Search

Previous studies have found an association between androgen deprivation therapy (ADT) and an increased risk of dementia and depression in elderly men. This association remains controversial, and little is known about the effects of ADT in younger men.To examine the association between the receipt of ADT and these outcomes in young men aged 40-64 yr presenting with nonmetastatic prostate cancer (PCa).For this observational study, we identified 9117 men aged 40-64 yr diagnosed with localized PCa between 2007 and 2014, without a pre-existing neurocognitive diagnosis, using the TRICARE military database.Kaplan-Meier curves were fitted to compare ADT versus no ADT. We also performed a subgroup analysis in patients undergoing ADT for ≥12 mo. The association between ADT and new-onset dementia or depression was evaluated using inverse-probability-of treatment-weight-adjusted Cox proportional hazards regression analysis.Patients receiving ADT had a significantly higher incidence of depression (30.2 vs 15.8 per 1000 person years) and dementia (17.9 vs 7.5 per 1000 person years). The risk of developing either outcome was higher in the ADT cohort (depression: hazard ratio [HR] 2.07, p 0.001; dementia: HR 1.70, p = 0.052). Additionally, there was a dose-response relationship between the duration of ADT and either outcome.In our cohort of young men with PCa, the receipt of ADT was associated with an increased risk of developing dementia and depression. Long-term use of ADT was associated with the highest risk of neurocognitive outcomes.In this study, we looked at the risk of dementia and depression in patients65 yr of age undergoing androgen deprivation therapy (ADT) for prostate cancer. We found that these patients had a higher risk of dementia and depression than those who did not undergo ADT.

Objectives: The aim of this study was to assess the impact of the advanced technology of the new ExAblate 2100 system (Insightec Ltd, Haifa, Israel) for magnetic resonance imaging (MRI)-guided focused ultrasound surgery on treatment outcomes in patients with symptomatic uterine fibroids, as measured by the nonperfused volume ratio. Materials and Methods: This is a retrospective analysis of 115 women (mean age, 42 years; range, 27-54 years) with symptomatic fibroids who consecutively underwent MRI-guided focused ultrasound treatment in a single center with the new generation ExAblate 2100 system from November 2010 to June 2011. Mean +/- SD total volume and number of treated fibroids (per patient) were 89 +/- 94 cm(3) and 2.2 +/- 1.7, respectively. Patient baseline characteristics were analyzed regarding their impact on the resulting nonperfused volume ratio. Results: Magnetic resonance imaging-guided focused ultrasound treatment was technically successful in 115 of 123 patients (93.5%). In 8 patients, treatment was not possible because of bowel loops in the beam pathway that could not be mitigated (n = 6), patient movement (n = 1), and system malfunction (n = 1). Mean nonperfused volume ratio was 88% +/- 15% (range, 38%-100%). Mean applied energy level was 5400 +/- 1200 J, and mean number of sonications was 74 +/- 27. No major complications occurred. Two cases of first-degree skin burn resolved within 1 week after the intervention. Of the baseline characteristics analyzed, only the planned treatment volume had a statistically significant impact on nonperfused volume ratio. Conclusions: With technological advancement, the outcome of MRI-guided focused ultrasound treatment in terms of the nonperfused volume ratio can be enhanced with a high safety profile, markedly exceeding results reported in previous clinical trials.

