Detection of pulmonary fat embolism with dual-energy CT: an experimental study in rabbits

• Published in: European radiology Vol. 27; no. 4; pp. 1377 - 1385
• Main Authors: Tang, Chun Xiang, Zhou, Chang Sheng, Zhao, Yan E., Schoepf, U. Joseph, Mangold, Stefanie, Ball, B. Devon, Han, Zong Hong, Qi, Li, Zhang, Long Jiang, Lu, Guang Ming
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2017; Springer Nature B.V
• Subjects: Accuracy; Angiography - methods; Animals; Blood; Catheters; Chest; Diagnostic Radiology; Disease Models, Animal; Embolism, Fat - diagnostic imaging; Embolisms; Energy; Humans; Imaging; Internal Medicine; Interventional Radiology; Ketamine; Medical imaging; Medicine; Medicine & Public Health; Neuroradiology; Pulmonary Artery - diagnostic imaging; Pulmonary Embolism - diagnostic imaging; Rabbits; Radiography, Dual-Energy Scanned Projection - methods; Radiology; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed - methods; Ultrasound; China; Animal model; Dual-energy CT; Lung perfusion blood volume; CT pulmonary angiography; Pulmonary fat embolism
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-016-4512-2

Objectives To evaluate the use of dual-energy CT imaging of the lung perfused blood volume (PBV) for the detection of pulmonary fat embolism (PFE). Methods Dual-energy CT was performed in 24 rabbits before and 1 hour, 1 day, 4 days and 7 days after artificial induction of PFE via the right ear vein. CT pulmonary angiography (CTPA) and lung PBV images were evaluated by two radiologists, who recorded the presence, number, and location of PFE on a per-lobe basis. Sensitivity, specificity, and accuracy of CTPA and lung PBV for detecting PFE were calculated using histopathological evaluation as the reference standard. Results A total of 144 lung lobes in 24 rabbits were evaluated and 70 fat emboli were detected on histopathological analysis. The overall sensitivity, specificity and accuracy were 25.4 %, 98.6 %, and 62.5 % for CTPA, and 82.6 %, 76.0 %, and 79.2 % for lung PBV. Higher sensitivity ( p  < 0.001) and accuracy ( p  < 0.01), but lower specificity ( p  < 0.001), were found for lung PBV compared with CTPA. Dual-energy CT can detect PFE earlier than CTPA (all p  < 0.01). Conclusion Dual-energy CT provided higher sensitivity and accuracy in the detection of PFE as well as earlier detection compared with conventional CTPA in this animal model study. Key points • Fat embolism occurs commonly in patients with traumatic bone injury . • Dual - energy CT improves diagnostic performance for pulmonary fat embolism detection . • Dual - energy CT can detect pulmonary fat embolism earlier than CTPA .