Dual-energy spectral CT imaging of pulmonary embolism with Mycoplasma pneumoniae pneumonia in children

Pulmonary embolism (PE) associated with Mycoplasma pneumoniae pneumonia (MPP) in children has already attracted more attention. CT pulmonary angiography (CTPA) has been the preferred method for diagnosing PE, but it has some limitations, especially for children. Dual-energy spectral CT has been used in diagnosing PE in adults.To evaluate the application of dual-energy spectral CT in diagnosing PE in children with MPP.Eighty-three children with MPP and highly suspected PE, underwent CTPA with spectral imaging mode, 25 children were diagnosis with PE. Noise, clot-to-artery contrast-to-noise ratio, image quality and diagnosis confidence were calculated and assessed on nine monochromatic image sets (40 to 80 keV). CTPA images were observed for the presence, localization and embolic degrees of PE. Clots were divided into intra- and extra-consolidation clots. For extra-consolidation clots, iodine concentration (IC) of perfusion defects and normal lung, perfusion defects of four children before and after the treatment were measured and compared. For intra-consolidation clots, IC of consolidation areas with clots and consolidation areas without clot were measured and compared.The optimal energy level for detecting PE in children was 55 keV. 116 clots (29 extra-consolidations) were found, IC of defect regions was 0.69 ± 0.28 mg/mL (extra-consolidations) and 0.90 ± 0.23 mg/mL (intra-consolidations), both significantly lower than the 2.76 ± 0.45 mg/mL in normal lungs and 10.25 ± 1.76 mg/mL in consolidations without clots (P < 0.001). Significant difference was found in the presence or absence of perfusion defects between occlusive clots and nonocclusive clots (P < 0.001). IC of the perfusion defects significantly increased after treatment (P < 0.001).In dual-energy spectral CTPA, 55 keV images optimize PE detection for children, and MD images quantify pulmonary blood flow of PE, and may help to detect small clots and quantify embolic degrees.