| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Vascular and Interventional Radiology |
1 From the Department of Radiology, Hôpital Calmette, University Center of Lille, Blvd Jules Leclerc, 59037 Lille, France. Received January 9, 2004; revision requested March 11; revision received April 1; accepted May 17. Address correspondence to M.R.J. (e-mail: mremy-jardin@chru-lille.fr).
 |
ABSTRACT |
|---|
 TOP ABSTRACT INTRODUCTIONMATERIALS AND METHODS RESULTSDISCUSSIONREFERENCES |
|---|
MATERIALS AND METHODS: Neither institutional board approval nor informed consent was required. Forty-eight consecutive patients (39 men, nine women; mean age, 55.7 years; range, 20–82 years) with hemoptysis of bronchial and nonbronchial systemic artery origin underwent multi–detector row helical CT angiography of the thorax with use of a four–detector row (n = 31) or 16–detector row (n = 17) scanner prior to embolization. Findings on CT angiograms, including CT scans, maximum intensity projections, and three-dimensional volume-rendered images, were used to evaluate the depiction of bronchial and nonbronchial systemic arteries. Retrospective analysis of the ostium and the course of bronchial and/or nonbronchial systemic arteries on CT angiograms enabled evaluation of the accuracy of this technique in identification of the relevant vasculature.
RESULTS: Among the 46 patients initially treated with bronchial artery embolization, 58 bronchial arteries were identified at CT and/or angiography. In 50 (86%) cases, concordant findings were observed with both modalities. In five (9%) cases, CT could not be used to identify the ostia of bronchial arteries. In three (5%) cases, CT depicted bronchial arteries that could not be selectively catheterized. Three-dimensional images were found to be superior to transverse CT scans in depicting the ectopic origin of the bronchial arteries, which enabled the interventional radiologists to perform successful embolization after direct catherization of the ectopic vessel in every case. In five (11%) patients, the nonbronchial systemic origin of bronchial bleeding was identified on CT angiograms.
CONCLUSION: Multi–detector row helical CT angiography provides more precise depiction of bronchial and nonbronchial systemic arteries than does conventional angiography.
© RSNA, 2004
Index terms: Angiography, comparative studies, 94.1211, 94.12916 • Arteries, bronchial • Computed tomography (CT), angiography, 94.12915, 94.12916, 94.12917 • Lung, hemorrhage
|
INTRODUCTION |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODS RESULTSDISCUSSIONREFERENCES |
|---|
To our knowledge, the role of chest computed tomography (CT) in the prediction of the source of bleeding has not been extensively evaluated. Until recently, most studies have focused on the respective contributions of chest radiography, conventional CT, and fiberoptic bronchoscopy to maximize the diagnostic yield and to locate the bleeding site (9–15). The introduction of dynamic contrast material–enhanced and helical CT has renewed interest in accurate identification of the source of hemorrhage. During the past 10 years, a few investigators have documented the anatomic characteristics of enlarged bronchial arteries on dynamic contrast-enhanced (16) and single—detector row helical (17,18) CT scans in selected populations. More recently, Yoon et al (19) have evaluated the accuracy of single–detector row helical CT in helping to predict the presence of a nonbronchial systemic arterial supply in patients with massive hemoptysis, but they did not evaluate the clinical effect of CT findings in therapeutic decisions. The purpose of the present study was to retrospectively evaluate the depiction of bronchial and nonbronchial systemic arteries with multi–detector row helical CT compared with conventional angiography in patients undergoing endovascular treatment of hemoptysis.
|
MATERIALS AND METHODS |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODS RESULTSDISCUSSIONREFERENCES |
|---|
The degree of hemoptysis prior to embolization was less than 100 mL of blood per day in six patients, 100–200 mL of blood per day in 23 patients, and more than 200 mL of blood per day in 19 patients. The causes of hemoptysis included bronchiectasis (n = 14), chronic bronchitis and emphysema (n = 9), intrathoracic tumoral disease (n = 9), silicosis (n = 6), tuberculosis (n = 3), anomalous systemic supply to normal lung (n = 2), chronic pulmonary embolism (n = 1), and lung infarction in the context of acute pulmonary embolism (n = 1). Three patients were considered to have idiopathic hemoptysis because standard chest radiographic, bronchoscopic, chest CT, or clinical findings failed to reveal the underlying disease. This study group comprised 45 patients with chronic pulmonary disease and three patients with acute pulmonary disease.
