Department of Clinical Radiology, University Hospitals Munich, Grosshadern Campus, Ludwig-Maximilians-University of Munich, Munich, Germany.
J Thorac Imaging. 2010 May;25(2):151-60. doi: 10.1097/RTI.0b013e3181d9ca1d.
Computed tomographic pulmonary angiography has become the standard of care for the evaluation of patients with suspected pulmonary embolism (PE). In addition to the direct depiction or exclusion of a pulmonary embolus in suspected PE, a number of predictive markers have been established to evaluate the patient's prognosis in acute and in chronic PE. An accurate risk stratification based on CT findings is crucial because optimal management, monitoring, and therapeutic strategies depend on the prognosis. With the recent introduction of the so-called "dual-source" CT scanners, that is, a scanner consisting of 2 tubes and 2 detectors mounted orthogonally to each other, different tube voltages can be used simultaneously, resulting in different energies of the emitted x-ray spectra (dual-energy CT; DECT). Initial results have shown that DECT is capable of iodine mapping of the pulmonary parenchyma, reliably depicting the segmental defects in iodine distribution in locations corresponding to embolic vessel occlusions. This study deals with a number of actual topics on PE imaging with multidetector CT and DECT, including the discussion of the relevant imaging findings to assess the patient's prognosis, the potential and additional benefit of dual-energy information on the parenchymal iodine distribution, the optimization of scan protocols including low-radiation dose chest pain protocols, and the discussion on future perspectives of CT in PE patients, such as the role of computer-aided diagnostic tools or the potential of ventilation imaging with DECT.
计算机断层扫描肺动脉造影已成为疑似肺栓塞（PE）患者评估的标准护理方法。除了直接描述或排除疑似 PE 中的肺动脉栓塞外，还建立了许多预测标志物来评估急性和慢性 PE 患者的预后。基于 CT 结果的准确风险分层至关重要，因为最佳的管理、监测和治疗策略取决于预后。随着最近所谓的“双源”CT 扫描仪的引入，即由 2 个管和 2 个探测器彼此正交安装组成的扫描仪，可以同时使用不同的管电压，从而产生不同能量的发射 X 射线光谱（双能 CT；DECT）。初步结果表明，DECT 能够对肺实质进行碘映射，可靠地描绘出与栓塞血管闭塞相对应的碘分布部位的节段性缺损。本研究涉及多排 CT 和 DECT 对 PE 成像的多个实际主题，包括讨论相关成像发现以评估患者的预后、双能信息在实质碘分布上的潜在和额外益处、扫描方案的优化（包括低辐射剂量胸痛方案），以及对 CT 在 PE 患者中的未来前景的讨论，例如计算机辅助诊断工具的作用或 DECT 通气成像的潜力。
