The presence of risk factors is an essential condition for clinical suspicion. Such evaluations are typically based on one of the two most extensively validated criteria-the Wells score (9) and the Geneva score (10)-which are detailed in Tables 1 and 2, respectively. The diagnostic evaluation of a patient with suspected PTE begins with the analysis of the pre-test probability and association with the D-dimer level. In this review article, we analyze the importance of the diagnosis of PTE, as well as the available imaging methods, with an emphasis on DECT. In imaging of the chest, DECT has been used for the clinical evaluation of pulmonary emphysema, pulmonary nodules, ground glass opacities, lung cancer, as well as for the diagnosis of acute PTE, chronic PTE, and chronic thromboembolic pulmonary hypertension (8). The imaging methods currently available for the diagnosis are conventional chest X-ray, pulmonary angiography, ventilation-perfusion lung scintigraphy, magnetic resonance imaging (MRI) of the chest, computed tomography (CT) of the chest (5), and dual-energy CT (DECT), which is the method developed most recently (6).Īlthough the concept of DECT originated in 1970, it was not incorporated into clinical practice until recently, when advancements in CT scanner technology, including single- and dual-source configurations, made it feasible (7). The diagnosis of PTE is based on the following (1): the clinical pre-test probability the D-dimer level and the findings in the image. Therefore, although PTE occurs frequently, the diagnosis continues to be a great clinical challenge, because the same signs and symptoms are present in a large number of diseases, as well as because the risk factors associated with PTE are nonspecific. Most such studies analyze autopsy data and show that, under those conditions, the prevalence of PTE ranges from 3.9% to 16.6% (3,4). Studies on the epidemiology of PTE in Brazil are rare. PTE is the third leading cause of cardiovascular death in the United States (1), with an incidence rate of 0.5–1. Pulmonary thromboembolism (PTE) is a common clinical entity that results in morbidity and mortality in a large number of patients. Neste artigo é feita revisão acerca da importância do diagnóstico de tromboembolismo pulmonar, bem como os métodos de imagem disponíveis, com ênfase na tomografia computadorizada com dupla energia. Nos últimos anos, houve o desenvolvimento da tomografia computadorizada com dupla energia e essa ferramenta tem se mostrado promissora para avaliação da perfusão pulmonar por meio do mapa de iodo. Os métodos de imagem fornecem o diagnóstico definitivo, sendo a tomografia computadorizada o método mais utilizado atualmente. Devido ao quadro clínico e fatores de risco inespecíficos, o diagnóstico de tromboembolismo pulmonar torna-se um desafio. In this article, we will review the importance of diagnosing pulmonary thromboembolism, as well as the imaging methods employed, primarily dual-energy computed tomography.Ī acurácia no diagnóstico de tromboembolismo pulmonar é essencial para reduzir a morbimortalidade causada por esta enfermidade. The recent development of dual-energy computed tomography has provided a promising tool for the evaluation of pulmonary perfusion through iodine mapping. Currently, the imaging method most commonly used in the evaluation of pulmonary thromboembolism is computed tomography. Imaging methods provide the definitive diagnosis. The diagnosis of pulmonary thromboembolism is challenging because of the nonspecific nature of the clinical profile and the risk factors. The accurate diagnosis of pulmonary thromboembolism is essential to reducing the morbidity and mortality associated with the disease. Keywords: Pulmonary embolism Tomography, emission-computed/methods Tomography, X-ray computed/methods Computed tomography, dual-energy scanned projection Ventilation-perfusion ratio.ĭescritores: Embolia pulmonar Tomografia computadorizada de emissão/métodos Tomografia computadorizada por raios X/métodos Tomografia computadorizada com dupla energia Relação ventilação-perfusão. Pulmonary thromboembolism: new diagnostic imaging techniquesĪutho(rs): Julia Noschang 1 Marcos Duarte Guimarães 2 Diogo Fábio Dias Teixeira 3 Juliana Cristina Duarte Braga 3 Bruno Hochhegger 4 Pablo Rydz Pinheiro Santana 5 Edson Marchiori 6
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