Post on 05-Jul-2018
8/16/2019 Insidental Deteksi Emboli paru pada MDCT Rutin Dada.docx
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Journal Reading
Incidental Detection of Pulmonary Emboli on Routine
MDCT of The Chest
Maria Luigia Storto, Angela Di Credico, Francesca Guido,
Anna Rita Larici, Lorenzo Bonomo
AJR 2005;!"#2$"%2$&
Deteksi Emboli PulmonumSecara Insidental pada MDCT
Thorax Rutin
Diterjemahkan oleh : dr. Monika Indah
Pembimbing : dr. Hesti Gunarti, Sp Rad
8/16/2019 Insidental Deteksi Emboli paru pada MDCT Rutin Dada.docx
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PPDS RDI!"!GI #$%"&S $'D!$&'R(
%(I)'RSI&S GDJH MD *!G*$R&+--
"'MR P'(G'SH(
Journal Reading
Incidental Detection of Pulmonary Emboli onRoutine MDCT of The Chest
Maria Luigia Storto, Angela Di Credico, Francesca Guido,
Anna Rita Larici, Lorenzo Bonomo AJR 2005;!"#2$"%2$&
Deteksi Emboli Pulmonum Secara Insidentalpada MDCT Thorax Rutin
Diajukan %ntuk Melengkapi Pers/aratan Pendidikan Dokter Spesialis Radiologi
#akultas $edokteran %GM
Dipresentasikan oleh : dr. Monika Indah
Pembimbing : dr. Hesti Gunarti, Sp Rad
0aktu presentasi : -- oktober +--
Diperiksa Dan Disetujui
$etua Program Studi Pembimbing
PPDS Radiologi #$ %GM
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Pro1.dr. ri1 #aisal, SpRad 2$3DHSM dr. Hesti Gunarti, Sp Rad
Deteksi 'mboli Pulmonum Se4ara
Insidental pada Rutin MD5& &hora6
Maria Luigia Storto , Angela Di Credico , Francesca Guido , Anna Rita Larici dan
Lorenzo Bonomo
bstrak
&%J%(. 'u(uan dari studi )ami adala* untu) menilai +realensi em-oli +ulmonum
.ang )e-etulan terdete)si di MDC' rutin dada dan untu) menentu)an a+a)a*
+enggunaan +engaturan wide window da+at mening)at)an dete)si em-oli +ulmonum
.ang ta) terduga/
H( D( M'&!D'. enin(auan retros+e)ti1 ter*ada+ MDC' scan t*ora
dengan )ontras dila)u)an +ada 5!3 +asien/ Angiogram C' .ang dila)u)an untu)
mencari em-oli +ulmonum atau +en.a)it aorta tora)s tida) di+ertim-ang)an/
4aluasi gam-ar dila)u)an +ada or)station )*usus selama dua sesi reie ter+isa*
mengguna)an +engaturan window .ang -er-eda# standar, dengan le-ar "00 6 dan
ting)at "0 6, dan le-ar, dengan le-ar $00 6 dan ting)at 00750 6/ 8ualitas
+en.angatan as)ular dicatat/
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HSI". Dela+an +emeri)saan di)eluar)an )arena )ualitas .ang -uru)/ 4m-oli
+ulmonum ta) terduga *adir di 20 9:,"< dari 5! +asien dengan +realensi raat
ina+ ",0 93="&"< dan +realensi raat (alan se-esar 0,3 9 = 0&
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scanner C' )onensional -erurutan sam+ai ,5 dengan single dete)tor C'7scanner
95,$,&
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C' scan di+erole* +ada scanner "7MDC' 9olume oom, Siemens Medical
Solutions< dari thoracic inlet melalui dia1ragma, dalam se)ali mena*an na+as/ asien
di+indai )e ara* craniocaudal mengguna)an collimation dari " E mm dan )ece+atan
ta-el & mm +er rotasi atau collimation dari " E 2,5 mm dan )ece+atan ta-el 5 mm
+er rotasi, 0,57deti) a)tu rotasi, "0 )+ , dan 20 mas/ ada a)*ir a)uisisi,
-erde)atan 57mm7te-al gam-ar a)sial .ang dire)onstru)si +ada semua +asien
mengguna)an )ernel re)onstru)si standar/ Durasi +emindaian total -er)isar antara 0
7 22 deti) tergantung +ada +roto)ol +emindaian/
Dela+an +ulu* mililiter -a*an )ontras non7ioni) 9:00 mg = ml iome+rol, omeron:00, Bracco< disunti) melalui ena antecu-ital dengan la(u : mL = deti)
mengguna)an in(ector otomatis 94nision C', M4DRAD
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sedang)an untu) sesi )edua, +engaturan wide window 9le-ar , $00 6; ting)at, 007
50 6< .ang diguna)an/ 8asus disa(i)an dalam urutan .ang -er-eda untu) setia+ sesi
dengan interal minggu memisa*)an sesi reie/
'ing)at o+asitas arteri +aru ditentu)an +ada daera* .ang dicurigai setinggi truntus
+ulmonar. atau arteri +ulmonar. utama )iri/ +asitas diangga+ -ai) )eti)a vessel
