized by a distinctive complex of findings on CT reflecting ischemic injury in the setting of a dual blood supply to the lung. Pleuritic chest pain was significantly associated with infarction.     

肺内多发结节的CT表现分析

目的 探讨肺内多发结节影为主要表现患者的CT表现特点。方法 回顾性分析北京世纪坛医院影像资料库胸部CT出现肺内多发结节影的53例患者资料,其中肺结核19例、肺转移瘤23例、肺慢性炎症5例、弥漫性淋巴管瘤病6例,总结比较4种疾病的CT表现特征。结果 13例(68.4%,13/19)肺结核及18例(78.3%,18/23)肺转移瘤的结节最大径达10~20mm,3例(3/5)肺慢性炎症与3例(3/6)弥漫性淋巴管瘤病的肺内结节最大径范围为3~8mm。肺慢性炎症的CT表现为结节以无分叶且边缘光滑为主共69个(79.3%;69/87)、病灶邻近胸膜增厚粘连36个(41.4%;36/87),结节无钙化及空洞;肺结核的CT表现为结节以无分叶且边缘光滑为主共128个(82.1%;128/156)、钙化86个(55.1%;86/156)、空洞43个(27.6%;43/156)、病灶邻近胸膜增厚粘连71个(45.5%;71/156);肺转移瘤的CT表现为结节以边缘见分叶及毛刺为主共369个(60.0%;369/615)、钙化23个(3.7%;23/615)、空洞111个(18.0%;111/615)、病灶邻近胸膜增厚粘连114个(18.5%;114/615)。肺慢性炎症、肺结核出现结节边缘无分叶且边缘光滑的比率分别与肺转移瘤组比较,差异有统计学意义(χ ²=47.613,P=0.000;χ ²=88.095,P=0.000),肺结核与肺转移瘤出现钙化的比率两者差异有统计学意义(χ ²=270.707,P=0.000),肺结核与肺转移瘤出现空洞的比率差异有统计学意义(χ ²=7.048,P=0.008),肺慢性炎症与肺转移瘤、肺结核与肺转移瘤出现病灶邻近胸膜增厚粘连的比率差异有统计学意义(χ ²=23.670,P=0.000;χ ²=49.650,P=0.000)。肺转移瘤空洞类型:空泡样空洞发生率(34.2%,38/111)>囊样空洞发生率(26.2%,29/111)>小环形空洞发生率(22.5%,25/111)>不规则空洞发生率(17.1%,19/111);所有的空泡样空洞仅出现在腺癌肺转移中、78.9%(30/38)的空泡样空洞结节边缘均见分叶、毛刺。5例肺慢性炎症患者均见边缘模糊的结节,边缘见局限的片状浸润影及索条状影。弥漫性淋巴管瘤病的结节常呈弥漫或多灶性分布,累及多个部位并呈多发的大小不等的囊性病变,肺内结节均边缘光滑、密度均匀。 结论 肺结核、肺转移瘤、肺慢性炎症和弥漫性淋巴管瘤病出现肺内多发结节时,其病灶大小、分布、形态、边缘、密度及与邻近结构的关系等各自具有一定特点,CT扫描对4种疾病进行鉴别诊断时具有重要价值。     

Primary pulmonary AIDS-related lymphoma: radiographic and CT findings

STUDY OBJECTIVES: To describe the radiographic and CT findings of primary AIDS-related lymphoma (ARL) of the lung (ARLL), and to evaluate percutaneous transthoracic needle biopsy (PTNB) in the diagnosis of primary ARLL. MATERIALS AND METHODS: Seven chest radiographs and seven CT scans of HIV-infected patients with histologically proved primary pulmonary non-Hodgkin's lymphoma (PPL) were reviewed at our institution. All of the patients had fibroscopy with BAL. The diagnosis of PPL was established histologically by means of PTNB (n = 4), open-lung biopsy (n = 2), or autopsy (n = 1). RESULTS: All but one patient had multiple peripheral well-defined nodules of various sizes on the chest X-ray film and CT scan. One patient had a subpleural parenchymal infiltrate and another had a main peripheral mass with spontaneous cavitation. Hilar/mediastinal adenopathies and pericardial/pleural effusion were never associated with the parenchymal abnormalities. Fibroscopy with BAL was always negative. PTNB, done in six cases, was diagnostic in four cases and suggested primary ARLL in two cases. No complications occurred during these procedures. CONCLUSION: After excluding infectious causes, multiple peripheral nodules and/or masses without hilar or mediastinal adenopathies and without pleural effusion are suggestive of primary pulmonary ARL. A specific diagnosis can be obtained by means of PTNB.     

