Parenchymal and pleural findings in pulmonary embolism visualized by multi-channel detector computed tomography.
BACKGROUND
A normal computed tomography (CT) scan of the pulmonary arteries in the presence of parenchymal and pleural abnormalities may indicate a false-negative diagnosis of pulmonary embolism (PE). Multi-channel detector CT (MDCT) with thinner collimation may improve the detection of small peripheral PEs causing such abnormalities.


OBJECTIVE
To investigate parenchymal and pleural findings visualized by contrast-enhanced MDCT in patients with and without PE, and to identify possible predictors of PE.


METHODS
129 patients with clinical signs of PE were included. In all patients an iopromide-enhanced 64-MDCT (64x0.625 mm collimation, pitch 1.375, overlapping reconstruction with a slice thickness of 0.625 mm, increment of overlapping slice reconstruction 0.43) was performed within 24 h after the onset of the symptoms.


RESULTS
MDCT detected PE in 45 of the 129 patients (35%). PE and parenchymal/pleural findings were localized predominantly within the lower lobes. Wedge-shaped opacities were significantly associated with PE (OR =3.00; 95% confidence interval 1.13-7.91). Vascular signs were only visualized in patients with PE. Nodules, consolidations, atelectasis, or effusions were not predictive of PE.


CONCLUSIONS
The present MDCT study verified that parenchymal and pleural findings can be found in patients with or without PE. Wedge-shaped opacities and vascular signs were significantly associated with PE and therefore can be potential predictors of PE.
Pfeil
Alexander
A
Department of Internal Medicine III, Friedrich-Schiller-University Jena, Germany. alexander.pfeil@med.uni-jena.de
Schmidt
Peter
P
Hermann
Regina
R
Böttcher
Joachim
J
Wolf
Gunter
G
Hansch
Andreas
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000008:administration & dosage; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007472:Iohexol / Q000008:administration & dosage / Q000031:analogs & derivatives; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000000981:diagnostic imaging* / Q000473:pathology; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000473:pathology; D011857:Radiographic Image Interpretation, Computer-Assisted; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide