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Clinical study and experimental pulmonary embolism

Author: YuTongFu
Tutor: WangDeHang
School: Nanjing Medical University
Course: Medical Imaging and Nuclear Medicine
Keywords: porcine acute subsegmental pulmonary embolism multislice spiral CT pulmonaryangiography vessel cast reconstructed slice thickness gold standardPulmonary embolism Obstruction index Computed Tomography AngiographyPulmonary embolism CT angiography Scoring system Catheter fragmentation
CLC: R563.5
Type: PhD thesis
Year: 2012
Downloads: 128
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Abstract


Objectives:1.To establish a porcine model of acute subsegmental pulmonary embolism which is suitable to study imaging diagnosis and to evaluate the techniquefeasibility and stability;2.To compare the visibility of subsegmental pulmonaryemboli by different slice thickness reconstruction using multislice spiral CTpulmonary angiography.3.To compare multislice spiral CT to digital subtractpulmonary angiography for the detection of subsegmental pulmonary emboli by usinga cast of porcine pulmonary vessels as an independent gold standard.Methods:1. Some polyvinyl chloride emboli (the diameter of the emboli was2-3mm)were injected into the right external jugular vein in eight porcines. DSPAand CTPA were performed respectively before and after pulmonary embolism. Theseporcine were put to death after pulmonary embolism within24hours. The pulmonarycasts were made of porcine lungs in vitro by using some resin, of which theconcentration was about32.8%.2.8porcine were underwent CT pulmonaryangiography with1.0mm collimation. Three different slice thickness werereconstructed from the raw data for each porcine:1.0mm/0.5mm(slice thickness/increment,group A),2.0mm/1.0mm(group B),3.0mm/1.5mm(group C).Thesensitivity and positive predictive value of subsegmental pulmonary emboli in the3groups were recorded.3.8porcine were underwent digital substract pulmonaryangiography, multislice spiral CT pulmonary angiography and pulmonary vessel castrespectively. The sensitivity and positive predictive value of subsegmental pulmonaryemboli in3different methods were counted.Results:1. The model of acute subsegmental pulmonary embolism was establishedsuccessfully with all8porcine.The obliteration of the subsegmental pulmonaryarterial branches was seen on the images of DSPA. The filling defect was seen in thesubsegmental pulmonary arteries on CTPA. And the polyvinyl chloride emboliwere found in the subsegmental pulmonary arteries of the pulmonary casts.2. Thesensitivity and its95%confidence interval of subsegmental pulmonary embolism in group A,B and C was93.02%(95%CI,82.45-101.43%),83.72%(95%CI,74.69-91.75%),83.72%(95%CI,75.69-91.19%),respectively. There wereno significant differences among3groups(P>0.05).The positive predictive value andits95%confidence interval of subsegmental pulmonary embolism in group A,B and C was78.43%(95%CI,66.41-88.95%),83.72%(95%CI,80.92-87.15%),90.00%(95%CI,81.65-97.52%). There was significant difference between A and C (P<0.05). There wasno significant difference between A and B or between B and C (P>0.05).3. Sensitivityfor multislice spiral CT and angiography respectively were:88%(95%CI,86-90%)(DSPA group),93%(95%CI,88-97%)(CTPA1mm group),85%(95%CI,81-89%)(CTPA2mm group),85%(95%CI,82-89%)(CTPA3mm group)(p>0.05).Positive predictive values for multislice spiral CT and angiographyrespectively were82%(95%CI,80-86%)(DSPA group),82%(95%CI,75-87%)(CTPA1mm group),84%(95%CI,81-87%)(CTPA2mm group),88%(95%CI,84-92%)(CTPA3mm group)(p>0.05).There was no difference betweenmultislice spiral CT and angiography for detection of subsegmental pulmonaryemboli.Conclusions:1. The model of acute subsegmental pulmonary embolism in porcineswith interventional technique is simple, reliable and microinvasive.The method doesserve as a useful model for the early medical imaging diagnosis and therapy of acutesubsegmental pulmonary embolism.2. Multislice spiral CT pulmonary angiographywith reconstructed slice thickness of1.0mm,2.0mm,3.0mm is enabled todemonstrate subsegmental pulmonary emboli, which should be the parameters of4-slice and more than4-slice spiral CT.3. Multislice spiral CT is comparable toangiography for the diagnosis of pulmonary embolism. Multislice spiral CT canreplace conventional pulmonary angiography, used as the firstline reliable examination of pulmonary embolism. Objectives: To quantitively evaluate the value of computed tomography(CT)obstruction index described by Qanadli et al in monitoring the outcomes of pulmonary embolism (PE) undertaken thrombolysis and(or) anticoagulation.Methods: Fifty-five consecutive patients (mean age57.5years) diagnosed as PE bycomputed tomography angiography (CTA) at the initial time(T0) were selected in thisstudy. All the patients were treated with thrombolysis and (or) anticoagulation. CTAwas performed again as the follow-up evaluation (T1) with the mean interval time1-6weeks after therapy. Qanadli obstruction index was calculated at both T0and T1.Other follow-up evaluation included oxygen saturation (Sat. O2)and pulmonaryartery pressure(PAP).Results: The improvements of Sat. O2and PAP immediately occurred in51of55patients after thrombolysis and(or) anticoagulation therapy. Qanadli obstruction indexin the51patients decreased from45.09%±18.22to10.86%±10.29at T0and T1respectively with statistically significant difference (P<0.001). No statisticalsignificance of Qanadli obstruction index between T0and T1(P=0.080)was found inthe rest four patients without improvement of Sat. O2and PAP. Significantcorrelations existed between Qanadli obstruction index and Sat. O2(r=0.934), as wellas CT obstruction index and PAP(r=0.813).Conclusion: Qanadli obstruction index is an accurate, convenient, and repeatable toolin quantitively evaluating therapeutic outcomes of pulmonary embolism (PE) withmanagement of thrombolysis and(or) anticoagulation. Objectives: To assess value of computed tomography pulmonary angiography(CTPA)in guiding therapeutic decisions and monitoring patients undertaken percutaneous catheter fragment for acute massive pulmonary embolism (PE).Methods:From Jan2003to Dec2009,35patients were diagnosised as acute massivePE by CTPA (T0) and treated with percutaneous catheter fragmentation. The severitywas assessed by CT obstruction index (Qanadli index) and compared with Millerindex. CTPA, Oxygen saturation(SaO2) and pulmonary artery pressure(PAP) wereperformed as follow-up index.Results: The mean percentage of Qanadli index was55%±13%(range,40%–75%),Miller index was62%±15%(range,45%–85%). Correlations between them werestatistically significant (r=0.867, p <0.0001). Qanadli index showed significantreduction (T0:55%±13%; T1:12%±10%%;p<0.001) in33patients. Significantcorrelation was observed between Qanadli index and SaO2(r=0.895),PAP(r=0.827).Conclusion: Qanadli index provides an accurate method to distinguish massive PEfrom sub-massive PE. It can be used to determine therapeutic options and monitorclinical outcomes.

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CLC: > Medicine, health > Internal Medicine > Respiratory system and chest diseases > Pulmonary disease > Pulmonary embolism
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