Der zunehmende Einsatz der MRT in der Mammadiagnostik erhoht den Stellenwert geeigneter Biopsieverfahren fur abklarungsbedurftige Befunde, die ausschlieslich im MRT sichtbar werden. MR-gestutzte Biopsieverfahren sind kostenaufwandig und zeitintensiv. Die standardisierte Qualitat der indikationsstellenden MRT-Untersuchung ist deshalb von entscheidender Bedeutung fur den sinnvollen Einsatz MR-gestutzter Biopsieverfahren. Bei geeigneter Indikationsstellung ist die MR-gefuhrte Vakuumbiopsie eine sehr sichere Abklarungsmethode, die auch bei kleinen Herdbefunden eine zuverlassige histopathologische Diagnose erlaubt. Bislang war der Biopsievorgang bei einer MR-gefuhrten Vakuumbiopsie aufgrund der fehlenden Kompatibilitat der Nadeln nicht der Bildgebung zuganglich. Besondere Sorgfalt gilt daher der Uberprufung der Reprasentativitat der Probengewinnung durch postinterventionelle Aufnahmen und die histopathologische Korrelation der bildgebenden Befunde. Kunftige Entwicklungen werden MR-kompatible Biopsienadeln in Herdlokalisation abbilden konnen und damit Lokalisationsunsicherheiten und Zeitaufwand der Methode weiter minimieren. Fur die Abklarung von Zweitherden bei bereits bestehender Operationsindikation bleibt die MR-gestutzte Nadelmarkierung ipsi- und kontralateraler Zweitherde eine technisch einfache und schnell durchfuhrbare Methode.

Bei der chronischen Lungenembolie sind Abschnitte der arteriellen Lungenstrombahn dauerhaft verschlossen. Dies kann zu einer Erhohung des pulmonal-arteriellen Drucks mit den Folgen einer Rechtsherzbelastung und strukturellen Veranderungen der Pulmonalarterien fuhren. Bildmorphologisch nachzuweisen sind Gefasverschlusse (Pulmonalisangiographie, MSCT, MRT) und die Minderperfusion des Lungenparenchyms (Szintigraphie, MSCT, MRT). Nach den bisherigen Empfehlungen gelten fur die Diagnostik der chronischen Lungenembolie die Lungenszintigraphie (Ventilation/Perfusion) und die Pulmonalisangiographie als Methoden der ersten Wahl. Die MSCT und MRT (Angiographie/Perfusion) stellen technische Alternativen dar. Differenzialdiagnostisch sind andere Formen der pulmonalen Hypertonie abzugrenzen. Trotz medikamentoser und chirurgischer Therapiemasnahmen (z. B. pulmonale Thrombendarterektomie) bleibt die Prognose der chronischen Lungenembolie ungunstig.

Rationale and Objectives To evaluate the performance of a prototype computer-aided diagnosis (CAD) tool using artificial intelligence techniques for the detection of pulmonary embolism (PE) and the possible benefit for general radiologists. Materials and Methods Forty multidetector row computed tomography datasets (16/64- channel scanner) using 100 kVp, 100 mAs effective/slice, and 1-mm axial reformats in a low-frequency reconstruction kernel were evaluated. A total of 80 mL iodinated contrast material was injected at a flow rate of 5 mL/seconds. Primarily, six general radiologists marked any PE using a commercially available lung evaluation software with simultaneous, automatic processing by CAD in the background. An expert panel consisting of two chest radiologists analyzed all PE marks from the readers and CAD, also searching for additional finding primarily missed by both, forming the ground truth. Results The ground truth consisted of 212 emboli. Of these, 65 (31%) were centrally and 147 (69%) were peripherally located. The readers detected 157/212 emboli (74%) leading to a sensitivity of 97% (63/65) for central and 70% (103/147) for peripheral emboli with 9 false-positive findings. CAD detected 168/212 emboli (79%), reaching a sensitivity of 74% for central (48/65) and 82%(120/147) for peripheral emboli. A total of 154 CAD candidates were considered as false positives, yielding an average of 3.85 false positives/case. Conclusions The CAD software showed a sensitivity comparable to that of the general radiologists, but with more false positives. CAD detection of findings incremental to the radiologists suggests benefit when used as a second reader. Future versions of CAD have the potential to further increase clinical benefit by improving sensitivity and reducing false marks.