CT Examination
Because of the upgrade of our equipment during this investigation, CT angiography was performed with a four–detector row scanner (Sensation 4; Siemens, Forchheim, Germany) for 31 patients (140 kV, 60–100 mAs, rotation time of 0.5 second, 1-mm collimation, pitch of 2) and a 16–detector row scanner (Sensation 16; Siemens) for 17 patients (140 kV, 70–120 mAs, rotation time of 0.5 second, 0.75-mm collimation, pitch of 1.5). The respective mean height of the volume scanned and the mean duration of data acquisition were 282 mm and 21 seconds with the four–detector row scanner and 325 mm and 12 seconds with the 16–detector row scanner.
Patients received 80–100 mL of contrast material (iohexol, Omnipaque 300; Amersham Health, Carrigtohill, Ireland) with 300 mg of iodine per milliliter and an injection rate of 4 mL/sec. For the four–detector row scanner, the start delay was empirically chosen and varied between 18 and 22 seconds. For the 16–detector row scanner, the automatic bolus triggering software program was systematically applied, with a circular region of interest positioned at the level of the ascending aorta and a threshold for triggering data acquisition preset at 100 HU.
From each data set, three series of images were systematically reconstructed as follows: contiguous 1-mm-thick transverse CT scans viewed at mediastinal and lung window settings, oblique coronal and sagittal maximum intensity projections (MIPs), and three-dimensional volume-rendered images of the thoracic vascular structures.
CT Interpretation
Analysis of bronchial arteries.—CT interpretation focused on the evaluation of bronchial arteries ipsilateral to the side of bleeding by recording the following parameters: (a) the site of the ostium of the bronchial artery (or arteries), which was coded as orthotopic when the artery was originating from the descending aorta between the levels of the T5 and T6 vertebrae or ectopic when identified at a level of the descending aorta other than the expected origin (ie, outside levels T5-T6), such as the level of the aortic arch or from any aortic collateral vessel; (b) the origin of orthotopic bronchial arteries, which was further analyzed and included a systematic analysis of its location on the wall of the descending aorta (ie, posterior, medial, anterior, or lateral) and its position relative to the tracheal carina; (c) the bronchial artery diameter, which was coded as enlarged when greater than 1.5 mm (16,20,21); and (d) the total number of bronchial arteries per side. For each bronchial artery considered in the present investigation, depiction of its ostium and recognition of its mediastinal and hilar course were analyzed on transverse CT scans and three-dimensional images to determine the ability of CT angiography to depict this vessel. When both criteria were met, CT angiography was considered to provide an accurate identification of the bronchial artery of interest. When only one of the criteria was met, CT angiography was coded as suboptimal for the depiction of this bronchial artery.
Because the presence of an anterior spinal artery arising from a right intercostobronchial trunk constitutes a contraindication to embolization of this latter vessel, we systematically included a search for this collateral whenever the intercostobronchial trunk was expected to be the source of bronchial bleeding. By using the CT angiographic criteria reported by Takase et al for the recognition of the Adamkiewicz artery (22), the anterior spinal artery was searched for as a thin enhanced vessel on the midline ventral surface of the spinal cord, with a typical hairpin curve on coronal and sagittal MIPs of the cervicothoracic region.
The presence of calcifications at the level of the thoracic aortic walls was systematically sought on the CT studies.
Analysis of nonbronchial systemic arteries.—Nonbronchial systemic arteries were defined as arteries that enter the parenchyma through the inferior pulmonary ligament or through the adherent pleura; their course is not parallel to that of the bronchi (23). The following features were considered to be suggestive of a nonbronchial systemic arterial supply as a source of hemoptysis: (a) abnormal enlargement of one or several of the branches of the subclavian and axillary arteries, particularly the internal mammary artery and its branches, the intercostal arteries, and the inferior phrenic arteries, and (b) the enlarged nonbronchial systemic arteries seen with or without the concurrent presence of pleural thickening and pulmonary abnormalities. CT features suggestive of a nonbronchial systemic arterial supply were recorded for each hemithorax in each patient together with a specific evaluation of the pulmonary circulation in the relevant area.
For each nonbronchial artery considered in the present investigation, depiction of its ostium and recognition of its course toward the adjacent lung parenchymal zone were analyzed on transverse CT scans and three-dimensional images to determine if CT angiography has the ability in helping to evaluate this vessel. When both criteria were met, CT angiography was considered to provide an accurate identification of the nonbronchial systemic artery of interest. When only one of the criteria was met, CT angiography was coded as suboptimal for the depiction of this nonbronchial systemic artery.
