Diagnostic Imaging in Acute Pulmonary Embolism

To evaluate the evidence for the use of spiral volumetric computed tomography (SVCT) in the diagnosis of acute pulmonary embolism (PE), the 11 English-language studies published through July 1998 that compared SVCT with a reference standard for PE were systematically reviewed. Among the reviewed studies, methodological problems were common. Only 5 of these studies fulfilled 5 of 11 basic standards addressing important issues in diagnostic test research. The reported sensitivities of SVCT compared with pulmonary angiography varied widely (64%-93%), which was likely the result of differences in study populations. Spiral volumetric computed tomography may be relatively sensitive and specific for diagnosing central pulmonary artery PEs, but it is insensitive for diagnosing subsegmental clots. Spiral volumetric computed tomography may have a role as a "rule-in" test for large central emboli, but additional research is required to establish its place in clinical practice.

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The Role of Spiral Volumetric Computed Tomography in the Diagnosis of Pulmonary Embolism

Mullins

Becker²,

Hagspiel³

et al. 2000

Arch Intern Med

187

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Radiodiagnostik der Lunge

Kauczor¹,

Thelen²

2000

Der Radiologe

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Radiological cross-sectional imaging modalities, particularly computed tomography (CT) have become the mainstays for diagnosing lung disease in recent years. These enable morphological visualization of pathological processes with the greatest possible spatial resolution. Modern technical developments and complementary strategies have led to new applications and new functional assessments which need to be reviewed together with state-of-the-art techniques in nuclear imaging. The diagnosis of pulmonary embolism using spiral CT angiography and magnetic resonance (MR) angiography certainly belongs in this category. CT has become the an alternative modality of first choice, and it is also challenging pulmonary angiography as the gold standard. Direct visualization of patent pulmonary arteries and thromboembolic material is complemented by that of effects on the pulmonary parenchyma and right heart function; it also provides perfusion studies and MR-based flow measurement to assess hemodynamic compromise. Ventilation studies have long been a domain of nuclear imaging, and new techniques for the direct visualization of ventilation are emerging from recent developments in the field of MR imaging, for example, using hyperpolarized inert gases. New functional parameters of ventilation can be derived from these studies. For the diagnosis of metabolically active disease, such as tumor and pneumonia, CT offers very high sensitivity, for example, in screening for intrapulmonary nodules using low-dose CT and in the early detection of pulmonary infiltrates in high-risk patients. Especially for characterizing pulmonary nodules there is a need to combine nuclear medicine techniques, such as in positron-emission tomography.

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Non-traumatic thoracic emergencies: CT diagnosis of acute pulmonary embolism: the first 10 years

2002

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Over the past 10 years, spiral CT angiography of the pulmonary arteries has reached a high accuracy in the evaluation of pulmonary embolism. Major advantages of CT compared with ventilation/perfusion lung scintigraphy and pulmonary angiography is direct visualization of clots in the pulmonary arteries, and to provide alternative findings or diagnosis. The recent introduction of multislice CT has improved the evaluation of peripheral pulmonary arteries, enabling high-resolution CT examinations over the entire thorax in a short breathhold. The examination techniques, imaging findings, pitfalls, and results of CT in the diagnosis of pulmonary embolism are reviewed in comparison with other diagnostic tests.

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Diagnostic Imaging in Acute Pulmonary Embolism

Cited by 10 publications

References 22 publications

The Role of Spiral Volumetric Computed Tomography in the Diagnosis of Pulmonary Embolism

The Role of Spiral Volumetric Computed Tomography in the Diagnosis of Pulmonary Embolism

Radiodiagnostik der Lunge

Non-traumatic thoracic emergencies: CT diagnosis of acute pulmonary embolism: the first 10 years

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