Insidental Deteksi Emboli paru pada MDCT Rutin Dada.docx

8/16/2019 Insidental Deteksi Emboli paru pada MDCT Rutin Dada.docx

1/17

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


2/17

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


3/17

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/

http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3DIncidental%2BDetection%2Bof%2BPulmonary%2BEmboli%2Bon%2BRoutine%2BMDCT%2Bof%2Bthe%2BChest%26hl%3Did%26client%3Dfirefox-a%26rls%3Dorg.mozilla:id:official%26channel%3Ds%26biw%3D1024%26bih%3D469%26prmd%3Divns&rurl=translate.google.co.id&sl=en&twu=1&u=http://www.ajronline.org/search%3Fauthor1%3DMaria%2BLuigia%2BStorto%26sortspec%3Ddate%26submit%3DSubmit&usg=ALkJrhhtkYSgQrzP48WWkHUeAglHZtUjEAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3DIncidental%2BDetection%2Bof%2BPulmonary%2BEmboli%2Bon%2BRoutine%2BMDCT%2Bof%2Bthe%2BChest%26hl%3Did%26client%3Dfirefox-a%26rls%3Dorg.mozilla:id:official%26channel%3Ds%26biw%3D1024%26bih%3D469%26prmd%3Divns&rurl=translate.google.co.id&sl=en&twu=1&u=http://www.ajronline.org/search%3Fauthor1%3DMaria%2BLuigia%2BStorto%26sortspec%3Ddate%26submit%3DSubmit&usg=ALkJrhhtkYSgQrzP48WWkHUeAglHZtUjEAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3DIncidental%2BDetection%2Bof%2BPulmonary%2BEmboli%2Bon%2BRoutine%2BMDCT%2Bof%2Bthe%2BChest%26hl%3Did%26client%3Dfirefox-a%26rls%3Dorg.mozilla:id:official%26channel%3Ds%26biw%3D1024%26bih%3D469%26prmd%3Divns&rurl=translate.google.co.id&sl=en&twu=1&u=http://www.ajronline.org/search%3Fauthor1%3DAngela%2BDi%2BCredico%26sortspec%3Ddate%26submit%3DSubmit&usg=ALkJrhiGLe3EvPcxJRGN7tUYcpKL8-q84ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3DIncidental%2BDetection%2Bof%2BPulmonary%2BEmboli%2Bon%2BRoutine%2BMDCT%2Bof%2Bthe%2BChest%26hl%3Did%26client%3Dfirefox-a%26rls%3Dorg.mozilla:id:official%26channel%3Ds%26biw%3D1024%26bih%3D469%26prmd%3Divns&rurl=translate.google.co.id&sl=en&twu=1&u=http://www.ajronline.org/search%3Fauthor1%3DAngela%2BDi%2BCredico%26sortspec%3Ddate%26submit%3DSubmit&usg=ALkJrhiGLe3EvPcxJRGN7tUYcpKL8-q84ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3DIncidental%2BDetection%2Bof%2BPulmonary%2BEmboli%2Bon%2BRoutine%2BMDCT%2Bof%2Bthe%2BChest%26hl%3Did%26client%3Dfirefox-a%26rls%3Dorg.mozilla:id:official%26channel%3Ds%26biw%3D1024%26bih%3D469%26prmd%3Divns&rurl=translate.google.co.id&sl=en&twu=1&u=http://www.ajronline.org/search%3Fauthor1%3DFrancesca%2BGuido%26sortspec%3Ddate%26submit%3DSubmit&usg=ALkJrhjVQKuvppSv9FxyTCXZGrSmfM8qJQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3DIncidental%2BDetection%2Bof%2BPulmonary%2BEmboli%2Bon%2BRoutine%2BMDCT%2Bof%2Bthe%2BChest%26hl%3Did%26client%3Dfirefox-a%26rls%3Dorg.mozilla:id:official%26channel%3Ds%26biw%3D1024%26bih%3D469%26prmd%3Divns&rurl=translate.google.co.id&sl=en&twu=1&u=http://www.ajronline.org/search%3Fauthor1%3DAnna%2BRita%2BLarici%26sortspec%3Ddate%26submit%3DSubmit&usg=ALkJrhhG0RImmI6d96uOH1oB_X2n9SCfgwhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3DIncidental%2BDetection%2Bof%2BPulmonary%2BEmboli%2Bon%2BRoutine%2BMDCT%2Bof%2Bthe%2BChest%26hl%3Did%26client%3Dfirefox-a%26rls%3Dorg.mozilla:id:official%26channel%3Ds%26biw%3D1024%26bih%3D469%26prmd%3Divns&rurl=translate.google.co.id&sl=en&twu=1&u=http://www.ajronline.org/search%3Fauthor1%3DLorenzo%2BBonomo%26sortspec%3Ddate%26submit%3DSubmit&usg=ALkJrhghWodVUCxY9F8tNnwbhlriJocvCwhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3DIncidental%2BDetection%2Bof%2BPulmonary%2BEmboli%2Bon%2BRoutine%2BMDCT%2Bof%2Bthe%2BChest%26hl%3Did%26client%3Dfirefox-a%26rls%3Dorg.mozilla:id:official%26channel%3Ds%26biw%3D1024%26bih%3D469%26prmd%3Divns&rurl=translate.google.co.id&sl=en&twu=1&u=http://www.ajronline.org/search%3Fauthor1%3DAngela%2BDi%2BCredico%26sortspec%3Ddate%26submit%3DSubmit&usg=ALkJrhiGLe3EvPcxJRGN7tUYcpKL8-q84ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3DIncidental%2BDetection%2Bof%2BPulmonary%2BEmboli%2Bon%2BRoutine%2BMDCT%2Bof%2Bthe%2BChest%26hl%3Did%26client%3Dfirefox-a%26rls%3Dorg.mozilla:id:official%26channel%3Ds%26biw%3D1024%26bih%3D469%26prmd%3Divns&rurl=translate.google.co.id&sl=en&twu=1&u=http://www.ajronline.org/search%3Fauthor1%3DFrancesca%2BGuido%26sortspec%3Ddate%26submit%3DSubmit&usg=ALkJrhjVQKuvppSv9FxyTCXZGrSmfM8qJQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3DIncidental%2BDetection%2Bof%2BPulmonary%2BEmboli%2Bon%2BRoutine%2BMDCT%2Bof%2Bthe%2BChest%26hl%3Did%26client%3Dfirefox-a%26rls%3Dorg.mozilla:id:official%26channel%3Ds%26biw%3D1024%26bih%3D469%26prmd%3Divns&rurl=translate.google.co.id&sl=en&twu=1&u=http://www.ajronline.org/search%3Fauthor1%3DAnna%2BRita%2BLarici%26sortspec%3Ddate%26submit%3DSubmit&usg=ALkJrhhG0RImmI6d96uOH1oB_X2n9SCfgwhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3DIncidental%2BDetection%2Bof%2BPulmonary%2BEmboli%2Bon%2BRoutine%2BMDCT%2Bof%2Bthe%2BChest%26hl%3Did%26client%3Dfirefox-a%26rls%3Dorg.mozilla:id:official%26channel%3Ds%26biw%3D1024%26bih%3D469%26prmd%3Divns&rurl=translate.google.co.id&sl=en&twu=1&u=http://www.ajronline.org/search%3Fauthor1%3DLorenzo%2BBonomo%26sortspec%3Ddate%26submit%3DSubmit&usg=ALkJrhghWodVUCxY9F8tNnwbhlriJocvCwhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3DIncidental%2BDetection%2Bof%2BPulmonary%2BEmboli%2Bon%2BRoutine%2BMDCT%2Bof%2Bthe%2BChest%26hl%3Did%26client%3Dfirefox-a%26rls%3Dorg.mozilla:id:official%26channel%3Ds%26biw%3D1024%26bih%3D469%26prmd%3Divns&rurl=translate.google.co.id&sl=en&twu=1&u=http://www.ajronline.org/search%3Fauthor1%3DMaria%2BLuigia%2BStorto%26sortspec%3Ddate%26submit%3DSubmit&usg=ALkJrhhtkYSgQrzP48WWkHUeAglHZtUjEA


4/17

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&


5/17

scanner C' )onensional -erurutan sam+ai ,5 dengan single dete)tor C'7scanner

95,$,&


6/17

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


7/17

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*


8/17

(alan 9 = 0& +asien


9/17

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


10/17

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


11/17

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/


12/17

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


13/17

+ulmonum adala* :3,57"3,5 9"


14/17

masing< dan +asien dengan +en.a)it neo+lasti) 9&0 dan !:, masing7masing


15/17

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


16/17

:/ 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&#22:%

225 >erratum in @AMA 33"; 2&#30!?

"/ 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


17/17

:/ 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

Insidental Deteksi Emboli paru pada MDCT Rutin Dada.docx

Documents

Transcript of Insidental Deteksi Emboli paru pada MDCT Rutin Dada.docx