Die MRT des Lungenparenchyms ist wegen des extrem niedrigen Protonengehalts des Lungengewebes und den starken Grenzflachen zwischen Luft und Parenchym prinzipiell sehr problematisch. Allerdings liegt bei pathologischen Lungengewebeveranderungen eine andere Situation vor, da infolge von Odem, Entzundung bzw. Tumorwachstum der Protonengehalt erhoht und die Grenzflachen reduziert sind. Viele Erkrankungen der Lunge fuhren dazu, dass der Patient den Atem nicht lange anzuhalten vermag. Daher sind MRT-Pulssequenzen erforderlich, die eine Datenakquisition in wenigen Sekunden gestatten. Aus technischer Sicht werden die vom CT bekannten Submillimeterschichten vielleicht nie realisierbar sein, sodass sicher auch in Zukunft kleine Rundherde mit einem Durchmesser deutlich unterhalb der Schichtdicke nicht mehr zuverlassig erfasst werden konnen. Auch Verkalkungen sind nicht mit der gleichen Sicherheit wie im CT zu identifizieren. Gleiches gilt fur den Nachweis von Luftsicheln und -einschlussen in Lasionen. Mit Hilfe der parallelen Bildgebung konnen beide Lungenflugel in 1–2 Atemstillstanden mit einer Ortsauflosung von 6 mm in der z-Achse und Submillimeterauflosung in der x- und y-Ebene untersucht werden. Raumzeiten

A novel ureter phantom was developed for investigations of image quality and dose in CT urography. The ureter phantom consisted of a water box (14 cm x 32 cm x 42 cm) with five parallel plastic tubes (diameter 2.7 mm) filled with different concentrations of contrast media (1.88-30 mg iodine/ml). CT density of the tubes and noise of the surrounding water were determined using two multidetector scanners (Philips MX8000 with four rows, Siemens Sensation 16 with 16 rows) with varying tube current-time product (15-100 mAs per slice), voltage (90 kV, 100 kV, 120 kV), pitch (0.875-1.75), and slice thickness (1 mm, 2 mm, 3.2 mm). Contrast-to-noise ratio as a parameter of image quality was correlated with dose (CTDI) and was compared with image evaluation by two radiologists. The CT densities of different concentrations of contrast media and contrast-to-noise ratio were significantly higher when low voltages (90 kV versus 120 kV, 100 kV versus 120 kV) were applied. Smaller slice thickness (1 mm versus 2 mm) did not change CT density but decreased contrast-to-noise ratio due to increased noise. Contrast phantom studies showed favourable effects of low tube voltage on image quality in the low dose range. This may facilitate substantial dose reduction in CT urography.

The objective of this study was to compare the accuracy in staging of various malignant tumors with whole-body magnetic resonance imaging (WB-MRI) using parallel imaging (PAT) and positron emission tomography-computed tomography (PET-CT).In a prospective study, 41 patients withoncologic diseases underwent [F]-fluoro-2-deoxy-D-glucose PET-CT for tumor staging and WB-MRI on a 32-channel-scanner with the use of PAT. Coronal T1w and STIR sequences at 5 body levels, axial HASTE imaging of the lung, and contrast-enhanced T1w sequences of the liver, brain, and abdomen were performed. TNM stage was assessed for both modalities in a separate consensus reading using histologic results and radiologic follow up within 6 months as the standard of reference.Three primary and 4 recurrent tumors were detected; one recurrent tumor was missed with WB-MRI. Sixty benign and 60 malignant lymph nodes were detected with a sensitivity of 98% and specificity of 83% for PET-CT and 80%/75% for WB-MRI, respectively. One hundred ninety-one malignant and 77 benign distant lesions were detected with a sensitivity/specificity of 82% for PET-CT and 96%/82% for WB-MRI. Accuracy for correct TNM staging was 96% for PET-CT and 91% for WB-MRI.WB-MRI and PET-CT are reliable imaging modalities for tumor staging. WB-MRI is highly sensitive in detecting distant metastases; PET-CT is superior in lymph node staging. PAT makes high-resolution WB-MRI feasible within less than 1 hour.

