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Pulmonary Embolism: Comprehensive Diagnosis by Using Electron-Beam CT for Detection of Emboli and Assessment of Pulmonary Blood Flow¹

¹ From the Departments of Clinical Radiology (U.J.S., R.B., H.K., C.R.B., J.W., P.H., A.H., M.F.R.) and Internal Medicine I-Cardiology (A.K., O.M., R.H.), Klinikum Grosshadern, University of Munich, Marchioninistrasse 15, 81377, Germany. Received October 14, 1999; revision requested November 18; final revision received February 23, 2000; accepted February 28. Address correspondence to U.J.S. (e-mail: schoepf@ikra.med.uni-muenchen.de).

PURPOSE: To comprehensively assess thoracic anatomy and pulmonary microcirculation in pulmonary embolism by using computed tomographic (CT) angiography of the pulmonary arteries combined with functional CT imaging of blood flow.

MATERIALS AND METHODS: Twenty-two patients suspected of having acute pulmonary embolism underwent contrast material–enhanced thin-section electron-beam CT angiography of the pulmonary arteries. In addition, in each patient, a dynamic multisection blood flow CT study was performed on a 7.6-cm lung volume with electrocardiographic gating. Pulmonary blood flow was calculated, and perfusion parameters were visualized on color-coded maps. The color-coded maps and CT angiograms were independently evaluated, segment by segment, by two readers for perfusion deficits and the presence of clots, respectively. The results were compared.

RESULTS: Mean pulmonary blood flow was 0.63 mL/min/mL in the occluded segments versus 2.27 mL/min/mL in the nonoccluded segments (P = .001). The sensitivity and specificity of perfusion maps for the presence of segmental pulmonary embolism compared with those of CT angiography were 75.4% and 82.3%, respectively, with positive and negative predictive values of 79.6% and 84.7%, respectively. The false-negative findings were caused mainly by partial occlusion of vessels. In eight patients, a substantial alternative or additional pathologic entity was diagnosed.

CONCLUSION: By combining CT angiography and dynamic CT imaging, a comprehensive and noninvasive diagnosis of thoracic structure and function is feasible with a single modality.

Index terms: Computed tomography (CT), angiography, 60.12116 • Computed tomography (CT), electron beam, 60.12112, 60.12113, 60.12116, 60.12118 • Computed tomography (CT), perfusion study, 60.12112, 60.12113, 60.12116, 60.12118 • Embolism, pulmonary, 60.72 • Lung, CT, 60.12112, 60.12113, 60.12116, 60.12118 • Lung, perfusion

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