Contrast-enhanced helical CT for pulmonary embolism detection: inter- and intraobserver agreement among radiologists with variable experience.

Chartrand-Lefèbvre, Carl; Howarth, Nigel; Lucidarme, O.; Beigelman, Catherine; Cluzel, Philippe; Mourey-Gerosa, I.; Cadi, M.; Greniér, Philippe

doi:10.2214/ajr.172.1.9888748

Cited by 75 publications

(37 citation statements)

References 5 publications

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“…Furthermore the accuracy of CTPA for peripheral pulmonary embolisms is not excellent. The a radiological finding of peripheral pulmonary embolism has a moderate interobserver agreement whit a kappa of 0.47, and the positive predictive value of apparent isolated subsegmental pulmonary embolisms is reported to be as low as 25% (9,21). Coupled with an increased complication rate from anticoagulation therapy this gives cause for concern (19).…”

Section: Discussionmentioning

confidence: 99%

Elevated d-dimer cut-off values for computed tomography pulmonary angiography—d-dimer correlates with location of embolism

et al. 2016

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Background: Acute pulmonary embolism (APE) is a potentially fatal condition, and making a timely diagnosis can be challenging. Computed tomography pulmonary angiography (CTPA) has become the modality of choice, and this contributes to the increasing load on emergency room CT scanners. Our purpose was to investigate whether an elevated d-dimer cut-off could reduce the demand for CTPA while maintaining a high sensitivity and negative predictive value (NPV). Methods:We retrospectively reviewed all patients referred for CTPA with suspicion of APE in 2012, and collected d-dimer values and CTPA results. We investigated the diagnostic performance of d-dimer using a 0.5 mg/L cut-off and an age adjusted cut-off. We also evaluated a new and elevated cut-off. Cases were categorized according to their CTPA result into: no embolism, peripheral embolism, lobar embolism and central embolism. Finally we investigated a possible correlation between d-dimer values and location of embolism.Results: We included 1,051 CTPAs, from which 216 (21%) showed pulmonary embolism. There were concomitant d-dimer analyses in 822 CTPA examinations. The current 0.5 mg/L cut-off achieved a sensitivity and NPV of 99%. The age-adjusted cut-off achieved a sensitivity and NPV of 98%, and our suggested cut-off of 0.9 mg/L achieved a sensitivity and NPV of 97%. Conclusions:We conclude that the elevated d-dimer cut-off of 0.9 mg/L achieved a high sensitivity and NPV, while reducing the number of CTPA by 27%. The correlation between d-dimer values and location of embolisms supports the suggestion of an elevated d-dimer value.

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Section: Discussionmentioning

confidence: 99%

Elevated d-dimer cut-off values for computed tomography pulmonary angiography—d-dimer correlates with location of embolism

et al. 2016

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“…Reduction in scan collimation permits a decrease in the volumeaveraging effect between parenchyma, vessel walls, and blood, responsible for areas of low attenuation which may be confused with PE on transverse CT scans. Such partial identification of vessels may create false-positive and false-negative results or lead the observer to an indeterminate answer [13]. Using thin-collimation and subsecond single-slice CT, Remy-Jardin et al have previously reported significant improvement in image quality due to a higher spatial resolution, resulting from a higher rate of analyzable segmental pulmonary arteries and a reduction in interpretive difficulties due to volume averaging [5,6].…”

Section: Discussionmentioning

confidence: 99%

CT angiography of pulmonary embolism in patients with underlying respiratory disease: impact of multislice CT on image quality and negative predictive value

et al. 2002

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“…Studies report high accuracies, with sensitivity and specificity greater than 90%-95% (15), but results vary widely between studies (16) and are confounded by the lack of an accurate gold standard and consequent verification bias. Moreover, there is significant interobserver disagreement as demonstrated by only moderate agreement, with a k of 0.47 for 3-mm-collimation CTPA (17). Many practitioners fail to realize the limitations of imaging tests, leading to both overdiagnosis and a delay in treatment, particularly when there is discordance between clinical pretest likelihood and the imaging result.…”

Section: Discussionmentioning

confidence: 99%

⁶⁸Ga PET/CT Ventilation–Perfusion Imaging for Pulmonary Embolism: A Pilot Study with Comparison to Conventional Scintigraphy

