Pulmonary embolism: validation of spiral CT angiography in 149 patients.

Rossum, A. B. Van; Pattynama, Peter M. T.; Ton, Evelien; Treurniet, F. E. E.; Arndt, J. W.; Eck, B. Van; Kieft, G. J.

doi:10.1148/radiology.201.2.8888242

Cited by 268 publications

(140 citation statements)

References 0 publications

Supporting

Mentioning

125

Contrasting

Unclassified

Order By: Relevance

“…With regard to the diagnosis of isolated subsegmental PE, we diagnosed a single case in a group-1 patient with underlying COPD (one of 24 patients with positive angiograms, i.e., 4%). Apart from Goodman et al who identified four cases among 11 positive scans (36%) [2], the reported prevalence of subsegmental PE on single-slice and dual-section spiral CT angiograms varies from 2 to 10% [3,4,6,15].…”

Section: Discussionmentioning

confidence: 96%

“…Compared with single-slice CT, and for a similar degree of functional impairment, we observed a significantly higher proportion of CT angiograms devoid of respiratory (64 vs 38%) and cardiac motion artifacts (62 vs 40%) with multislice CT. Because of the well-known difficulties in assessing acute PE in patients with underlying respiratory disease, the benefit of multislice CT, which allows obtainment of a higher number of examinations interpretable down to the subsegmental pulmonary arterial bed compared with single slice CT, is emphasized. As underlined by several investigators [2,4,14,15], the limitations of single-slice CT in the detection of clots in small vessels are related mainly to lower spatial resolution and to the fact that subsegmental vessels of the upper and lower lobes frequently lie outside the limits of z-axis coverage. Consequently, the remaining indications of pulmonary angiography, namely the exclusion of subsegmental PE after a negative CT angiogram down to the segmental level, are expected to dramatically decline with the widespread availability of multislice CT scanners.…”

Section: Discussionmentioning

confidence: 99%

“…Initially performed with single-slice CT scanners and a 5-mm collimation, CT angiography provided an accurate evaluation of central pulmonary arteries but was unable to reliably identify endoluminal clots within segmental and subsegmental branches [1,2,3,4]. An important step was the availability of subsecond scanning in the late 1990s which allowed scanning of patients with thinner collimations, i.e., 3-to 2 mm, over a longer region of interest.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

“…2 Most scans are interpreted as either positive or negative for pulmonary embolism, providing clinicians with a greater sense of diagnostic certainty than with the probabilistic results of lung scintigraphy. Initial studies of CTPA supported this appearance of diagnostic certainty, reporting sen-sitivity and specificity of greater than 90%, 3,4 but several subsequent studies have failed to reproduce these results. [5][6][7] Newer multidetector CT scans are believed to be more accurate than earlier singledetector CT, 8 but true estimates of CTPA test characteristics will not be known until publication of the forthcoming PIOPED II study.…”

Section: S Piral Computed Tomographic Pulmonary Angiography (Ctpa)mentioning

confidence: 98%

Impact of reliance on CT pulmonary angiography on diagnosis of pulmonary embolism: A Bayesian analysis

Ranji

Shojania

Trowbridge

et al. 2006

Journal of Hospital Medicine

View full text Add to dashboard Cite

BACKGROUNDSpiral computed tomographic pulmonary angiography (CTPA) has become the primary test used to investigate suspected pulmonary embolism (PE) at many institutions, despite uncertainty regarding its sensitivity and specificity. Although CTPA‐based diagnostic algorithms focus on minimizing the false‐negative rate, we hypothesized that increasing use of CTPA also might lead to false‐positive diagnoses.OBJECTIVEDetermine the frequency of possible false‐positive diagnoses of PE when CTPA is the primary diagnostic test.DESIGNRetrospective cohort study.SETTINGTwo academic teaching hospitals.PARTICIPANTS322 patients with suspected PE evaluated with CTPA.MEASUREMENTSWe used a validated prediction rule to determine the pretest probability of PE in each patient. We combined these pretest probabilities with published estimates of CTPA test characteristics to generate expected posttest probabilities of PE. We compared these posttest probabilities to actual treatment decisions to determine the rate of false‐positive diagnoses of PE.RESULTSAmong 322 patients investigated for PE, 37 (12%) had high pretest probability, 101 (32%) moderate, and 184 (57%) low. CT scans were interpreted as positive for PE in 57 patients (17.8%). Regardless of the pretest probability of PE, 96.5% of patients with a positive CTPA were treated with anticoagulants. Even under an optimistic assumption of CTPA test characteristics, as many as 25.4% of these patients may have been treated unnecessarily as a result of a false‐positive diagnosis. Most of these patients had a low pretest probability of PE.CONCLUSIONSFailure to utilize Bayesian reasoning when interpreting CTPA may lead to false‐positive diagnoses of pulmonary embolism in a substantial proportion of patients. Journal of Hospital Medicine 2006;1:81–87. © 2006 Society of Hospital Medicine

