Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 9/2016

01-09-2016 | Chest

Dual-energy CT-based iodine quantification for differentiating pulmonary artery sarcoma from pulmonary thromboembolism: a pilot study

Authors: Suyon Chang, Jin Hur, Dong Jin Im, Young Joo Suh, Yoo Jin Hong, Hye-Jeong Lee, Young Jin Kim, Byoung Wook Choi

Published in: European Radiology | Issue 9/2016

Login to get access

Abstract

Objectives

The purpose of this study was to determine whether dual-energy computed tomography (DECT) angiography could differentiate pulmonary thromboembolism (PTE) from pulmonary artery sarcoma (PAS).

Methods

We prospectively enrolled 19 patients that had a filling defect in the main pulmonary artery on DECT. Six patients who had PAS and underwent DECT were retrospectively enrolled for comparison. Pathological results or follow-up CT after anticoagulation therapy were used to make the final diagnosis. Two investigators measured the following parameters at the filling defect in the main pulmonary artery: CT attenuation density [Hounsfield units (HU)], iodine-related HU (IHU) and iodine concentration (IC, mg/ml).

Results

From a total of 25 patients (M:F = 10:15; mean age, 65 years old), 19 were categorised into the PTE group and six were categorised into the PAS group. The mean HU values were not significantly different between the PTE and PAS groups (45.5 ± 15.9 vs 47.1 ± 9.2 HU; P = 0.776). However, the mean IHU and IC values of the lesions were significantly different between the PTE and PAS groups (10.6 ± 7.2 vs 27.9 ± 9.1 HU; P = 0.004, and 0.61 ± 0.39 vs 1.49 ± 0.57; P = 0.001).

Conclusions

DECT angiography using a quantitative analytic methodology can be used to differentiate PTE and PAS.

