Diagnosing Pulmonary Embolism With Computed Tomography Pulmonary Angiography

Abstract

Purpose: Computed tomography pulmonary angiography (CT-PA) is frequently used in the diagnostic workup of pulmonary embolism (PE), even in highly radiosensitive patient populations. This study aims to assess CT-PA with reduced z-axis coverage (compared with a standard scan range covering the entire lung) for its sensitivity for detecting PE and its potential to reduce the radiation dose. Materials and Methods:We retrospectively analyzed 602 consecutive CT-PA scans with definite or possible PE reported. A reduced scan range was defined based on the topogram, where the cranial slice was set at the top of the aortic arch and the caudal slice at the top of the lower hemidiaphragm. Locations of emboli in relation to the reduced scan range were recorded. Results:We included 513 CT-PA scans with definite acute PE in statistical analysis. Patients' median age was 66 (52 to 77) years, 46% were female. Median dose length product was 270.8 (111.3 to 503.9) mGy*cm. Comparing the original and reduced scan ranges, the mean scan length was significantly reduced by 48.0 ± 8.6% (26.8 ± 3.0 vs. 13.9 ± 2.6 cm, P < 0.001). Single emboli outside the reduced range in addition to emboli within were found in 15 scans (2.9%), while only 1 scan (0.2%) had an embolus outside the reduced range and none within it. The resulting sensitivity of CT-PA with reduced scan range was 99.81% (95% confidence interval: 98.74%-99.99%) for detecting any PE. Conclusion:A reduced scan length in CT-PA, as defined above, would substantially decrease radiation dose while maintaining diagnostic accuracy for detecting PE.

Multimodality imaging of acute and chronic pulmonary thromboembolic disease

“…CTPA is conventionally performed by acquiring images of the whole thorax after intravenous CM administration in the pulmonary arterial phase, with the objective of optimal opacification of pulmonary arteries up to the subsegmental branches [ 15 ]. In a recent publication [ 16 ], shortening the scan range (upper edge of the aortic arch and the lower hemidiaphragm) could provide an estimated average radiation dose reduction by 48% without significant loss of sensitivity for PE detection. This is of particular importance in populations that are particularly radiosensitive such as breast irradiation in young females.…”