Computed tomography (CT) has become an increasingly accepted technique and is the method of choice for direct visualization of pulmonary emboli (PE). The quantitative assessment of tissue perfusion may yield more important information for patient management than the direct visualization of emboli by CT alone. Several attempts have been made to measure pulmonary blood flow by administration of intravenous contrast material. In this article, various experimental CT approaches for visualization and quantification of pulmonary perfusion are discussed. Ideally, CT will be able to provide both structural and functional information. Simple measurement of lung density before and after intravenous contrast delivery has been performed with single-slice CT technology using region-of-interest methodology. For electron-beam CT, a repeated data acquisition on a 7.6-cm lung volume has proven to be technically feasible. Using such dynamic scanning, reduced blood flow was observed in occluded lung segments. Color-encoded parenchymal density distribution in the axial, coronal, and sagittal planes was derived from thin collimation data sets using four-row multi-slice spiral CT (MSCT). Initial animal data from 16-slice MSCT offer a real CT-subtraction technique of the entire chest for the first time.

Multilokulare Metastasen von soliden Tumoren stellen haufig ein diagnostisches wie therapeutisches Problem dar. Sie entziehen sich haufig einer kurativen, chirurgischen Therapie. In diesen Fallen konnen nicht selten die Verfahren der minimal-invasiven, interventionellen Therapie eine sinnvolle Alternative sein. Problematisch ist, dass eine vorbehandelte Lasion haufig allein mit der morphologischen Bildgebung nicht in ihrer Vitalitat beurteilt wird. Die Kombination der Computertomographie mit der Positronenemissionstomographie kann insbesondere zur Planung, Steuerung und Nachkontrolle sehr wertvoll sein. So konnte die Indikation fur eine Intervention bestatigt oder auch verworfen werden. Die PET/CT erwies sich auch fur das Follow-up als geeignet. Daruber hinaus lieferte die PET/CT wichtige Informationen fur die Planung und Steuerung der interventionellen Verfahren, wie der Radiofrequenzablation und der Vertebroplastie. Ob dadurch auch eine hohere Ansprechrate und ein langeres Uberleben der Patienten erreicht werden kann, ist bisher nicht geklart.

Purpose To compare high-resolution T2-weigthed images of the liver with and without integrated parallel acquisition techniques (iPAT) using either breath-hold sequences in combination with prospective acquisition motion correction (PACE) or respiratory triggering. Materials and Methods Ten volunteers and 10 patients underwent each four different high-resolution fast spin echo (FSE) T2-weigthed sequences with 5 mm slice thickness and a full 320 matrix: a multi-breath-hold FSE sequence with and without iPAT and PACE and a respiratory-triggered FSE sequence with and without iPAT. Image quality was rated with a five-point scale by two independent readers. Signal intensity measurements were performed on a water phantom. Results The sequences with iPAT required a substantially shorter acquisition time without loss of image quality. Overall image quality was rated equal for all sequences by both readers. Image time for nine slices with iPAT was 13 seconds (19 seconds without iPAT) with multi-breath-hold and on average 4:00 minutes (7:02 minutes without iPAT) with respiratory triggering. Imaging with the PACE technique resulted in more correct positioning of the image stacks. Conclusion T2-weighted fast imaging with iPAT is feasible and results in high-quality images within a short acquisition time. Overall image quality is not negatively affected by iPAT. J. Magn. Reson. Imaging 2004;20:443–450. © 2004 Wiley-Liss, Inc.