Angiographic Procedure and Interpretation
CT angiograms were interpreted in consensus by two faculty radiologists (M.R.J. and J.R., with 15 and 20 years of experience with CT, respectively), who were blinded to the conventional angiography results but not to clinical information. The CT images were reviewed as hard-copy images with the option of a cine-mode display on the workstation, if needed. After several weeks, the two readers reviewed the conventional angiographic studies in consensus; subsequently, the degree of concordance between the results of CT angiography and those of conventional angiography was evaluated.
In all patients, conventional angiography was performed with a digital substraction technique (Siregraph Top; Siemens Medical Systems, Erlangen, Germany) within 1 week after CT. Embolization was performed by subspecialty-trained chest radiologists (N.B. or P.Y.B., both with 3 years of experience in embolization), who were also involved in CT scanning in the same department. In all 48 patients, angiography was performed with a transfemoral approach and the Seldinger technique. Various types of angiographic catheters were used to selectively inject different systemic arteries. Management of hemoptysis in patients with acquired chest disorders was based on the general recommendation that bronchial arteries ipsilateral to the side of bronchial bleeding should be embolized first (24). Persistent hemoptysis after a technically successful bronchial artery embolization constituted an indication for embolization of nonbronchial systemic arteries, which was always considered at second intention because of (a) the potential neurologic iatrogenic risks when embolizing these vessels, especially collaterals of the subclavian artery (owing to the proximity of the vertebral artery) and the intercostal and inferior phrenic arteries (owing to the likelihood of a major spinal cord supply from these branches), and (b) the lack of a constant relationship between arterial hypervascularity and bronchial bleeding. On the contrary, embolization of nonbronchial systemic arteries was systematically considered at first intention for the management of hemoptysis of congenital origin.
Although bronchial bleeding may occur from normal-sized bronchial arteries, the following angiographic findings were considered to be predictive of the vessels responsible for hemoptysis: (a) tortuous enlargement of bronchial and/or nonbronchial systemic arteries that supplied the area of parenchymal staining and (b) a shunt into pulmonary vessels. For the benefit of each patient, angiographic procedures were performed with the knowledge of CT findings. No complications were encountered after the embolization of bronchial and nonbronchial systemic arteries in the studied population.
|
RESULTS |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODS RESULTSDISCUSSIONREFERENCES |
|---|
Hemoptysis of Bronchial Artery Origin
Hemoptysis was treated with bronchial artery embolization in 46 patients, which enabled the comparison of CT angiographic and conventional angiographic findings on the right side in 24 patients and on the left side in 22 patients. Presence of calcifications of the aortic walls in 31 (67%) of the 46 patients did not hamper the analysis of bronchial arteries.
Evaluation of right bronchial arteries at CT angiography.—Among the 24 patients who underwent right bronchial artery embolization, CT angiography accurately depicted bronchial arteries in 20 patients. In four patients, it was graded as suboptimal. In these four patients, the hilar path of the bronchial artery was identified in every case, but the ostium of the bronchial artery could not be depicted because of the presence of an ipsilateral tumoral hilar mass (n = 3) and/or a poor signal-to-noise ratio (n = 3). Two CT scans were obtained with a four–detector row scanner and two were obtained with a 16–detector row scanner.
In 20 patients, both the site of the origin of the bronchial artery and its hilar path were precisely identified. Seventeen (85%) patients had a single right bronchial artery and three (15%) had two right bronchial arteries, which led to the analysis of a total of 23 right bronchial arteries. Nine (39%) of the 23 right bronchial arteries were dilated with a tortuous mediastinal course. The site of the origin of the 23 bronchial arteries was (a) orthotopic in 19 (83%) cases, originating from an intercostobronchial trunk (n = 17) (Fig 1) or from the descending aorta (n = 2) as a single artery (n = 1) or a common trunk for the right and left side (n = 1), and (b) ectopic in four (17%) cases. The orthotopic right bronchial arteries arose in the medial (n = 9), anteromedial (n = 6), or posteromedial (n = 4) wall of the descending aorta at the level of (n = 10) or slightly lower than (n = 9) the tracheal carina. The ectopic right bronchial arteries were seen originating from the concavity of the aortic arch (n = 2) and from the ipsilateral subclavian artery (n = 2) (Fig 2). No anterior spinal artery was seen arising from the right intercostobronchial trunk.