Hofman¹,

Beauregard²,

Barber³

et al. 2011

J Nucl Med

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Ventilation-perfusion (V/Q) scintigraphy is established for regional assessment of lung function in a variety of diseases, including pulmonary embolism (PE). PET/CT may further improve the accuracy and utility of V/Q imaging because of its superior technical characteristics. This pilot study assessed the feasibility of performing V/Q PET/CT and compared diagnostic utility with conventional V/Q imaging in patients with clinical suspicion of PE. Methods: Ten patients undergoing conventional V/Q imaging were prospectively recruited. PET/ CT V/Q imaging was performed after inhalation of 68 Ga-carbon nanoparticles ("Galligas") and administration of 68 Ga-macroaggregated albumin. Blinded to the results of the other study, SPECT/CT (n 5 9) or SPECT (n 5 1) images and PET/CT images were graded by a predefined scoring system for scan quality. The number of matched or unmatched defects and diagnosis were also measured and compared with a final diagnosis. Results: PET image quality was equivalent or superior to SPECT in all patients, with more homogeneous radiotracer distribution for both ventilation and perfusion studies (P , 0.01). Based on conventional V/Q imaging, the diagnosis was acute PE in 2 patients and no PE in 7 patients, and the imaging results were nondiagnostic in 1 patient. The PET/CT diagnosis was concordant in 8 patients, and these studies demonstrated a similar number and distribution of matched and unmatched defects. In 1 discordant case, a patient with a SPECT/CT study that was nondiagnostic because of severe airway disease showed no PE on PET/CT. In another, the diagnosis of PE established on SPECT/CT was not reported on PET/CT 2 d later, possibly because of interval clot lysis or migration. Conclusion: This intraindividual comparative study demonstrated that V/Q PET/CT with 68 Ga-labeled radiotracers can be performed in clinical practice. Compared with conventional V/Q imaging, advantages include higher-resolution, fully tomographic images with potentially better regional quantitation of lung function. The short half-life of 68 Ga also enables more flexible acquisition protocols with the option of performing ventilation studies selectively on patients with abnormal perfusion. On the basis of our results, further studies are indicated to assess whether V/Q PET/CT can improve diagnostic algorithms for patients with suspected PE. Vent ilation-perfusion (V/Q) scintigraphy allows assessment of regional lung function in a variety of diseases. Most studies are performed to assess patients with suspected pulmonary embolism (PE) because presenting symptoms and signs are variable and insufficient for a clinical diagnosis. The Prospective Investigation of Pulmonary Embolism Diagnosis study (1), designed in 1983, established V/Q imaging as the standard of care at the time. V/Q imaging has improved in the past 3 decades because of major advances in image acquisition, reconstruction, and analysis techniques. The use of 99m Tc-labeled carbon nanoparticles (Technegas; Cyclopharm) has improved the assessment of ventil...

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Contrast-enhanced helical CT for pulmonary embolism detection: inter- and intraobserver agreement among radiologists with variable experience.

Cited by 75 publications

References 5 publications

Elevated d-dimer cut-off values for computed tomography pulmonary angiography—d-dimer correlates with location of embolism

Elevated d-dimer cut-off values for computed tomography pulmonary angiography—d-dimer correlates with location of embolism

CT angiography of pulmonary embolism in patients with underlying respiratory disease: impact of multislice CT on image quality and negative predictive value

⁶⁸Ga PET/CT Ventilation–Perfusion Imaging for Pulmonary Embolism: A Pilot Study with Comparison to Conventional Scintigraphy

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Contrast-enhanced helical CT for pulmonary embolism detection: inter- and intraobserver agreement among radiologists with variable experience.

Cited by 75 publications

References 5 publications

Elevated d-dimer cut-off values for computed tomography pulmonary angiography—d-dimer correlates with location of embolism

Elevated d-dimer cut-off values for computed tomography pulmonary angiography—d-dimer correlates with location of embolism

CT angiography of pulmonary embolism in patients with underlying respiratory disease: impact of multislice CT on image quality and negative predictive value

68Ga PET/CT Ventilation–Perfusion Imaging for Pulmonary Embolism: A Pilot Study with Comparison to Conventional Scintigraphy

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⁶⁸Ga PET/CT Ventilation–Perfusion Imaging for Pulmonary Embolism: A Pilot Study with Comparison to Conventional Scintigraphy