Recent years have seen an increasing importance of computed tomography (CT) in the diagnosis of pulmonary embolism (PE), mainly brought about by the advent of fast CT image acquisition techniques (Kauczor et al. 1999; Remy-Jardin and Remy 1999; Schoepf et al. 2000a, b). Competing imaging modalities are in decline: nuclear scanning allows functional assessment of lung ventilation and perfusion but lacks spatial resolution (PIOPED-Investigators 1990). Once the first line of defense in the diagnostic algorithm of PE, this modality is currently withdrawing to diagnostic niches due to limited availability, poor inter-observer correlation (Blachere et al. 2000), and notorious lack of specificity (PIOPED-Investigators 1990). Pulmonary angiography, the one-time gold standard for the diagnosis of PE, is becoming increasingly tarnished (Diffin et al. 1998; Stein et al. 1999). Its ability to detect isolated peripheral emboli does not seem to exceed the accuracy of computed tomography (Diffin et al. 1998; Stein et al. 1999).

Die Mehrschichtcomputertomographie (MSCT) hat seit ihrer Einfuhrung vor wenigen Jahren eine weite Verbreitung erfahren und sich bei zahlreichen Indikationen als leistungsfahiges Verfahren etabliert. Problematisch ist die z. T. deutlich hohere Strahlenexposition der Patienten, sowohl im Vergleich zur Einzelschicht-CT wie auch im Vergleich zu anderen diagnostischen Verfahren.

Fragestellung. Ziel war die Implementierung eines Protokolls fur die abdominelle CT-Angiographie an einem 16-Detektorzeilen-CT. Zudem erfolgte der Vergleich mit der selektiven Katheterangiographie.

Fragestellung. Evaluation der Bildqualitat der koronaren CT-Angiographie (CTA) mit einem 16-Mehrzeilen-Spiral-CT (MSCT), bei einer Rekonstruktion von 0,75-mm-Schichten fur optimale raumliche Auflosung und Vergleich mit 1,3-mm-Schichten, die die raumliche Auflosung eines 4-MSCT simulieren.

To assess the technical and clinical results of MRgFUS treatment and factors affecting clinical treatment success. A total of 252 women (mean age, 42.1 ± 6.9 years) with uterine fibroids underwent MRgFUS. All patients underwent MRI before treatment. Results were evaluated with respect to post-treatment nonperfused volume (NPV), symptom severity score (SSS), reintervention rate, pregnancy and safety data. NPV ratio was significantly higher in fibroids characterized by low signal intensity in contrast-enhanced T1-weighted fat saturated MR images and in fibroids distant from the spine (>3 cm). NPV ratio was lower in fibroids with septations, with subserosal component and in skin-distant fibroids (p

To comprehensively assess thoracic anatomy and pulmonary microcirculation in pulmonary embolism by using computed tomographic (CT) angiography of the pulmonary arteries combined with functional CT imaging of blood flow.Twenty-two patients suspected of having acute pulmonary embolism underwent contrast material-enhanced thin-section electron-beam CT angiography of the pulmonary arteries. In addition, in each patient, a dynamic multisection blood flow CT study was performed on a 7.6-cm lung volume with electrocardiographic gating. Pulmonary blood flow was calculated, and perfusion parameters were visualized on color-coded maps. The color-coded maps and CT angiograms were independently evaluated, segment by segment, by two readers for perfusion deficits and the presence of clots, respectively. The results were compared.Mean pulmonary blood flow was 0.63 mL/min/mL in the occluded segments versus 2.27 mL/min/mL in the nonoccluded segments (P: =.001). The sensitivity and specificity of perfusion maps for the presence of segmental pulmonary embolism compared with those of CT angiography were 75.4% and 82.3%, respectively, with positive and negative predictive values of 79.6% and 84.7%, respectively. The false-negative findings were caused mainly by partial occlusion of vessels. In eight patients, a substantial alternative or additional pathologic entity was diagnosed.By combining CT angiography and dynamic CT imaging, a comprehensive and noninvasive diagnosis of thoracic structure and function is feasible with a single modality.

