CT Angiography in the Evaluation of Acute Pulmonary Embolus

Costantino, Mary; Randall, Geneva; Gosselin, Marc V.; Brandt, Marissa; Spinning, Kristopher; Vegas, C. David

doi:10.2214/ajr.07.2552

Cited by 107 publications

(78 citation statements)

References 18 publications

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“…Three other studies of similar size report CTPAs positive for PEs in their cohort to be around 10% and similarly highlight CTPA use as a screening rather than diagnostic test [20][21][22]. So relative to other studies, our centre does well with a result of 15% of CTPAs being positive for PE.…”

Section: Resultssupporting

confidence: 55%

Audit on the use of CTPA in pulmonary embolism (PE) diagnosis

Anwar¹,

Wong²,

Muza³

2017

Gen Int Med Clin Innov

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Section: Resultssupporting

confidence: 55%

Audit on the use of CTPA in pulmonary embolism (PE) diagnosis

Anwar¹,

Wong²,

Muza³

2017

Gen Int Med Clin Innov

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…”

mentioning

confidence: 99%

Reproducibility of CT Signs of Right Ventricular Dysfunction in Acute Pulmonary Embolism

Kang

Ramos-Duran

Schoepf

et al. 2010

American Journal of Roentgenology

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Contrast medium-enhanced pulmonary CT angiography (CTA) is increasingly used as the first-line imaging test in suspected PE and is available 24 hours a day at most institutions [10][11][12][13][14]. Pulmonary CTA not only allows direct visualization of emboli but provides information regarding the status of the right heart [15,16]. In several studies, the ratio of the RV to left ventricle (LV) diameters on pulmonary CTA has been proposed as a sign for RV dysfunction [17][18][19]. Other signs have been described, including bowing of the interventricular septum and reflux of contrast medium into the inferior vena cava (IVC) [20,21]. However, a variety of different methods for the quantitative assessment of RV dysfunction on pulmonary CTA have been proposed [17][18][19][20][21][22][23][24] and the literature shows variable results for the prognostic power of pulmonary CTA signs of RV dysfunction to predict adverse outcomes. This variability may in part be explained by the somewhat subjective nature of diagnosing RV dysfunction on pulmonary CTA because formal criteria for es- AJR 2010; 194:1500-1506 0361-803X/10/1946-1500 © American Roentgen Ray Society A cute pulmonary embolism (PE) is a common disease with a 3-month mortality rate of up to 17.4% [1][2][3][4]. Even if PE is properly treated with anticoagulation, the mortality rate in hemodynamically stable patients varies from 8.1% to 15.1% [4,5]. Death is usually caused by acute right heart failure [4][5][6][7][8][9]. Acute PE increases the pressure of the pulmonary arterial system and right ventricle (RV) resulting in RV dysfunction, which may progress to right heart failure and circulatory collapse [5,6]. Patients with RV dysfunction have a higher mortality rate than those without, even if they are initially hemodynamically stable [6,7]. Thus, the presence of RV dysfunction is a marker for adverse clinical outcome in patients with acute PE [6][7][8]. Echocardiography is the most common first-line examination to diagnose the signs of RV dysfunction [6][7][8][9]. However, this test has limited off-hour availability at many institutions, and occasionally the RV may be difficult to image with the trans thoracic approach. OBJECTIVE. The purpose of our study was to determine the interobserver reproducibility of CT findings of right ventricular (RV) dysfunction in pulmonary embolism (PE). Reproducibility of CT C a r d io p u lm o n a r y I m ag i ng • O r ig i n a l R e s e a rc hMATERIALS AND METHODS. Two experienced observers independently and retrospectively evaluated pulmonary CT angiography (CTA) studies of 50 patients with acute PE for the following signs: bowing of the interventricular septum, inferior vena cava (IVC) contrast medium reflux, RV diameter (RVD)/left ventricular diameter (LVD) ratio on axial sections and four-chamber (4-CH) views, and RV volume (RVV)/left ventricular volume (LVV) ratio. Analysis used kappa statistics, Spearman's rank correlation, and Bland-Altman statistics.RESULTS. The two observers had fair to moderate agreement (κ = 0.32-0.44)...

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“…This study analyses the diagnostic performance of CTPA in patients with suspected PE based on a single center experience and has two findings which are considered important from a clinical perspective: first, the diagnostic yield of CTPA is more than 30%, which is above the acceptance level of 15% [17,18]. This indicates the appropriate use of CTPA for routine diagnosis of PE.…”

Section: Discussionmentioning

confidence: 99%

“…Further, no guidelines Research Article Sun, Lei are available about the minimum acceptable diagnostic yield of CTPA, thus leading to overuse of CTPA as a routine diagnostic tool [17,18]. Sharma and Lucas reported the direct correlation between CTPA and positive rates of PE detection with results justifying the increased use of CTPA [19].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic yield of CT pulmonary angiography in the diagnosis of pulmonary embolism: A single center experience

Sun¹,

Lei²

2017

Interventional-Cardiology

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The purpose of this study was to investigate the clinical application of computed tomography pulmonary angiography (CTPA) in patients with suspected pulmonary embolism (PE) based on a single-center experience. Medical records and radiological reports of 450 patients (272 men and 178 women; mean age 58.9 years; range 14-95 years) with suspected PE who underwent CTPA and triple rule-out CT scans over a period of 6 months were retrospectively reviewed. Prevalence of PE was analysed to determine the diagnostic yield of CT in these two scanning protocols. Of 450 patient records, the positive rate of PE was 30.7%. Triple rule-out CT protocol was performed in 75 out of 450 patients with the diagnostic yield of PE being only 8% (6 out of 75 patients had PE), which is significantly lower than the 35.2% as shown in the CTPA group (132 out of 375 had PE). Mean effective dose was 2.8±2.6 mSv and 13.5±7.8 mSv for CTPA and triple rule-out protocols, respectively. This study shows that CTPA has high diagnostic yield in the diagnosis of pulmonary embolism, hence justifying its appropriateness as a routine imaging modality. However, triple rule-out CT is not recommended due to the low diagnostic yield. Further reduction in radiation and contrast medium doses is necessary.

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CT Angiography in the Evaluation of Acute Pulmonary Embolus

Cited by 107 publications

References 18 publications

Audit on the use of CTPA in pulmonary embolism (PE) diagnosis

Audit on the use of CTPA in pulmonary embolism (PE) diagnosis

Reproducibility of CT Signs of Right Ventricular Dysfunction in Acute Pulmonary Embolism

Diagnostic yield of CT pulmonary angiography in the diagnosis of pulmonary embolism: A single center experience

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