show abstract

“…Several studies have shown a high sensitivity and specificity for spiral CT in the diagnosis of PE [37][38][39]. In an increasing number of centres, spiral CT has become the imaging modality of choice in the diagnosis of PE.…”

Section: Spiral Computed Tomographymentioning

confidence: 99%

Computed tomography and magnetic resonance imaging: past, present and future

Nl¹

2002

European Respiratory Journal

View full text Add to dashboard Cite

The aims of this paper are to summarize the current recommendations for the use of computed tomography (CT) and magnetic resonance imaging (MRI) in the chest and to suggest some possible future developments.The main developments of CT in the chest have been the introduction of highresolution CT (HRCT), spiral CT and, more recently, multidetector spiral CT.HRCT is defined as thin-section CT (1-to 2-mm collimation scans), optimized by using a high-spatial resolution (edge-enhancing) algorithm. Several studies have shown that HRCT closely reflects macroscopic (gross) pathological findings. HRCT currently has the best sensitivity and specificity of any imaging method used for the assessment of focal and diffuse lung diseases.The advent of spiral CT and, more recently, multidetector CT scanners, has allowed for major improvements in the imaging of airways, pulmonary and systemic vessels, and lung nodules. Spiral CT facilitates multiplanar and three-dimensional display of structures and visualization of pulmonary and systemic vessels, with a level of detail that is comparable to that of conventional angiography. With the use of graphics-based software programs, spiral CT enables depiction of the luminal surface of the airways with images that resemble those of bronchoscopy (virtual bronchoscopy) or bronchography (virtual bronchography). Several studies have shown a high sensitivity and specificity for spiral CT in the diagnosis of acute pulmonary embolism. Therefore, spiral CT is rapidly becoming the imaging modality of choice in the diagnosis of pulmonary embolism.Like the radiograph, signal intensity on computed tomography is mainly due to a single parameter: electron density. The signal intensity of the magnetic resonance image depends on four parameters: nuclear density, two relaxation times called T1 and T2, and motion of the nuclei within the imaged lung volume. Abnormal soft tissue can be identified more easily through measurement of these four parameters than through use of computed tomography. Furthermore, because the spatial orientation of the image is determined by manipulation of magnetic fields, scans can be performed in any plane. The main indications for magnetic resonance in the chest have been in the evaluation of the heart, major vessels, mediastinum, and hilar structures because of the natural contrast provided by flowing blood. Of particular interest for the respirologist has been the recent development of magnetic resonance angiography. This technique consists of three-dimensional single breath-hold images obtained using gadolinium-based contrast agents. This is a promising technique for the diagnosis of acute and chronic pulmonary embolism. Eur Respir J 2002; 19: Suppl. 35, 3s- For many years, the plain chest radiograph was the only imaging modality used in the diagnosis of lung disease. With the advent of computed tomography (CT) came the first opportunity to assess gross lung structure. Conventional 8-to 10-mm collimation scans allowed better assessment of the lung parenchyma than was...

show abstract

Pulmonary embolism: validation of spiral CT angiography in 149 patients.

Abstract: Spiral CT angiography is an accurate method for the detection and exclusion of PE, with the exception of isolated subsegmental PE.

Cited by 268 publications

References 0 publications

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

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

Impact of reliance on CT pulmonary angiography on diagnosis of pulmonary embolism: A Bayesian analysis

Computed tomography and magnetic resonance imaging: past, present and future

Contact Info

Product

Resources

About