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Emergency Radiology

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01-12-2017 | Original Article

Pulmonary CTA in sickle cell patients: quantitative assessment of enhancement quality

Authors: Jeff Jensen, Tony Lin, Elliot K. Fishman, Pamela T. Johnson

Published in: Emergency Radiology | Issue 6/2017

Abstract

Purpose

The purpose of this study was to validate the observation that pulmonary artery (PA) enhancement is often decreased in sickle cell disease (SCD) patients imaged with MDCT for suspected pulmonary embolism and determine whether contrast infusion parameters are accountable for lower enhancement levels.

Materials and methods

Retrospective comparison of 35 adult SCD patients imaged for suspected pulmonary embolism (PE) in our emergency department using 128-slice dual source MDCT scanner to 34 age and weight matched adult controls. Bolus tracking data was recorded, and enhancement levels of the main PA and descending aorta were measured. Electronic records were reviewed for demographics, imaging and lab correlation, and infusion parameters.

Results

Age, weight, contrast infusion rate, and contrast volume were similar for both SCD and control patients. SCD patients had significantly lower main PA enhancement (mean 233 HU, range 151–361 HU) than the control subjects (mean 290 HU, range 138–487 HU) (p < 0.001). Most (74%) SCD subjects had PA enhancement that was <250 HU, while most (68%) control patients had PA enhancement ≥250 HU. Change in PA enhancement per second during bolus tracking was lower in SCD patients (12 HU/s, range −24 to 91 HU/s) than control patients (mean 30 HU/s, range −37 to 138 HU/s), although the difference was not statistically significant (p = 0.08). Hemoglobin levels were significantly lower in the SCD cohort (p < 0.001).

Conclusion

In this series of adult SCD patients with suspected PE imaged with MDCT, main PA enhancement level was lower than controls. Quality improvement investigations should focus on protocol optimization to improve enhancement quality and likelihood of a definitive diagnosis.

Kline JA, Kabrhel C (2015) Emergency evaluation for pulmonary embolism, part 1: clinical factors that increase risk. J Emerg Med 48:771–780CrossRefPubMed

Silverstein MD, Heit JA, Mohr DN et al (1998) Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population based study. Arch Intern Med 158:585–593CrossRefPubMed

Cushman M, Tsai AW, White RH et al (2004) Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am J Med 117:19–25CrossRefPubMed

Goldhaber SZ, Visani L, De Rosa M (1999) Acute pulmonary embolism: clinical outcomes in the international cooperative pulmonary embolism registry (ICOPER). Lancet 353:1386–1389CrossRefPubMed

Calder KK, Herbert M, Henderson SO (2005) The mortality of untreated pulmonary embolism in emergency department patients. Ann Emerg Med 45:302–310CrossRefPubMed

Horlander KT, Mannino DM, Leeper KV (2003) Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data. Arch Intern Med 163:1711–1717CrossRefPubMed

Mekontso Dessap A, Deux JF, Abidi N et al (2011) Pulmonary artery thrombosis during acute chest syndrome in sickle cell disease. Am J Respir Crit Care Med 184:1022–1029CrossRefPubMed

Novelli EM, Huynh C, Gladwin MT, Moore CG, Ragni MV (2012) Pulmonary embolism in sickle cell disease: a case-control study. J Thromb Haemost 10:760–766CrossRefPubMedPubMedCentral

Stein PD, Beemath A, Meyers FA, Skaf E, Olson RE (2006) Deep venous thrombosis and pulmonary embolism in hospitalized patients with sickle cell disease. Am J Med 119:897.e7–897.11CrossRef

10.

Denenberg BS, Criner G, Jones R, Spann JF (1983) Cardiac function in sickle cell anemia. Am J Cardiol 51:1674–1678CrossRefPubMed

11.

Voskaridou E, Christoulas D, Terpos E (2012) Sickle-cell disease and the heart: review of the current literature. Br J Haematol 157:664–673CrossRefPubMed

12.