|
|
|
In 21 patients, both the site of the origin of the bronchial artery and its hilar path were precisely identified. Twelve (57%) patients had a single left bronchial artery and nine (43%) patients had two left bronchial arteries, which led to the analysis of a total of 30 left bronchial arteries. Eight (27%) of the 30 left bronchial arteries were dilated with a tortuous mediastinal course. The site of the origin of the 30 bronchial arteries was orthotopic in 22 (73%) cases and ectopic in eight (27%) cases. The orthotopic left bronchial arteries arose at the anterior (n = 14), anterolateral (n = 5), or anteromedial (n = 3) wall of the descending aorta at the level of (n = 6) or slightly lower than (n = 16) the tracheal carina. The eight ectopic left bronchial arteries arose from the concavity of the aortic arch in six cases, either as a single artery (n = 1) or as a common trunk for the right and left sides (n = 5), and from the lower third of the thoracic aorta in two cases (Fig 3).
|
|
|
|
|
|
|
|
|
|
|
|
|
|
DISCUSSION |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODS RESULTSDISCUSSIONREFERENCES |
|---|
The ostia of the right and left bronchial arteries, which were adequately depicted on CT angiograms, were found to be orthotopic in 83% (19 of 23 arteries) of cases on the right side and in 73% (22 of 30 arteries) of cases on the left side. These results are in agreement with previous reports, which emphasized that more than 70% of bronchial arteries arise from the descending aorta (25–27). As expected, 17 of the 19 orthotopic right bronchial arteries were seen originating from a right intercostobronchial trunk, whereas the 22 orthotopic left bronchial arteries were found originating from the descending aorta. Our study findings confirm that the majority of right bronchial arteries arise in the medial wall of the descending aorta, whereas most left bronchial arteries arise in the anterior wall of the descending aorta (8,16).
In addition to the location of the ostium of orthotopic bronchial arteries on the surface of the aortic wall, we analyzed their caudocranial level of origin. Whereas most authors describe the origins of bronchial arteries based on the level or range of thoracic vertebrae (25–27), we agree with Tanomkiat and Tanisaro (28) that this area of reference is wide and difficult to accurately identify at fluoroscopy. Using trachea as the anatomic reference, we found that all orthotopic right and left bronchial arteries arose at the level of or slightly lower than the tracheal carina, thus facilitating their selective catheterization. Because of the well-known individual variability in the number of bronchial arteries, we also found it useful to be aware of the number of bronchial arteries ipsilateral to the side of bronchial bleeding prior to embolization. Seventeen (85%) of 20 patients with an adequate evaluation of bronchial arteries on CT angiograms had a single right bronchial artery, whereas three (15%) patients had two right bronchial arteries. Twelve (57%) of the 21 patients with an adequate depiction of bronchial arteries on CT angiograms had a single left bronchial artery, whereas nine (43%) patients had two left bronchial arteries.
CT angiography was also very helpful in depicting bronchial arteries of ectopic origin. These branches, sometimes referred to as bronchial arteries of anomalous origin, were defined as arteries originating from the descending aorta outside the T5-T6 level, with an intrapulmonary course along the major bronchi (23). In our study group, four (17%) of 23 right arteries and eight (27%) of 30 left arteries adequately depicted on CT angiograms had an ectopic origin. On both sides, the most frequent origin of ectopic bronchial arteries was the concavity of the aortic arch, which was observed in eight (14%) of the 58 bronchial arteries analyzed. These results are in agreement with the anatomic series published by Cauldwell et al (25), who described a 14% prevalence of bronchial arteries originating from the concave surface of the aortic arch. When available, the anatomic information provided on angiograms helped in the guidance of successful catheterization and rapid embolization of orthotopic and ectopic bronchial arteries, factors that were especially important in patients who presented for endovascular treatment of life-threatening hemoptysis.
Because recurrent hemoptysis after a successful bronchial artery embolization may be related to the presence of a nonbronchial systemic arterial supply, one should emphasize the usefulness of its depiction with CT angiography prior to the second embolization session. Of particular importance is the subclavian artery and its branches (most commonly, the internal mammary artery) for upper-lobe bleeding and the inferior phrenic artery for lower-lobe bleeding (3,4,6–8,29,30). However, numerous additional vessels may give rise to a nonbronchial systemic arterial supply to the lung, such as the branches of the axillary arteries, the intercostal arteries, or the hepatic and gastric arteries (31–33). The time required to successfully cannulate and embolize the appropriate vasculature may take hours or the procedure may be ultimately unsuccessful for a number of technical reasons. Therefore, the ability to concentrate on the relevant vasculature reduces the procedure time and the potential iatrogenic risks of a selective hunt for abnormal nonbronchial systemic arteries (34).
