IQon Spectral CT in the Diagnosis of Pulmonary Embolism and Left Ventricular Thrombus

By Gopal Punjabi, MD

An elderly male presented with nonspecific symptoms. This patient had poor kidney function, and the clinical team wanted to rule out pulmonary embolism (PE). However, they also wanted to investigate the aorta and to scan the chest, abdomen, and pelvis with a little contrast. A CT exam on the IQon Spectral CT scanner from Philips was ordered.

Approximately 56mL of Omnipaque 350 was administered to the patient and a color iodine map was generated with the IQon and superimposed on the CT image. The attenuation of iodine was increased on lower kV images, showing high-quality opacification of the pulmonary arterial system and the aorta.

A clot was identified in the right lower-lobe pulmonary artery. Spectral CT imaging of perfusion in the lung helped to identify a defect in the right lower lobe, as well as a subtle filling defect in the left lower lobe pulmonary artery. However, the patient had an implant, a cardioverter defibrillator (ICD), resulting in some artifacts.

The left ventricle also showed a filling defect. When magnified, it showed no iodine uptake, consistent with a thrombus. A pulmonary embolism and left ventricular thrombus were diagnosed with a high degree of confidence on a low-contrast scan using spectral CT.

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IQon Spectral CT in the Diagnosis of Pulmonary Embolism and Left Ventricular Thrombus.  Appl Radiol. 

December 16, 2021
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