Ancillary Findings on CT Pulmonary Angiograms and Abnormalities on Chest Radiographs in Patients in Whom Pulmonary Embolism was Excluded

Abstract

To determine whether chest radiographs identify some abnormalities not shown as ancillary findings on computed tomography(CT) pulmonary angiograms of patients in whom pulmonary embolism (PE) was excluded. This was a retrospective study of reports of negative 64-detector CT pulmonary angiograms and chest radiographs. Among 332 patients with no PE, pulmonary parenchymal disease was shown in 60 (18%) only on standard chest radiographs, and pleural or pericardial disease was shown in 17 (5%) only on chest radiographs. Skeletal abnormalities were reported more frequently on standard chest radiographs, lymph nodes more frequently on CT angiograms. Some abnormalities on chest radiographs of patients in whom PE is excluded may not be described as ancillary findings on CT pulmonary angiograms. This suggests a need for ancillary findings on CT pulmonary angiograms to be described systematically. At present, however, plain chest radiographs in some patients show ancillary findings not reported on CT angiograms. [corrected].

Incidence of actionable findings on contrast enhanced magnetic resonance angiography ordered for pulmonary embolism evaluation

“…Therefore, we built upon the methodology used by Richman et al [18], the largest study to date in this field, and simplified that categorization scheme into two clinically relevant groups: actionable Type 1 findings requiring follow-up and the combination of non-actionable Type 2 findings requiring no follow-up and exams that were totally normal Type 3 (Table 1). Using these groups to sort the CTA data, we observed a large amount of variability in the incidence of Type 1 (17-67%) and Type 2 + Type 3 findings on CTA (33-83%) extracted from the prior literature (Table 2) [18][19][20][21]. Surprisingly, however, we found that the percentages of Type 1 and the combined categories of Type 2 and Type 3 findings found at MRA in this study were equivalent to those reported by Richman et al [18] ( Table 3).…”

“…This method is similar to the Richman category A-findings requiring immediate follow up and Richman category B-findings requiring follow up to prevent significant morbidity in subsequent weeks or months as subcategories into one new Category-Type 1 and the Richman Category C-findings requiring no immediate action into this study's Type 2 and Richman Category D-inderminant findings along with all normal exams into a third group of findings for this study-Type 3. The single most important of the many findings derived from the final report of each case were categorized by consensus of two radiologists (JA and MS) using a very complete rubric derived from the exiting CTA literature for all of the previously listed ancillary findings (Table 2) [18,32]. The first category (Type 1) includes all radiology report findings that required some form of follow-up by the referring clinician.…”

“…Comparison of patient demographics, percentage of exams with pulmonary embolism, Type 1 and Type 2 plus Type 3 findings for the eight separate publications that have reviewed non-thrombotic findings on CTA negative exams for pulmonary embolism [14][15][16][17][18][19][20][21].The CTA publications in the shaded part of the table can be compared with the current study that performed a similar analysis of MRA for the same indication. Each publication is quite different with respect to the population studied, percentage of positive examinations, age and sex distribution and the percentage of Type 1 and Type 2 plus Type 3 findings that were observed.…”

“…1). Comparable studies from the prior CTA literature are summarized in Table 2, the largest of which is the 2004 study performed by Richman et al in 1025 patients [14][15][16][17][18][19][20][21]. There were 85/514 (17%) cases of Type 1 finding (those requiring some degree of clinical, surgical or imaging follow up), 188/514 (36%) of Type 2 (those findings not requiring follow up) and Type 3-241/514 (47%) totally normal exams.…”

“…CTA is also particularly useful in those patients with preexisting lung disease (Emphysema./Chronic obstructive pulmonary disease (COPD)), conditions that are known to limit the efficacy of V/Q scanning [13]. Several studies have evaluated the role of CTA in the diagnosis of alternative (non-thromboembolic) etiologies in patients being evaluated for PE [14][15][16][17][18][19][20][21].…”