In three of the 46 patients initially treated with bronchial artery embolization who had recurrent hemoptysis, CT angiographic findings enabled direct selective catheterization and embolization of an abnormal nonbronchial systemic artery in the vicinity of the bleeding site, namely two lateral thoracic arteries and one inferior phrenic artery, which was followed by an immediate cessation of bleeding. These results suggest that multi–detector row helical CT angiography can help in the planning of a focused and efficient nonbronchial systemic artery embolization, as was recently reported with single–detector row CT (19). Consequently, thoracic aortography, an invasive procedure still recommended by many authors to improve the detection of arteries contributing to hemoptysis (30,31,35–37), should be replaced with CT angiography. Similar conclusions can be drawn for the depiction of the abnormal systemic artery responsible for bronchial bleeding in patients with congenital anomalies of the lung. In two patients of our study group with a purely vascular sequestration, CT angiography allowed precise and noninvasive recognition of the systemic artery and also of the other key features of this rare congenital malformation, namely the absence of pulmonary arterial supply in the segment supplied by the anomalous systemic artery, a normal venous drainage in the affected area together with the absence of lung parenchymal abnormalities, and a normal bronchial branching pattern (38). Both patients underwent selective catheterization and embolization of the anomalous artery in a single angiographic session, obviating thoracic aortography (39).
The anatomic information provided on CT angiograms was reliably depicted on transverse CT scans alone for 23 (43%) of the 53 bronchial arteries coded as analyzable on CT angiograms, but a simultaneous reading of transverse CT scans and three-dimensional reconstructions for the remaining 30 (57%) bronchial arteries was required. Because of the thin collimation of CT angiograms, we did not encounter difficulties similar to those reported by Furuse et al (16). By investigating enlarged bronchial arteries on 10-mm-thick dynamic CT scans, the authors observed that the size and course of the bronchial arteries greatly affected their depiction on transverse CT scans because of partial volume averaging of horizontal and oblique arteries. Whereas we found no difficulty in depicting the ostium of bronchial arteries on transverse CT scans, we failed to confidently analyze their mediastinal and hilar course, especially in cases of enlarged and tortuous vessels. This limitation of transverse CT scans led Murayama et al (17) to evaluate the usefulness of curved reformations of bronchial arteries to demonstrate their origins and course. Although curved reformations provided complementary information for most right orthotopic bronchial arteries, left bronchial arteries were not adequately demonstrated because of their short mediastinal length. The advent of high-quality three-dimensional multi–detector row spiral CT scans allows the radiologists to overcome the technical limitations of two-dimensional reformations of small and tortuous vessels such as the bronchial arteries.
In addition to the improvement in recognition of orthotopic bronchial arteries, another advantage of three-dimensional images was the possibility of providing angiogram-like images of unusual anatomic situations, such as those encountered with ectopic bronchial arteries and abnormal systemic collateral supply. Because the most dreaded consequence of a bronchial artery embolization is inadvertent occlusion of spinal arteries, we included the search for an anterior spinal artery on curved MIPs of the cervicothoracic junction in the 17 patients who underwent right intecostobronchial trunk embolization. The lack of identification of this vessel on CT and/or conventional angiograms in these patients precludes any conclusion regarding the accuracy of CT angiography in depicting this important collateral, which was present in about 5% of patients (1,40). Further investigation of the accuracy of CT in depicting an anterior spinal artery is worth pursuing since CT angiography could represent a useful complementary means to prevent spinal cord ischemia when it is performed in association with the monitoring of somatosensory evoked potentials, a technique routinely used in our clinical practice (41,42). Image quality and underlying diseases were found to influence the overall effect of CT angiography. Five (9%) of the 58 bronchial arteries evaluated in our population were not adequately depicted on CT angiograms because of suboptimal image quality and/or presence of an ipsilateral tumoral hilar mass.
From this preliminary experience, the authors conclude that multi–detector row helical CT angiography can provide a precise road map for the interventional radiologist in performing an endovascular treatment for hemoptysis. The availability of this information before the patient arrives in the angiographic suite is expected to help reduce the examination time by facilitating attempts at direct selective catheterization of the arteries to be occluded.
|
FOOTNOTES |
|---|
Authors stated no financial relationship to disclose.