Objective The radiation exposure of a dual-source-64-channel multi-detector-computed-tomography-scanner (Somatom-Defintion, Siemens, Germany) was assessed in a phantom-study performing coronary-CT-angiography (CTCA) in comparison to patients’ data randomly selected from routine scanning. Methods 240 CT-acquisitions of a computed tomography dose index (CTDI)-phantom (PTW, Freiburg, Germany) were performed using a synthetically generated Electrocardiography (ECG)-signal with variable heart rates (30–180 beats per minute (bpm)). 120 measurements were acquired using continuous tube-output; 120 measurements were performed using ECG-synchronized tube-modulation. The pulsing window was set at minimum duration at 65% of the cardiac cycle between 30 and 75 bpm. From 90–180 bpm the pulsing window was set at 30–70% of the cardiac cycle. Automated pitch adaptation was always used. A comparison between phantom CTDI and two patient groups’ CTDI corresponding to the two pulsing groups was performed. Results Without ECG-tube-modulation CDTI-values were affected by heart-rate-changes resulting in 85.7 mGray (mGy) at 30 and 45 bpm, 65.5 mGy/60 bpm, 54.7 mGy/75 bpm, 46.5 mGy/90 bpm, 34.2 mGy/120 bpm, 27.0 mGy/150 bpm and 22.1 mGy/180 bpm equal to effective doses between 14.5 mSievert (mSv) at 30/45 bpm and 3.6 mSv at 180 bpm. Using ECG-tube-modulation these CTDI-values resulted: 32.6 mGy/30 bpm, 36.6 mGy/45 bpm, 31.4 mGy/60 bpm, 26.8 mGy/75 bpm, 23.7 mGy/90 bpm, 19.4 mGy/120 bpm, 17.2 mGy/150 bpm and 15.6 mGy/180 bpm equal to effective doses between 5.5 mSv at 30 bpm and 2.6 mSv at 180 bpm. Significant CTDI-differences were found between patients with lower/moderate and higher heart rates in comparison to the phantom CTDI-results. Conclusions Dual source CTCA is particularly dose efficient at high heart rates when automated pitch adaptation, especially in combination with ECG-based tube-modulation is used. However in clinical routine scanning for patients with higher heart rates and corresponding enlarged pulsing window a significant different dose resulted.

To compare parallel acquisition magnetic resonance (MR) imaging with thin-section helical computed tomography (CT) for depiction of pulmonary abnormalities suggestive of pneumonia in immunocompromised patients.The institutional review board approved this study; prior consent was obtained. Thirty consecutive neutropenic patients (10 women, 20 men; mean age, 51 years +/- 15 [standard deviation]; range, 25-75 years) with fever of unknown origin or clinical signs and symptoms of lung infection were examined with breath-hold single-shot half-Fourier turbo spin-echo MR imaging. To reduce image blurring and increase MR signal in the lungs, the echo time was shortened with generalized autocalibrating partially parallel acquisition (GRAPPA). Patients underwent thoracic CT (four detector rows and 1-mm section thickness [4 x 1 mm]; pitch, 6) as reference standard. Pulmonary abnormalities (ill-defined nodules, ground-glass opacity areas, and consolidation), their location and distribution, and lesion characteristics were analyzed at MR imaging by three readers, blinded to results of CT, in consensus. Frequencies were calculated for each feature; paired Wilcoxon rank sum test was used to examine whether differences between CT and MR imaging features were statistically significant (alpha.05). Bonferroni adjustments were performed. Overall sensitivity, specificity, and positive and negative predictive values were determined.Twenty-two patients had pulmonary abnormalities at CT. In 21 (95%) patients, pneumonia was correctly diagnosed with MR imaging. One false-negative finding occurred in a patient with ill-defined nodules smaller than 1 cm at CT. One false-positive finding with MR imaging was the result of blurring and respiratory artifacts (sensitivity, 95%; specificity, 88%; positive predictive value, 95%; negative predictive value, 88%). There was no significant difference in lesion location and distribution.With parallel imaging (GRAPPA technique) and fast MR imaging, detection of pulmonary abnormalities is almost as good as with CT. MR imaging has a slight disadvantage in its lower capability to assist in characterization of specific internal features, such as cavitations.

