ED patients with symptoms suspicious for PE were included. Further, the efficacy of recombinant tissue plasminogen activator (r-tPA) and the combination of r-tPA and recombinant annexin-2 (rA2) was characterized by clot visualization during lysis. Associated LAR had mean and maximum values of 0.3% and 12% for cancer incidence and 0.2% and 6.8% for cancer mortality, respectively. Join ResearchGate to find the people and research you need to help your work. This HIPAA-compliant study was approved by the institutional review board with waiver of informed consent. 2015 Jun;22(3):221-9. doi: 10.1007/s10140-014-1265-6. Only 25 to 30 percent of patients with symptoms compatible with pulmonary embolism are confirmed to have thromboembolism on objective testing. Results: Of the 153 eligible patients, 3 patients were missed, 16 patients declined, and 134 (88%) patients were enrolled. In patients with suspected PE, helical CT can be used safely as the primary diagnostic test to rule out PE. The objective of our study was to exposit the shifting perspectives on contrast-induced nephropathy (CIN) for IV low-osmolar iodinated contrast media. In the 921 patients without PE, the mean prevalences (ranges between sites) of concordant categorized non-PE findings were: A = 7% (range 3%-11%), B = 10% (7%-13%), C = 17% (10%-20%), D = 4% (0%-8%), and no ancillary finding = 41% (29% to 45%). CTPA as the gold standard for the diagnosis of pulmonary embolism. 13 Gaps in the evidence. Compression ultrasonography revealed DVT in 2 patients at the first examination; findings on repeated compression ultrasonography at days 4 and 7 were normal. ... 56 It carries a significant risk in patients with acute PE. The largest pulmonary arterial branch with PE was central or lobar in 66 (51%), segmental in 35 (27%), and isolated subsegmental in 29 (22%) patients. An overview of the natural history of pulmonary embolism is outlined. Binary logistic regression analysis for both groups demonstrated that the only variable associated with CTPA as gold standard for the diagnosis of PE was being a chest radiologist. Gold standard for diagnosis pulmonary embolism - 1) Ventilation perfusion scan Sensitivity, specificity, and accuracy of CT were 100%, 89%, and 91%, respectively. We performed a retrospective review of the complete medical records from a population-based inception cohort of 2218 patients who resided within Olmsted County, Minnesota, and had an incident deep vein thrombosis or pulmonary embolism during the 25-year period from 1966 through 1990. Images at low energies had low sensitivities and low false positive rates; images at high energies had high sensitivities and high false positive rates. Objective: To determine the safety of using a simple clinical model combined with D-dimer assay to manage patients presenting to the emergency department with suspected pulmonary embolism. To formulate comprehensive recommendations for the diagnostic approach to patients with suspected pulmonary embolism, based on randomized trials. Patients underwent helical CT of the pulmonary arteries within 24 hours after presenting with signs and symptoms of PE. The purpose of this study is to evaluate a series of missed pulmonary emboli (PE) identified on abdominal CT and to describe their characteristics and the clinical scenario. Renal dysfunction, either major (requiring dialysis) or less severe, occurred in 13 of 1,111 (1%). The most common category A findings included infiltrate or consolidation suggesting pneumonia (81%), aortic aneurysm or dissection (7%), and mass suggesting undiagnosed malignancy (7%). We evaluated the CT examinations of 41 patients who underwent CTA for evaluation of the pulmonary arteries which suffered from suboptimal contrast enhancement. Treatment of PE is primarily anticoagulation. Multi-detector row CT has an accuracy of 91% in the depiction of suspected acute PE when conventional PA is used as the reference standard. Clinical pretest probability serves as the root of any diagnostic approach. Board-certified radiologists gave CT readings, which were reviewed by two independent emergency physicians who categorized the non-PE findings into one of four acuity categories: A = requiring specific and immediate intervention, B = requiring specific action on follow-up, C = requiring no action, and D = indeterminate findings. ... A normal value of D-dimers is unlikely to occur in PE or deep vein thrombosis. However, when subsegmental vessels were included, CT results were 63%, 89%, and 5.7, respectively. The kappa values for these findings were 0.65, 0.20, 0.58 and 0.54, respectively. Four hundred eighty-seven consecutive patients clinically suspected of having PE were examined in six Dutch hospitals from May 1997 through