Computed tomography pulmonary angiogram diagnosis of pulmonary embolism

Abstract

Over the last decade, contrast-enhanced spiral CT has been established as a non-invasive alternative to catheter angiography and is now regarded as the first-line imaging investigation for the diagnosis of pulmonary embolism (PE). The reported sensitivities for the diagnosis of PE of spiral CT vary from 45 to 100% and the specificities vary from 78 to 100%. Prospective outcome studies have shown a high negative predictive value for a single-detector spiral CT for PE. Patients' outcomes were not adversely affected in these studies when anticoagulation was withheld after a negative CT pulmonary angiogram. The main limitation of single-detector spiral CT has been its limited ability to detect isolated subsegmental PE. However, multidetector spiral CT allows evaluation of pulmonary vessels down to sixth-order branches and significantly increases the rate of detection of PE in segmental and subsegmental levels. The interobserver correlations for diagnosis of subsegmental PE with multidetector spiral CT exceed the reproducibility of selective pulmonary angiography. If appropriate equipment is available (multidetector CT), then CT pulmonary angiogram is safe to be used as the first-line imaging investigation for the diagnosis of PE.

Ethnicity as an independent predictive factor for the results of computed tomography pulmonary angiography and ultrasonography of the lower limbs

“…Although our sample size of non‐European patients limited further subgroup analysis, our data do suggest the very low yield of low pretest probability group, one positive scan out of 23. This rate is equivalent to or lower than the false negative rate of CTPA …”

Elevation of troponin values in differential diagnosis of chest pain in view of pulmonary thromboembolism

“…The reported sensitivities and specificities for the diagnosis of PE of spiral CT vary (45%-100% and 78%-100%), and depend on the type of CT (single or multi-detector spiral CT). MDCT allows evaluation of pulmonary vessels down to sixth-order branches and significantly increases the rate of detection of PE in segmental and subsegmental levels 14 .…”

A cohort study on the incidence and outcome of pulmonary embolism in trauma and orthopedic patients

“…On the basis of current evidence, CT-PA is considered the gold standard for the diagnosis of PE [13,31]. Chest contrast enhanced CT replaced catheter angiography due to its less invasive nature and accuracy, and has been proven to be superior or equal to angiography [31].…”

“…CT-PA scans were considered as positive according to the following criteria: failure of contrast material to fill the entire lumen because of a central filling defect (the artery may be enlarged, as compared with similar arteries); a partial filling defect surrounded by contrast material on a cross-sectional image; contrast material between the central filling defect and the artery wall on an in-plane, longitudinal image; and a peripheral intraluminal filling defect that forms an acute angle with the artery wall [13,14]. A CT Venogram (CTV) was routinely performed in those patients that had a positive CT-PA.…”