The aim of the study was to implement an abdominal CT angiography protocol using 100 kVp and to compare SNR and CNR, as well as subjective image quality, to a standard CT angiography protocol using 120 kVp on a 16 detector-row CT scanner. Forty-eight patients were referred for routine abdominal CT angiography on a 16 detector-row CT scanner. Patients were scanned using either 120 or 100 kVp at constant mAs settings. Vessel opacification was provided by automated contrast injection using similar injection protocols. Density measurements were performed along the aorto-iliac axis with SNR and CNR calculation. In addition, the estimated effective patient radiation dose was calculated. Results of both protocols were compared. The 100-kVp protocol (432+/-80 HU) showed a significantly higher vessel density than the 120-kVp (333+/-90 HU; P

The aim of this study was to reduce radiation exposure in multislice CT (MSCT) coronary artery calcium screening using different tube settings, and to determinate its impact on the detection and quantification of coronary artery calcification. Forty-eight patients underwent routine MSCT coronary artery calcium scoring (Somatom VolumeZoom, Siemens, Forchheim, Germany) with retrospective ECG-gated data acquisition. Scanning was performed with a 4 x 2.5-mm collimation. In each patient data acquisition was performed twice using tube settings of 120 kVp with 133 mAs (protocol 1) and of 80 kVp with 300 mAs (protocol 2). Together with the 80-kVp protocol additional online ECG-related tube current modulation (ECG pulsing) was used. Three-millimeter overlapping slices (increment 1.5 mm) were calculated for each data set. Semi-automated calcium quantification was performed calculating absolute Ca-hydroxylapatite mass. In addition to patient examinations, the radiation exposure for both protocols was evaluated using computed tomography dose index (CTDI) phantom measurements. Protocol 2 showed a significantly lower patient radiation exposure than protocol 1 (0.72 vs 2.04 mSv; p0.0001). The CTDI phantom measurements revealed a 65% reduction of radiation dose. Calcium scoring results of both protocols showed a high correlation ( r=0.99; p0.0001) for absolute Ca-Hydroxylapatite mass measurements. Using 80-kVp protocols patient radiation exposure can be significantly reduced in MSCT coronary artery calcium screening without affecting the detection and quantification of coronary artery calcification; therefore, this technique should be used with retrospective ECG-gated cardiac CT examinations in patients with regular sinus rhythm.

In recent years CT has been established as the method of choice for the diagnosis of central pulmonary embolism (PE) to the level of the segmental arteries. The key advantage of CT over competing modalities is the reliable detection of relevant alternative or additional disease causing the patient's symptoms. Although the clinical relevance of isolated peripheral emboli remains unclear, the alleged poor sensitivity of CT for the detection of such small clots has to date prevented the acceptance of CT as the gold standard for diagnosing PE. With the advent of multislice CT we can now cover the entire chest of a patient with 1-mm slices within one breath-hold. In comparison with thicker sections, the detection rate of subsegmental emboli can be significantly increased with 1-mm slices. In addition, the interobserver correlation which can be achieved with 1-mm sections by far exceeds the reproducibility of competing modalities. Meanwhile use of multislice CT for a combined diagnosis of PE and deep venous thrombosis with the same modality appears to be clinically accepted. In the vast majority of patients who receive a combined thoracic and venous multislice CT examination the scan either confirms the suspected diagnosis or reveals relevant alternative or additional disease. The therapeutic regimen is usually chosen based on the functional effect of embolic vascular occlusion. With the advent of fast CT scanning techniques, also functional parameters of lung perfusion can be non-invasively assessed by CT imaging. These advantages let multislice CT appear as an attractive modality for a non-invasive, fast, accurate, and comprehensive diagnosis of PE, its causes, effects, and differential diagnoses.