March 1998. We studied 16 anesthetized, juvenile pigs and injected colored methacrylate beads (3.8 mm, small; 4.2 mm, large) via the jugular vein. Objectives: To evaluate the hypothesis that computed tomography (CT) angiography often yields a result interpreted as an alternative diagnosis to pulmonary embolism (PE) in emergency department (ED) patients. For each set of images, each subsegmental artery was independently graded by three radiologists as open, containing emboli, or indeterminate. The interview included eight questions. Finally, we show that ischemic lesion volumes as defined by DSC are comparable to those defined by ASL. Clearly, the proper management of pulmonary embolism improves survival, and it is the focus of this article to review the natural history of pulmonary embolism as it relates to the appropriateness of several alternative therapeutic strategies. During pulmonary CT angiography, mean radiation dose delivered at middle of chest was 21.5, 19.5, and 18.2 mGy for four-detector row CT and for 16-detector row CT without and with dose-modulation program, respectively. Managing patients for suspected pulmonary embolism on the basis of pretest probability and D -dimer result is safe and decreases the need for diagnostic imaging. The reported sensitivity for the diagnosis of PE with CT-PA varies from 45 to 100% and the specificity from 78 to 100%. Diagnosis of pulmonary embolism with spiral volumetric CT was based on the direct visualization of intraluminal clots: partial filling defects (n = 41; 37%), complete filling defects (n = 51; 46%), "railway track" signs (n = 6; 5%), and mural defects (n = 14; 12%). Pulmonary embolism in pediatric patients survey of CT pulmonary angiography practices and policies. Medical radiation exposure of the U.S. population has not been systematically evaluated for almost 25 years. We prospectively enrolled patients who came to the emergency department with suspicion of acute PE. When properly diagnosed and treated, clinically apparent pulmonary embolism was an uncommon cause of death, and it recurred in only a small minority of patients. In one case of normal pulmonary angiographic findings, asymmetry in pulmonary arterial perfusion was misinterpreted as pulmonary embolism with spiral volumetric CT. Spiral volumetric CT can reliably depict thromboemboli in second- to fourth-division pulmonary vessels. Cumulative CT radiation exposure added incrementally to baseline cancer risk in the cohort. HHS The purpose of this study was to determine the diagnostic accuracy of unenhanced multidetector CT (MDCT) for diagnosis of central PE using CTPA as the gold standard. Of 849 patients in whom a diagnosis of pulmonary-embolism had initially been excluded, 5 (0.6% [95% CI, 0.2% to 1.4%]) developed pulmonary embolism or deep venous thrombosis during follow-up. Patients received instructions to report any symptoms or signs of PE or deep venous thrombosis (DVT) during the 3-month follow-up period. Three-month follow-up for the diagnosis of pulmonary embolism was performed. To compare vascular conspicuity and ability to connect pulmonary arterial branches on pulmonary angiograms obtained with helical multi-detector row computed tomography (CT) with those on pulmonary angiograms obtained with helical single-detector row CT. 2-SpSCT and 4-SpSCT showed higher values for sensitivity, specificity, accuracy, and the area under the curve at all DL compared with FS. In ED patients with suspected PE, the CT angiogram frequently provides evidence suggesting an important alternative diagnosis to PE. Results: The prevalence of PE among the 1,025 patients studied was 10% (95% CI = 8% to 12%). There was an overall trend for over-management in the various clinical scenarios. The pretest probability of pulmonary embolism was low, moderate, and high in 527, 339, and 64 patients (1.3%, 16.2%, and 37.5% had pulmonary embolism), respectively. 6 Electrocardiographic changes in acute PE consist of signs of right ventricular strain, right bundle branch block, right QRS axis deviation and S1Q3T3 pattern, although the ECG may be entirely normal. For subjective image assessment, three experienced radiologists evaluated the diagnostic quality. The per-caput effective dose increased to about 0.75 mSv and the collective dose to about 220,000 person Sv. Sudarski S, Haubenreisser H, Henzler T, Reischauer C, Kolokythas O, Matoori S, Herzog BA, Schönberg SO, Gutzeit A. PLoS One. Materials and methods: Estrada-Martin and Oldham developed surveys to determine different opinions among radiologists towards the use of CTPA for the diagnosis of PE, and their results showed that most radiologists chose CTPA as the gold standard to diagnose PE, ... 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