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Suction/Inspiration against resistance or standardized Mueller maneuver : a new breathing technique to improve contrast density within the pulmonary artery: a pilot CT study

Andreas Gutzeit, Johannes M Froehlich, Stephan Wälti, Justus E Roos, Matthias Meissnitzer, Klaus Hergan, Constantin Von Weymarn, David Czell, Matthias Goyen & Carolin Reischauer

abstract

OBJECTIVE
Our aim was to prospectively investigate whether the recently introduced suction/inspiration against resistance breathing method leads to higher computed tomography (CT) contrast density in the pulmonary artery compared to standard breathing.

MATERIAL AND METHODS
The present study was approved by the Medical Ethics committee and all subjects gave written informed consent. Fifteen patients, each without suspicious lung emboli, were randomly assigned to four different groups with different breathing maneuvers (suction against resistance, Valsalva, inspiration, expiration) during routine CT. Contrast enhancement in the central and peripheral sections of the pulmonary artery were measured and compared with one another.

RESULTS
Peripheral enhancement during suction yielded increased mean densities of 138.14 Hounsfield units (HU) (p = 0.001), compared to Valsalva and a mean density of 67.97 HU superior to inspiration (p = 0.075). Finally, suction in comparison to expiration resulted in a mean increase of 30.51 HU (p = 0.42). Central parts of pulmonary arteries presented significantly increased enhancement values (95.74 HU) for suction versus the Valsalva technique (p = 0.020), while all other mean densities were in favour of suction (versus inspiration: p = 0.201; versus expiration: p = 0.790) without reaching significance.

CONCLUSION
Suction/Inspiration against resistance is a promising technique to improve contrast density within pulmonary vessels, especially in the peripheral parts, in comparison to other breathing maneuvers.

KEY POINTS
• Suction/Inspiration against resistance is promising to improve contrast density within the pulmonary artery. • Patients potentially suffering pulmonary embolism are able to follow suction/inspiration against resistance. • Contrast density after suction is superior in comparison to other breathing maneuvers.
   
citation Gutzeit A, Froehlich J M, Wälti S, Roos J E, Meissnitzer M, Hergan K, Von Weymarn C, Czell D, Goyen M, Reischauer C. Suction/Inspiration against resistance or standardized Mueller maneuver : a new breathing technique to improve contrast density within the pulmonary artery: a pilot CT study. Eur Radiol 2015; 25:3133-42.
   
type journal paper/review (English)
date of publishing 02-06-2015
journal title Eur Radiol (25/11)
ISSN electronic 1432-1084
pages 3133-42
PubMed 26032878
DOI 10.1007/s00330-015-3735-y