attenuation le-i* -esar dari 50 6, memuas)an )eti)a itu )urang dari 50 6 ta+i
le-i* -esar dari 00 6, dan )urang -ai) (i)a )urang dari 00 6/
La+oran radiologi dan catatan medis +asien dengan em-oli +ulmonum ta) terduga
(uga dinilai untu) mendete)si em-oli +ada saat C', studi )orelati1 9s)intigra1i +aru,
Sonogra1i Do++ler ena e)stremitas -aa*
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(alan 9 = 0& +asien
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Gambar. - 8 Ianita $" ta*un dengan em-oli +ulmonum ta) terduga di arteri
segmental lo-us )anan -aa*/ Partial filling defect +ada +osterior -asal segmental
arteri +ada right lower lobe 9 +ana* , < .ang tida) terli*at +ada gam-ar C' dili*at
dengan standar +engaturan window mediastinum 23, namun, itu diidenti1i)asi +ada
gam-ar .ang dili*at dengan +engaturan wider window 23.
Gambar. - 8 Ianita $" ta*un dengan em-oli +ulmonum ta) terduga di arteri
segmental lo-us )anan -aa*. Partial filling defect +ada +osterior -asal segmental
arteri pada right lower lobus 9 panah, < .ang tida) terli*at +ada gam-ar C' dengan
+engaturan standard mediastinal window 9
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studi )orelati1 .ang mendu)ung diagnosis em-oli +ulmonum/ Studi ini termasu) C'
angiogra1i +aru dengan temuan +ositi1 +ada em+at +asien, Sonogra1i Do++ler
e)stremitas -aa* +ada dela+an +asien 9enam +ositi1
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Gambar. + 9 +ria &0 ta*un dengan )an)er +aru7+aru dan silent em-oli +ulmonum di
arteri segmental lo-us )anan -aa*. C' scan di+erole* : -ulan )emudian
menun(u))an +er)em-angan em-oli +ulmonum dengan multiple filling defects dalam
arteri segmental lo-us )anan -aa* 23 dan di arteri lo-aris )anan tenga* dan in1erior
253. 4m-oli ulmonum didiagnosis dengan -enar ada saat ini/
Gambar. +5 9 +ria &0 ta*un dengan )an)er +aru7+aru dan silent em-oli +ulmonum
di arteri segmental lo-us )anan -aa*/ C' scan di+erole* : -ulan )emudianmenun(u))an +er)em-angan em-oli +ulmonum dengan multiple filling defects dalam
arteri segmental lo-us )anan -aa* 23 dan di arteri lo-aris )anan tenga* dan in1erior
253. 4m-oli ulmonum didiagnosis dengan -enar ada saat ini/
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Gambar. 9. ria 5$7ta*un dengan metastasis +aru dari )arsinoma usus dan em-oli
+ulmonum segmental terisolasi/ C' scan melalui lo-us )iri atas menun(u))an filling
defect +arsial (panah) di arteri segmental anterior/ 'emuan ini ta) terdete)si ole* a*li
radiologi +ada C' ini/
Diskusi
Silent em-oli +ulmonum mung)in ter(adi dalam +ersentase .ang tinggi dari +asien/
Dalam se-ua* +enelitian oto+si, diagnosis ta) terduga +ada " 9&0< dari 20 +asien
.ang meninggal )arena em-oli +ulmonum 90
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+ulmonum adala* :3,57"3,5 9"
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masing< dan +asien dengan +en.a)it neo+lasti) 9&0 dan !:, masing7masing
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dua dari enam +asien dengan em-oli +ulmonum .ang tida) terdete)si menderita
)an)er +aru7+aru, sala* satu memili)i +en.a)it metastati) dari )arsinoma usus -esar,
dua tela* e1usi +leura, dan satu sar)oidosis +aru/
Be-era+a )eter-atasan +enelitian )ami memerlu)an +ertim-angan/ 8arena desain
+enelitian )ami retros+e)ti1, +emeri)saan )on1irmasi .ang tersedia *an.a sem-ilan
dari 20 +asien dengan em-oli +ulmonum/ em-atasan lain .ang +otensial adala*
section width ang lebar diguna)an untu) re)onstru)si gam-ar a)sial/ 8ami secara
rutin mere)onstru)si gam-ar a)sial MDC' mengguna)an 57mm section width, .ang
-iasan.a cu)u+ untu) +engaturan rutin se-agian -esar tan+a -an.a) +ening)atandalam (umla* gam-ar untu) mere)onstru)si dan review 95
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:/ Moser 8M, Fedullo F, Litte@o*n @8, Cra1ord R/ FreNuent as.m+tomatic
+ulmonar. em-olism in +atients it* dee+ enous t*rom-osis/ JA"A 33";2:%
225 >erratum in @AMA 33"; 2!?