Key Points

• DECT can be useful for differentiation of PAS and PTE.
• With quantitative analysis, DECT offers tissue characterisation by detecting lesion parameter increases.
• The patients without predisposing factors for PTE can be candidates for DECT.
Literature
1.
Coli A, Parente P, Bigotti G (2007) Pulmonary artery sarcoma: an insidious tumor still diagnosed too late. Analysis of the literature and report of a case. J Exp Clin Cancer Res 26:151–156PubMed
2.
Blackmon SH, Rice DC, Correa AM et al (2009) Management of primary pulmonary artery sarcomas. Ann Thorac Surg 87:977–984CrossRefPubMed
3.
Mussot S, Ghigna MR, Mercier O et al (2013) Retrospective institutional study of 31 patients treated for pulmonary artery sarcoma. Eur J Cardiothorac Surg 43:787–793CrossRefPubMed
4.
5.
Furest I, Marin M, Escribano P, Gomez MA, Cortinac J, Blanquer R (2006) Intimal sarcoma of the pulmonary artery: a rare cause of pulmonary hypertension. Arch Bronconeumol 42:148–150CrossRefPubMed
6.
Chhaya NC, Goodwin AT, Jenkins DP, Pepke-Zaba J, Dunning JJ (2006) Surgical treatment of pulmonary artery sarcoma. J Thorac Cardiovasc Surg 131:1410–1411CrossRefPubMed
7.
Gutierrez A, Sauler M, Mitchell JM et al (2014) Unresolved pulmonary embolism leading to a diagnosis of pulmonary artery sarcoma. Heart Lung 43:574–576CrossRefPubMed
8.
Cox JE, Chiles C, Aquino SL, Savage P, Oaks T (1997) Pulmonary artery sarcomas: a review of clinical and radiologic features. J Comput Assist Tomogr 21:750–755CrossRefPubMed
9.
Scheffel H, Stolzmann P, Plass A et al (2008) Primary intimal pulmonary artery sarcoma: a diagnostic challenge. J Thorac Cardiovasc Surg 135:949–950CrossRefPubMed
10.
Gan HL, Zhang JQ, Huang XY, Yu W (2013) The wall eclipsing sign on pulmonary artery computed tomography angiography is pathognomonic for pulmonary artery sarcoma. PLoS One 8, e83200CrossRefPubMedPubMedCentral
11.
Yi CA, Lee KS, Choe YH, Han D, Kwon OJ, Kim S (2004) Computed tomography in pulmonary artery sarcoma: distinguishing features from pulmonary embolic disease. J Comput Assist Tomogr 28:34–39CrossRefPubMed
12.
Caraway NP, Salina D, Deavers MT, Morice R, Landon G (2015) Pulmonary artery intimal sarcoma diagnosed using endobronchial ultrasound-guided transbronchial needle aspiration. Cytojournal 12:3CrossRefPubMedPubMedCentral
13.
Attina D, Niro F, Tchouante P et al (2013) Pulmonary artery intimal sarcoma. Problems in the differential diagnosis. Radiol Med 118:1259–1268CrossRefPubMed
14.
Johnson TR, Krauss B, Sedlmair M et al (2007) Material differentiation by dual energy CT: initial experience. Eur Radiol 17:1510–1517CrossRefPubMed
15.
Kim HK, Choi YS, Kim K et al (2008) Surgical treatment for pulmonary artery sarcoma. Eur J Cardiothorac Surg 33:712–716CrossRefPubMed
16.
Kruger I, Borowski A, Horst M, de Vivie ER, Theissen P, Gross-Fengels W (1990) Symptoms, diagnosis, and therapy of primary sarcomas of the pulmonary artery. Thorac Cardiovasc Surg 38:91–95CrossRefPubMed
17.
Parish JM, Rosenow EC 3rd, Swensen SJ, Crotty TB (1996) Pulmonary artery sarcoma. Clinical features. Chest 110:1480–1488CrossRefPubMed
18.
Castaner E, Gallardo X, Rimola J et al (2006) Congenital and acquired pulmonary artery anomalies in the adult: radiologic overview. Radiographics 26:349–371CrossRefPubMed
19.
Walley VM, Virmani R, Silver MD (1990) Pulmonary arterial dissections and ruptures: to be considered in patients with pulmonary arterial hypertension presenting with cardiogenic shock or sudden death. Pathology 22:1–4CrossRefPubMed
20.
21.
Neimatallah MA, Hassan W, Moursi M, Al Kadhi Y (2007) CT findings of pulmonary artery dissection. Br J Radiol 80:e61–e63CrossRefPubMed
22.
Stern EJ, Graham C, Gamsu G, Golden JA, Higgins CB (1992) Pulmonary artery dissection: MR findings. J Comput Assist Tomogr 16:481–483CrossRefPubMed
23.
Anderson MB, Kriett JM, Kapelanski DP, Tarazi R, Jamieson SW (1995) Primary pulmonary artery sarcoma: a report of six cases. Ann Thorac Surg 59:1487–1490CrossRefPubMed
24.
Khawar MU, Bhardwaj B, Bhardwaj H (2015) Pulmonary artery sarcoma: not every filling defect is a pulmonary thromboembolism. J Thorac Oncol 10:218–219CrossRefPubMed