肺内孤立性炎性结节的CT表现

目的 总结分析肺内孤立性炎性结节的CT形态学表现和CT灌注成像图像特征,以提高孤立性炎性结节的CT诊断正确率.方法 选取16例经病理证实或经临床短期随访观察病变消失或明显缩小的肺内孤立性炎性结节的高分辨CT影像资料,计算动态增强曲线参数.全部患者均行16层螺旋CT平扫及动态增强扫描.结果 结节最大者直径约2.9 cm,最小者直径约1 cm.结节形态为圆形或类圆形.结节边缘光滑清晰者6例,边缘模糊者10例;4例有浅分叶,余无分叶.所有结节周围均无卫星灶、血管集束,所有结节内均无钙化灶.15例CT灌注成像图像上时间-密度曲线为速升速降型,1例为缓升缓降型.结论 结合CT形态学和灌注成像图像,可明显提高肺内孤立性炎性结节的CT诊断准确率.     

Computer-aided detection of pulmonary embolism on CT angiography: initial experience

OBJECTIVE: To evaluate the performance of a computer-aided detection (CAD) system for diagnosis of pulmonary embolism on computed tomography (CT) pulmonary angiography. MATERIALS AND METHODS: One hundred and four pulmonary CT angiograms for pulmonary emboli (PE) were reviewed both by radiologists and a CAD detection system (ImageChecker CT V2.0, R2 Technology Inc, Sunnyvale, CA). CT scans, read and reported by radiologists in a routine daily clinical setting, were later processed by the CAD system. The performance of the CAD system was analyzed. RESULTS: Forty-five PE were identified by the radiologists in 15 patients. The CAD system revealed 123 findings, interpreted by the system as PE. Twenty-six of them, detected in 8 patients, represented true-positive results. Ninety-seven (78.9%) CAD findings were not true PE and were defined as false-positive. Nineteen true PE in 7 patients were missed by the CAD system constituting 42% false-negative rate. Sensitivity of the CAD system was 53.3% and the specificity was 77.5%. The positive predictive value of CAD system was 28.5% and the negative predictive value was 90.7%. CONCLUSIONS: With the evaluated CAD system, it is relatively simple and fast to check all detected findings and decide if they represent true PE. However, high false-negative results demand technologic improvement, to increase the sensitivity of the system. It is anticipated to become a promising supplement to the work and eyes of the radiologist in detecting PE on pulmonary CT angiography.     

High-resolution CT findings in pulmonary hyalinizing granuloma

A 47-year-old man with pulmonary hyalinizing granuloma is herein presented. The patient, whose chief complaint was a mild cough, was found by chest radiograph to have multiple bilateral nodules. Subsequent high-resolution computed tomography demonstrated multiple slightly irregular nodules, perinodular ground-glass opacity, peribronchovascular interstitial thickening, and cysts. A mild enlargement of systemic lymph nodes was also noted. Laboratory tests disclosed a slight elevation in the C-reactive protein, gamma-globulin, interleukin-6, and soluble interleukin-2 receptor levels. A histopathologic examination of the specimen yielded from a thoracoscopic lung biopsy resulted in a definite diagnosis of pulmonary hyalinizing granuloma.     

CT findings of cases of pulmonary alveolar proteinosis

The CT findings of pulmonary alveolar proteinosis were studied. The subjects consisted of five cases; 4 men and 1 woman with an average age of 47.4 years old. The total of 19 CT views were analyzed with a mean follow-up duration of 5.7 +/- 1.2 years. The interval from the estimated onset to the first CT examination day was considered to be 6.0 +/- 3.1 years. The purposes of this report were; 1) Whether one could obtain useful information for the diagnosis by initial CT? 2) What were the changes of imaging with the passage of time on CT? 3) How one could predict the prognosis of the patients by CT? From the results of initial CT, pulmonary alveolar proteinosis showed diffuse, non-segmental densities with a mixture of various degrees of consistency, with peripheral clear zone which could be detected under posterior and lateral chest wall and/or interlobar area, and occasional air bronchograms. Irregular shaped patchy densities attached to the anterior chest wall were detected in 4 cases. These densities made the anterior pleural line irregular. In two cases, densities which were thought to represent the deposition of protein-like material in alveolar spaces decreased in the clinical course. Interstitial changes of the lung field were thought to cause the loss of lung volume, dilatation of bronchi and bronchioles, resulting in cystic changes and respiratory difficulty increased. In another case, the densities spontaneously disappeared during a period of one year.(ABSTRACT TRUNCATED AT 250 WORDS)     

Inhalational pulmonary talcosis: high-resolution CT findings in 3 patients

We describe the high-resolution CT findings in 3 patients with pulmonary talcosis acquired by the inhalation of talc. The predominant abnormalities consisted of small centrilobular and subpleural nodules and conglomerated masses containing focal areas of high attenuation consistent with talc deposition. All patients also had focal ground glass opacities. The abnormalities were diffuse but were most severe in the upper and middle lung zones with relative sparing of the lung bases.