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Optimization of Combined CT Pulmonary Angiography with Lower Extremity CT Venography

David F. Yankelevitz1, Gordon Gamsu1, Ami Shah1, Jurgen Rademaker1,2, Dorith Shaham1,3, Natasha Buckshee1, Matthew D. Cham1 and Claudia I. Henschke1

1 Department of Radiology, New York Presbyterian Hospital—Weill Cornell Medical Center, 525 E. 68th St., New York, NY 10023



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  		Fig. 1. —Time-density curve of common femoral artery and vein at level of greater trochanter after completion of CT pulmonary angiography in one patient. Note baseline or unenhanced value. Density measurement at time T0 was obtained immediately after CT pulmonary angiography. Subsequent density measurements were obtained at 30-sec intervals for 5 min. Note difference in shape of two curves. Arterial peak occurs earlier than venous peak and arterial enhancement subsequently decreases more rapidly. Eventually the two curves decrease to same level.

 


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  		Fig. 2. —For each patient, time interval (in sec) during which contrast enhancement of common femoral vein remained within 90% of peak value attained (CT scanning every 30 sec from 0 to 360 sec). At time T120, 85% of patients were within 90% of their peak.

 


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  		Fig. 3. —58-year-old woman with deep venous thrombi (DVT) in common femoral vein after CT pulmonary angiography. CT scan shows that degree of venous enhancement is clearly sufficient to visualize thrombus (arrow). DVT was confirmed by subsequent lower extremity venous Doppler sonography (not shown).

 

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