25.
Wittram C, Maher MM, Yoo AJ, Kalra MK, Shepard JA, McLoud TC (2004) CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis. Radiographics 24:1219–1238CrossRefPubMed
26.
Ito K, Kubota K, Morooka M et al (2009) Diagnostic usefulness of 18F-FDG PET/CT in the differentiation of pulmonary artery sarcoma and pulmonary embolism. Ann Nucl Med 23:671–676CrossRefPubMed
27.
Sandhu A, Yates TJ, Kuriakose P (2008) Pulmonary artery sarcoma mimicking a pulmonary embolism. Indian J Cancer 45:27–29CrossRefPubMed
28.
Chong S, Kim TS, Kim BT, Cho EY, Kim J (2007) Pulmonary artery sarcoma mimicking pulmonary thromboembolism: integrated FDG PET/CT. AJR Am J Roentgenol 188:1691–1693CrossRefPubMed
29.
Allen S, Todd J, Copley S, Al-Nahhas A (2005) F-18 FDG uptake in bilateral pulmonary artery leiomyosarcomata, one mimicking a pulmonary embolus. Clin Nucl Med 30:418–419CrossRefPubMed
30.
Kamel EM, McKee TA, Calcagni ML et al (2005) Occult lung infarction may induce false interpretation of 18F-FDG PET in primary staging of pulmonary malignancies. Eur J Nucl Med Mol Imaging 32:641–646CrossRefPubMed
31.
32.
Kacl GM, Bruder E, Pfammatter T, Follath F, Salomon F, Debatin JF (1998) Primary angiosarcoma of the pulmonary arteries: dynamic contrast-enhanced MRI. J Comput Assist Tomogr 22:687–691CrossRefPubMed
33.
Wu HW, Cheng JJ, Li JY, Yin Y, Hua J, Xu JR (2012) Pulmonary embolism detection and characterization through quantitative iodine-based material decomposition images with spectral computed tomography imaging. Invest Radiol 47:85–91CrossRefPubMed
34.
35.
Pontana F, Remy-Jardin M, Duhamel A, Faivre JB, Wallaert B, Remy J (2010) Lung perfusion with dual-energy multi-detector row CT: can it help recognize ground glass opacities of vascular origin? Acad Radiol 17:587–594CrossRefPubMed
36.
Lu GM, Zhao Y, Zhang LJ, Schoepf UJ (2012) Dual-energy CT of the lung. AJR Am J Roentgenol 199:S40–S53CrossRefPubMed
37.
Kim SS, Hur J, Kim YJ, Lee HJ, Hong YJ, Choi BW (2014) Dual-energy CT for differentiating acute and chronic pulmonary thromboembolism: an initial experience. Int J Cardiovasc Imaging 30:113–120CrossRefPubMed
38.
Chai X, Zhang LJ, Yeh BM, Zhao YE, Hu XB, Lu GM (2012) Acute and subacute dual energy CT findings of pulmonary embolism in rabbits: correlation with histopathology. Br J Radiol 85:613–622CrossRefPubMedPubMedCentral
39.
Grazioli V, Vistarini N, Morsolini M et al (2014) Surgical treatment of primary pulmonary artery sarcoma. J Thorac Cardiovasc Surg 148:113–118CrossRefPubMed
40.
Bleisch VR, Kraus FT (1980) Polypoid sarcoma of the pulmonary trunk: analysis of the literature and report of a case with leptomeric organelles and ultrastructural features of rhabdomyosarcoma. Cancer 46:314–324CrossRefPubMed
Metadata
Title
Dual-energy CT-based iodine quantification for differentiating pulmonary artery sarcoma from pulmonary thromboembolism: a pilot study
Authors
Suyon Chang
Jin Hur
Dong Jin Im
Young Joo Suh
Yoo Jin Hong
Hye-Jeong Lee
Young Jin Kim
Byoung Wook Choi
Publication date
01-09-2016
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 9/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-4140-2

Other articles of this Issue 9/2016

European Radiology 9/2016 Go to the issue

Breast

The Yield of Pre-operative Breast MRI in Patients According to Breast Tissue Density

Hepatobiliary-Pancreas

Identification of Imaging Predictors Discriminating Different Primary Liver Tumours in Patients with Chronic Liver Disease on Gadoxetic Acid-enhanced MRI: a Classification Tree Analysis

Neuro

Short-term UROD treatment on cerebral function in codeine-containing cough syrups dependent male individuals

Musculoskeletal

Assessment of two-dimensional (2D) and three-dimensional (3D) lower limb measurements in adults: Comparison of micro-dose and low-dose biplanar radiographs

Magnetic Resonance

Magnetic resonance imaging of pulmonary nodules: accuracy in a granulomatous disease–endemic region

Hepatobiliary-Pancreas

Acute extrahepatic infectious or inflammatory diseases are a cause of transient mosaic pattern on CT and MR imaging related to sinusoidal dilatation of the liver