Author contributions: Guarantors of integrity of entire study, M.R.J., J.R.; study concepts and design, M.R.J., J.R.; literature research, J.B., M.R.J., J.R.; clinical studies, N.B., P.D., P.Y.B., J.B.; data acquisition, all authors; data analysis/interpretation, M.R.J., J.R.; manuscript definition of intellectual content and editing, M.R.J., J.R.; manuscript preparation, revision/review, and final version approval, M.R.J., J.R., J.B.
|
REFERENCES |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODS RESULTSDISCUSSIONREFERENCES |
|---|
This article has been cited by other articles:
|
|
 |
|
  C. S. Restrepo, A. Eraso, D. Ocazionez, J. Lemos, S. Martinez, and D. F. Lemos The Diaphragmatic Crura and Retrocrural Space: Normal Imaging Appearance, Variants, and Pathologic Conditions RadioGraphics, September 1, 2008; 28(5): 1289 - 1305. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. SIRAJUDDIN and T.-L. H. MOHAMMED A 44-year-old man with hemoptysis: A review of pertinent imaging studies and radiographic interventions Cleveland Clinic Journal of Medicine, August 1, 2008; 75(8): 601 - 607. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Matsuura, K. Takase, H. Ota, T. Yamada, A. Sato, F. Satoh, and S. Takahashi Radiologic Anatomy of the Right Adrenal Vein: Preliminary Experience with MDCT Am. J. Roentgenol., August 1, 2008; 191(2): 402 - 408. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Sugita, T. Yamazaki, N. Fujita, T. Naitoh, M. Kobari, and S. Takahashi Cystic Artery and Cystic Duct Assessment with 64-Detector Row CT before Laparoscopic Cholecystectomy Radiology, July 1, 2008; 248(1): 124 - 131. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Khalil, A. Parrot, C. Nedelcu, M. Fartoukh, C. Marsault, and M.-F. Carette Severe Hemoptysis of Pulmonary Arterial Origin: Signs and Role of Multidetector Row CT Angiography Chest, January 1, 2008; 133(1): 212 - 219. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A Poyanli, B Acunas, I Rozanes, K Guven, S Yilmaz, A Salmaslioglu, E Terzibasioglu, and R Cirpin Endovascular therapy in the management of moderate and massive haemoptysis Br. J. Radiol., May 1, 2007; 80(953): 331 - 336. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Khalil, M. Fartoukh, M. Tassart, A. Parrot, C. Marsault, and M.-F. Carette Role of MDCT in Identification of the Bleeding Site and the Vessels Causing Hemoptysis Am. J. Roentgenol., February 1, 2007; 188(2): W117 - W125. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A Khalil, M Soussan, G Mangiapan, M Fartoukh, A Parrot, and M-F Carette Utility of high-resolution chest CT scan in the emergency management of haemoptysis in the intensive care unit: severity, localization and aetiology Br. J. Radiol., January 1, 2007; 80(949): 21 - 25. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.-Y. Brillet, P. Dumont, N. Bouaziz, A. Duhamel, F. Laurent, J. Remy, and M. Remy-Jardin Pulmonary Arteriovenous Malformation Treated with Embolotherapy: Systemic Collateral Supply at Multidetector CT Angiography after 2-20-year Follow-up Radiology, December 1, 2006; 242(1): 267 - 276. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Coulden State-of-the-Art Imaging Techniques in Chronic Thromboembolic Pulmonary Hypertension Proceedings of the ATS, September 1, 2006; 3(7): 577 - 583. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Nael, H. J. Michaely, U. Kramer, M. H. Lee, J. Goldin, G. Laub, and J. P. Finn Pulmonary Circulation: Contrast-enhanced 3.0-T MR Angiography--Initial Results Radiology, September 1, 2006; 240(3): 858 - 868. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Chung, J. H. Lee, K. S. Lee, Y. C. Yoon, O J. Kwon, and T. S. Kim Bronchial and Nonbronchial Systemic Arteries in Patients with Hemoptysis: Depiction on MDCT Angiography. Am. J. Roentgenol., March 1, 2006; 186(3): 649 - 655. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. F. Bruzzi, M. Remy-Jardin, D. Delhaye, A. Teisseire, C. Khalil, and J. Remy Multi-Detector Row CT of Hemoptysis RadioGraphics, January 1, 2006; 26(1): 3 - 22. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| RADIOLOGY | RADIOGRAPHICS | RSNA JOURNALS ONLINE |