Heusch P, Lanzman RS, Aissa J et al (2014) Evaluation of a high iodine delivery rate in combination with low tube current for dose reduction in pulmonary computed tomography angiography. J Thorac Imaging 29:293–297CrossRefPubMed

13.

Campbell KL, Hud LM, Adams S et al (2012) Safety of iodinated intravenous contrast medium administration in sickle cell disease. Am J Med 125:100.e11–100.e16CrossRef

14.

BD Nexiva Diffusics closed IV catheter system. Available at http://www.bd.com/Documents/brochures/infusion/MPS_VA_IV-catheters-and-devices-portfolio_BR_EN.pdf. Accessed 31 Aug 2017

15.

Johnson PT, Christensen GM, Fishman EK (2014) I.V. Contrast administration with dualsource 128-MDCT: a randomized controlled study comparing 18-gauge nonfenestrated and 20-gauge fenestrated catheters for catheter placement success, infusion rate, image quality, and complications. AJR 202(6):1166–1170CrossRefPubMed

16.

Bulla S, Pache G, Bley T, Langer M, Blanke P (2012) Simultaneous bilateral contrast injection in computed tomography pulmonary angiography. Acta Radiol 53:69–75CrossRefPubMed

17.

Zamboni GA, Guariglia S, Bonfante A et al (2012) Low voltage CTPA for patients with suspected pulmonary embolism. Eur J Radiol 81:e580–e584CrossRefPubMed

18.

Matsuoka S, Hunsaker AR, Gill RR et al (2009) Vascular enhancement and image quality of MDCT pulmonary angiography in 400 cases: comparison of standard and low kilovoltage settings. AJR 192:1651–1656CrossRefPubMed

19.

Szucs-Farkas Z, Christe A, Megyeri B et al (2014) Diagnostic accuracy of computed tomography pulmonary angiography with reduced radiation and contrast material dose: a prospective randomized clinical trial. Investig Radiol 49:201–208CrossRef

20.

Szucs-Farkas Z, Kurmann L, Strautz T et al (2008) Patient exposure and image quality of low-dose pulmonary computed tomography angiography: comparison of 100- and 80-kVp protocols. Investig Radiol 43:871–876CrossRef

21.

Nance JW Jr, Henzler T, Meyer M et al (2012) Optimization of contrast material delivery for dual-energy computed tomography pulmonary angiography in patients with suspected pulmonary embolism. Investig Radiol 47:78–84CrossRef

22.

Faggioni L, Neri E, Sbragia P et al (2012) 80-kV pulmonary CT angiography with 40 mL of iodinated contrast material in lean patients: comparsion of vascular enhancement with iodixanol (320 mg I/mL) and iomeprol (400 mg I /mL). AJR 199:1220–1225CrossRefPubMed

23.

Gosselin MV, Rassner UA, Thieszen SL, Phillips J, Oki A (2004) Contrast dynamics during CT pulmonary angiogram: analysis of an inspiration associated artifact. J Thorac Imaging 19:1–7CrossRefPubMed

24.

Mortimer AM, Singh RK, Hughes J, Greenwood R, Hamilton MC (2011) Use of expiratory CT pulmonary angiography to reduce inspiration and breath-hold associated artefact: contrast dynamics and implications for scan protocol. Clin Radiol 66:1159–1166CrossRefPubMed

25.

Chen YH, Velayudhan V, Weltman DI et al (2008) Waiting to exhale: salvaging the nondiagnostic CT pulmonary angiogram by using expiratory imaging to improve contrast dynamics. Emerg Radiol 15:161–169CrossRefPubMed

Title: Pulmonary CTA in sickle cell patients: quantitative assessment of enhancement quality
Authors: Jeff Jensen
Tony Lin
Elliot K. Fishman
Pamela T. Johnson
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: Emergency Radiology / Issue 6/2017
Print ISSN: 1070-3004
Electronic ISSN: 1438-1435
DOI: https://doi.org/10.1007/s10140-017-1541-3

At a glance: The STEP trials

Springer Medicine

Pulmonary CTA in sickle cell patients: quantitative assessment of enhancement quality

Abstract

Purpose

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

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