Influence of device-assisted suction against resistance (Mueller maneuver) on image quality in CTPA for suspected lung embolism.
Pulmonary artery
Pulmonary embolism
Radiology
Journal
European radiology
ISSN: 1432-1084
Titre abrégé: Eur Radiol
Pays: Germany
ID NLM: 9114774
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
03
01
2023
accepted:
12
04
2023
revised:
10
04
2023
medline:
27
10
2023
pubmed:
20
6
2023
entrez:
20
6
2023
Statut:
ppublish
Résumé
To investigate the effect of a device-assisted suction against resistance Mueller maneuver (MM) on transient interruption of contrast (TIC) in the aorta and pulmonary trunk (PT) on computed tomography pulmonary angiogram (CTPA). In this prospective single-center study, 150 patients with suspected pulmonary artery embolism were assigned randomly with two different breathing maneuvers (Mueller maneuver (MM) or standard end-inspiratory breath-hold command (SBC)) during routine CTPA. The MM was performed using a patented prototype (Contrast Booster™) which allows both the patient by means of visual feedback and the medical staff in the CT scanning room to monitor whether the patient is sucking sufficiently or not. Mean Hounsfield attenuation in descending aorta and PT was measured and compared. Overall, patients with MM showed an attenuation of 338.24 HU in the pulmonary trunk, compared to 313.71 HU in SBC (p = 0.157). In the aorta, the values for MM were lower compared to SBC (134.42 HU vs. 177.83 HU, p = 0.001). The TP-aortic ratio was significantly higher in the MM group at 3.86 compared to the SBC group at 2.26, p = 0.001. TIC phenomenon was absent in the MM group, whereas it was present in 9 patients (12.3%) in the SBC group (p = 0.005). Overall contrast was better on all levels for MM (p < 0.001). The presence of breathing artifacts was higher in the MM group (48.1% vs. 30.1%, p = 0.038), without clinical consequence. Performing the MM with the application of the prototype is an effective way of preventing the TIC phenomenon during i.v. contrast-enhanced CTPA scanning compared to the standard end-inspiratory breathing command. Compared to standard end-inspiratory breathing command, the device-assisted Mueller maneuver (MM) improves contrast enhancement and prevents the transient interruption of contrast (TIC) phenomenon in CTPA. Therefore, it may offer optimized diagnostic workup and timely treatment for patients with pulmonary embolism. • Transient interruption of contrast (TIC) may impair image quality in CTPA. • Mueller Maneuver using a device prototype could lower the rate of TIC. • Device application in clinical routine may increase diagnostic accuracy.
Identifiants
pubmed: 37338555
doi: 10.1007/s00330-023-09834-3
pii: 10.1007/s00330-023-09834-3
pmc: PMC10598181
doi:
Substances chimiques
Contrast Media
0
Types de publication
Randomized Controlled Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
7840-7848Informations de copyright
© 2023. The Author(s).
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