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Multi–Detector Row CT Angiography of Pulmonary Circulation with Gadolinium-based Contrast Agents: Prospective Evaluation in 60 Patients¹

¹ From the Departments of Radiology (M.R., J. Bahepar, J. Bruzzi, J.R.), Pulmonology (J.J.L.), and Nephrology (P.D.), Calmette Hospital, University Center of Lille, Boulevard Jules Leclerc, 59037 Lille, France; Schering SA, Lys-Lez-Lannoy, France (O.E.); and Department of Medical Statistics, University of Lille, Lille, France (V.D., A.D.). Received December 11, 2004; revision requested February 4, 2005; revision received April 1; accepted April 15; final version accepted May 26. Address correspondence to M.R. (e-mail: mremy-jardin{at}chru-lille.fr).

View larger version (125K): [in a new window]   Figure 1: Transverse gadolinium-enhanced CT angiogram at level of right middle lobe bronchus in a 72-year-old man with a history of anaphylactic reaction to penicillin (weight, 70 kg; height, 168 cm) to follow-up right-sided mesothelioma (80 kV; 80 mAs; gadolinium dose, 0.3 mmol/kg; volume administered, 42 mL). Image shows excellent opacification of pulmonary arteries (right lower lobe pulmonary artery [large arrow], 265 HU; left lower lobe segmental pulmonary arteries [small arrows], 237 HU), which enables precise delineation of the right hilar tumoral extent. Note excellent degree of opacification of aorta, pulmonary veins, and left atrium, as well as additional presence of right lung retraction and abnormal right pleural thickening ().

View larger version (125K): [in a new window]   Figure 2a: Transverse gadolinium-enhanced multi–detector row CT angiograms obtained in a 75-year-old man (weight, 57 kg; height, 172 cm) for follow-up of right upper lobe carcinoma in the context of chemotherapy-related renal failure (80 kV; 80 mAs; gadolinium dose, 0.4 mmol/kg; volume administered, 46 mL). Scans obtained at the levels of the (a) carina and (b) right bronchus intermedius show excellent opacification of central () (273 HU) and peripheral (segmental [large arrow] and subsegmental [small arrows]) (277 HU) pulmonary arteries despite the presence of large pericardial and bilateral pleural effusions.

View larger version (124K): [in a new window]   Figure 2b: Transverse gadolinium-enhanced multi–detector row CT angiograms obtained in a 75-year-old man (weight, 57 kg; height, 172 cm) for follow-up of right upper lobe carcinoma in the context of chemotherapy-related renal failure (80 kV; 80 mAs; gadolinium dose, 0.4 mmol/kg; volume administered, 46 mL). Scans obtained at the levels of the (a) carina and (b) right bronchus intermedius show excellent opacification of central () (273 HU) and peripheral (segmental [large arrow] and subsegmental [small arrows]) (277 HU) pulmonary arteries despite the presence of large pericardial and bilateral pleural effusions.

View larger version (125K): [in a new window]   Figure 3a: Transverse gadolinium-enhanced multi–detector row CT angiograms obtained in a 64-year-old man (weight, 88 kg; height, 175 cm) suspected of having acute pulmonary embolism in the context of lung carcinoma and chemotherapy-related renal failure (120 kV; 100 mAs; gadolinium dose, 0.3 mmol/kg; volume administered, 53 mL). Scans obtained at the levels of the (a) tracheal bifurcation, (b) right bronchus intermedius, and (c) lower lobes show the overall good level of enhancement within pulmonary arteries (pulmonary trunk, 124 HU), which enables depiction of numerous filling defects (arrows) (72 HU) surrounded by contrast-enhanced blood (142–162 HU).

View larger version (129K): [in a new window]   Figure 3b: Transverse gadolinium-enhanced multi–detector row CT angiograms obtained in a 64-year-old man (weight, 88 kg; height, 175 cm) suspected of having acute pulmonary embolism in the context of lung carcinoma and chemotherapy-related renal failure (120 kV; 100 mAs; gadolinium dose, 0.3 mmol/kg; volume administered, 53 mL). Scans obtained at the levels of the (a) tracheal bifurcation, (b) right bronchus intermedius, and (c) lower lobes show the overall good level of enhancement within pulmonary arteries (pulmonary trunk, 124 HU), which enables depiction of numerous filling defects (arrows) (72 HU) surrounded by contrast-enhanced blood (142–162 HU).

View larger version (145K): [in a new window]   Figure 3c: Transverse gadolinium-enhanced multi–detector row CT angiograms obtained in a 64-year-old man (weight, 88 kg; height, 175 cm) suspected of having acute pulmonary embolism in the context of lung carcinoma and chemotherapy-related renal failure (120 kV; 100 mAs; gadolinium dose, 0.3 mmol/kg; volume administered, 53 mL). Scans obtained at the levels of the (a) tracheal bifurcation, (b) right bronchus intermedius, and (c) lower lobes show the overall good level of enhancement within pulmonary arteries (pulmonary trunk, 124 HU), which enables depiction of numerous filling defects (arrows) (72 HU) surrounded by contrast-enhanced blood (142–162 HU).

View larger version (99K): [in a new window]   Figure 4a: Transverse gadolinium-enhanced multi–detector row CT angiograms obtained in a 51-year-old woman (weight, 57 kg; height, 160 cm) suspected of having acute pulmonary embolism in the context of previous laryngeal edema after administration of iodinated contrast material (80 kV; 80 mAs; gadolinium dose, 0.3 mmol/kg; volume administered, 34 mL). Scans obtained at the levels of the (a) right bronchus intermedius, (b) right middle lobe bronchus, and (c) lower lung lobes depict almost complete filling defects at the level of the right pulmonary arterial bed (arrow). Note the presence of pseudo–filling defects within left-sided pulmonary arteries, which are most likely to be linked to image noise and dilution of gadolinium from unenhanced blood owing to the limited amount of gadolinium-based contrast material administered.

View larger version (99K): [in a new window]   Figure 4b: Transverse gadolinium-enhanced multi–detector row CT angiograms obtained in a 51-year-old woman (weight, 57 kg; height, 160 cm) suspected of having acute pulmonary embolism in the context of previous laryngeal edema after administration of iodinated contrast material (80 kV; 80 mAs; gadolinium dose, 0.3 mmol/kg; volume administered, 34 mL). Scans obtained at the levels of the (a) right bronchus intermedius, (b) right middle lobe bronchus, and (c) lower lung lobes depict almost complete filling defects at the level of the right pulmonary arterial bed (arrow). Note the presence of pseudo–filling defects within left-sided pulmonary arteries, which are most likely to be linked to image noise and dilution of gadolinium from unenhanced blood owing to the limited amount of gadolinium-based contrast material administered.

View larger version (98K): [in a new window]   Figure 4c: Transverse gadolinium-enhanced multi–detector row CT angiograms obtained in a 51-year-old woman (weight, 57 kg; height, 160 cm) suspected of having acute pulmonary embolism in the context of previous laryngeal edema after administration of iodinated contrast material (80 kV; 80 mAs; gadolinium dose, 0.3 mmol/kg; volume administered, 34 mL). Scans obtained at the levels of the (a) right bronchus intermedius, (b) right middle lobe bronchus, and (c) lower lung lobes depict almost complete filling defects at the level of the right pulmonary arterial bed (arrow). Note the presence of pseudo–filling defects within left-sided pulmonary arteries, which are most likely to be linked to image noise and dilution of gadolinium from unenhanced blood owing to the limited amount of gadolinium-based contrast material administered.