"/ Meignan M, Rosso @, Gaut*ier 6, et al/ S.stematic lung scans reeal a *ig*
1reNuenc. o1 silent
+ulmonar. em-olism in +atients it* +roimal dee+ enous t*rom-osis/ Arch #ntern
"ed 2000;$0#53%$"
5/ Gosselin M, Ru-in GD, Leung AJ, 6uang @, Riz) JI/ Knsus+ected +ulmonar.
em-olism#
+ros+ectie detection on routine *elical C' scans/ Radiolog 33!;20!#203%25
$/ ersc*a)elen @A, ani(c) 4, Bogaert @, Baert AL/ Detection o1 sus+ected central
+ulmonar. em-olism it* conentional contrast7en*anced C'/ Radiolog
33:;!!#!"&%!50
&/ Iinston CB, Iec*sler R@, Salazar AM, 8urtz AB, S+irn I/ ncidental +ulmonar.
em-oli detected at *elical C'# e11ect on +atient care/ Radiolog 33$;20#2:%2&
!/ Ra+to+oulos , Boiselle M/ Multi7detector ro s+iral C' +ulmonar.
angiogra+*.# com+arison it* single7detector ro s+iral C'/ Radiolog
200;22#$0$%$:
3/ Leis MA/ Multislice C'# o++ortunities and c*allenges/ $r J Radiol 200;&"#&&3%
&! 0/ Stein D, 6enr. @I/ realence o1 acute +ulmonar. em-olism among
+atients in a general *os+ital and at auto+s./ !hest 335;0!#3&!%3!
/ Jielsen 68, 6usted S4, 8rusell LR, Fasting 6, C*arles , 6ansen 66/ Silent
+ulmonar. em-olism in +atients it* dee+ enous t*rom-osis# incidence and 1ate in a
randomised, controlled trial o1 anticoagulation ersus no anticoagulation/ J #ntern
"ed 33";2:5#"5&%"$
2/ Lo+ez7Beret , into @M, Romero A, rgaz A, Fontcu-erta @, -las M/
S.stematic stud. o1 occult +ulmonar. t*rom-oem-olism in +atients it* dee+ enous
t*rom-osis/ J %asc Surg 200;::#55%52
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:/ Brin) @A, Ioodard 8, 6ores* L, et al/ De+iction o1 +ulmonar. em-oli it*
s+iral C'# o+timization o1 dis+la. indo settings in a +orcine model/ Radiolog
33&;20"#&0:%&0!
"/ Samuel S, 8undel 6L, Jodine CF, 'oto LC/ Mec*anism o1 satis1action o1 searc*#
e.e +osition recordings in t*e reading o1 c*est radiogra+*s/ Radiolog 335;3"#!35%
302
5/ ro)o+ M/ General +rinci+les o1 MDC'/ &ur J Radiol 200:;"5>su++l?#S"%S0
$/ G*a.e B, Sza+iro D, Mastora , et al/ eri+*eral +ulmonar. arteries# *o 1ar in
t*e lung does
multi7detector ro s+iral C' allo anal.sis Radiolog 200;23#$23%$:$
&/ Sc*oe+1 K@, 6olz)nec*t J, 6elm-erger '8, et al/ Su-segmental +ulmonar.
em-oli# im+roed detection it* t*in7collimation multi7detector ro s+iral C'/
Radiolog 2002;222#"!:%"30
!/ atel S, 8azerooni 4A, Cascade J/ ulmonar. em-olism# o+timization o1 small
+ulmonar. arter. isualization at multi7detector ro C'/ Radiolog 200:;22"55%
"$0