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Dual-energy spectral CT imaging of pulmonary embolism with Mycoplasma pneumoniae pneumonia in children

  • Chest Radiology
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Background

Pulmonary embolism (PE) associated with Mycoplasma pneumoniae pneumonia (MPP) in children has already attracted more attention. CT pulmonary angiography (CTPA) has been the preferred method for diagnosing PE, but it has some limitations, especially for children. Dual-energy spectral CT has been used in diagnosing PE in adults.

Purpose

To evaluate the application of dual-energy spectral CT in diagnosing PE in children with MPP.

Materials and methods

Eighty-three children with MPP and highly suspected PE, underwent CTPA with spectral imaging mode, 25 children were diagnosis with PE. Noise, clot-to-artery contrast-to-noise ratio, image quality and diagnosis confidence were calculated and assessed on nine monochromatic image sets (40 to 80 keV). CTPA images were observed for the presence, localization and embolic degrees of PE. Clots were divided into intra- and extra-consolidation clots. For extra-consolidation clots, iodine concentration (IC) of perfusion defects and normal lung, perfusion defects of four children before and after the treatment were measured and compared. For intra-consolidation clots, IC of consolidation areas with clots and consolidation areas without clot were measured and compared.

Results

The optimal energy level for detecting PE in children was 55 keV. 116 clots (29 extra-consolidations) were found, IC of defect regions was 0.69 ± 0.28 mg/mL (extra-consolidations) and 0.90 ± 0.23 mg/mL (intra-consolidations), both significantly lower than the 2.76 ± 0.45 mg/mL in normal lungs and 10.25 ± 1.76 mg/mL in consolidations without clots (P < 0.001). Significant difference was found in the presence or absence of perfusion defects between occlusive clots and nonocclusive clots (P < 0.001). IC of the perfusion defects significantly increased after treatment (P < 0.001).

Conclusions

In dual-energy spectral CTPA, 55 keV images optimize PE detection for children, and MD images quantify pulmonary blood flow of PE, and may help to detect small clots and quantify embolic degrees.

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Availability of data and material

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

Code availability

N/A.

References

  1. Carpenter SL, Richardson T, Hall M (2018) Increasing rate of pulmonary embolism diagnosed in hospitalized children in the United States from 2001 to 2014. Blood Adv 2(12):1403–1408

    Article  Google Scholar 

  2. van Ommen CH, Heijboer H, Büller HR, Hirasing RA, Heijmans HSA, Peters M (2001) Venous thromboembolism in childhood: a prospective two-year registry in The Netherlands. J Pediatr 139(5):676–681

    Article  Google Scholar 

  3. Tamura A, Matsubara K, Tanaka T, Nigami H, Yura K, Fukaya T (2008) Methylprednisolone pulse therapy for refractory Mycoplasma pneumoniae pneumonia in children. J Infect 57(3):223–228

    Article  Google Scholar 

  4. Liu J, He R, Wu R, Wang B, Xu H, Zhang Y, Li H, Zhao S (2020) Mycoplasma pneumoniae pneumonia associated thrombosis at Beijing Children’s hospital. BMC Infect Dis 20(1):51

    Article  CAS  Google Scholar 

  5. Huang Z, Zhang B, Cheng B (2016) Mycoplasma pneumoniae pneumonia complicated with pulmonary embolism: a systematic analysis of published case reports. Int J Clin Exp Med 9(6):11574–11581

    Google Scholar 

  6. Raja AS, Greenberg JO, Qaseem A, Denberg TD, Fitterman N, Schuur JD (2015) Clinical Guidelines Committee of the American College of P: evaluation of patients with suspected acute pulmonary embolism: best practice advice from the clinical guidelines committee of the American College of Physicians. Ann Intern Med 163(9):701–711

    Article  Google Scholar 

  7. Schoepf UJ, Costello P (2004) CT Angiography for diagnosis of pulmonary embolism: state of the Ar. Radiology 230(2):329–337

    Article  Google Scholar 

  8. Kritsaneepaiboon S, Lee EY, Zurakowski D, Strauss KJ, Boiselle PM (2009) MDCT pulmonary angiography evaluation of pulmonary embolism in children. AJR Am J Roentgenol 192(5):1246–1252

    Article  Google Scholar 

  9. Ritchie G, McGurk S, McCreath C, Graham C, Murchison JT (2007) Prospective evaluation of unsuspected pulmonary embolism on contrast enhanced multidetector CT (MDCT) scanning. Thorax 62(6):536–540

    Article  Google Scholar 

  10. Geyer LL, Scherr M, Korner M, Wirth S, Deak P, Reiser MF, Linsenmaier U (2012) Imaging of acute pulmonary embolism using a dual energy CT system with rapid kVp switching: initial results. Eur J Radiol 81(12):3711–3718

    Article  Google Scholar 

  11. Wu HW, Cheng JJ, Li JY, Yin Y, Hua J, Xu JR (2012) Pulmonary embolism detection and characterization through quantitative iodine-based material decomposition images with spectral computed tomography imaging.pdf. Investig Radiol 47(1):85

  12. Cui Y, Gao SY, Wang ZL, Li XT, Sun YS, Tang L, Zhang XP (2012) Which should be the routine cross-sectional reconstruction mode in spectral CT imaging: monochromatic or polychromatic? Br J Radiol 85(1018):e887–e890

    Article  CAS  Google Scholar 

  13. Zhang D, Li X, Liu B (2011) Objective characterization of GE discovery CT750 HD scanner: gemstone spectral imaging mode. Med Phys 38(3):1178–1188

    Article  Google Scholar 

  14. Cheng J, Yin Y, Wu H, Zhang Q, Hua J, Hua X, Xu J (2013) Optimal monochromatic energy levels in spectral CT pulmonary angiography for the evaluation of pulmonary embolism. PLoS One 8(5):e63140

  15. Pelland-Marcotte M-C, Tucker C, Klaassen A, Avila ML, Amid A, Amiri N, Williams S, Halton J, Brandão LR (2019) Outcomes and risk factors of massive and submassive pulmonary embolism in children: a retrospective cohort study. Lancet Haematol 6(3):e144–e153

    Article  Google Scholar 

  16. Pontana F, Faivre J-B, Remy-Jardin M, Flohr T, Schmidt B, Tacelli N, Pansini V, Remy J (2008) Lung perfusion with dual-energy multidetector-row CT (MDCT). Acad Radiol 15(12):1494–1504

    Article  Google Scholar 

  17. Clark AR, Milne D, Wilsher M, Burrowes KS, Bajaj M, Tawhai MH (2014) Lack of functional information explains the poor performance of “clot load scores” at predicting outcome in acute pulmonary embolism. Respir Physiol Neurobiol 190:1–13

    Article  CAS  Google Scholar 

  18. Brown SM, Padley S, Bush A, Cummins D, Davidson S, Buchdahl R (2008) Mycoplasma pneumonia and pulmonary embolism in a child due to acquired prothrombotic factors. Pediatr Pulmonol 43(2):200–202

    Article  Google Scholar 

  19. Diederich S, Theegarten D, Stamatis G (2006) R L: Solitary pulmonary nodule with growth and constrast enhancement at CT: Inflammatory pseudotumour as an unusual benign cause. Br J Radiol 79(937):76–78

    Article  CAS  Google Scholar 

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Acknowledgements

This study was supported by The Special Fund of The Pediatric Medical Coordinated Development Center of Beijing Municipal Administration (XTCX201814 and XTZD20180104), and Advanced Innovation Center of Beijing (BHME-201908).

Funding

This study was supported by The Special Fund of The Pediatric Medical Coordinated Development Center of Beijing Municipal Administration (XTCX201814 and XTZD20180104), and Advanced Innovation Center of Beijing (BHME-201908).

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Authors and Affiliations

  1. Department of Radiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, No.56, Nanlishi Road, Xicheng District, 100045, Beijing, China

    Lixin Yang, Jihang Sun & Yun Peng

  2. GE Healthcare, Milwaukee, WI, USA

    Jianying Li

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  1. Lixin Yang
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  2. Jihang Sun
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Correspondence to Yun Peng.

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The author of this manuscript declares relationship with the following companies: GE Healthcare (J. L.). Other authors declare that they have no conflict of interest.

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The present study was approved by the Ethics Committee of Beijing Children’s Hospital.

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Yang, L., Sun, J., Li, J. et al. Dual-energy spectral CT imaging of pulmonary embolism with Mycoplasma pneumoniae pneumonia in children. Radiol med 127, 154–161 (2022). https://doi.org/10.1007/s11547-021-01442-9

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  • DOI: https://doi.org/10.1007/s11547-021-01442-9

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