Reassessment of Pulmonary Angiography for the Diagnosis of Pulmonary Embolism: Relation of Interpreter Agreement to the Order of the Involved Pulmonary Arterial Branch

Stein, Paul D.; Henry, Jerald W.; Gottschalk, Alexander

doi:10.1148/radiology.210.3.r99mr41689

Cited by 204 publications

(88 citation statements)

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“…Moreover, its sensitivity is not 100% as recurrent venous thromboembolic events have been observed in a limited number of patients with normal angiograms (11). Interobserver agreement rates for detection of subsegmental emboli with pulmonary angiography ranged from 45% to 66% (12,13). For multidetector CT this is in the range of 56%-85% (14,15).…”

mentioning

confidence: 99%

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Doğan

A²,

Geleijins³

et al. 2015

Diagn Interv Radiol

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A cute pulmonary embolism (PE) is the third most common cardiovascular condition, after coronary artery disease and stroke (1). Due to lack of specific sets of symptoms that accurately predict or exclude the diagnosis of acute PE, the diagnosis strongly relies on noninvasive imaging techniques. Diagnostic strategies for evaluating PE have undergone important changes over the past decades (2). Due to rapid technical advances in speed and spatial resolution, the utility of computed tomography (CT) angiography has been recognized in vascular imaging. Particularly, after the development of multidetector row CT in 1998 (3), CT pulmonary angiography (CTPA) has become the imaging method of choice in the diagnosis of acute PE (4). CTPA has advantages over conventional invasive X-ray pulmonary angiography and nuclear ventilation-perfusion (V/Q) imaging. CT is a widely available, fast and noninvasive technique, has the capability to directly visualize emboli, and may provide alternative diagnoses (4).Despite adequate diagnosis and anticoagulant therapy, death rate after a diagnosis of acute PE is still 8%-15% (5, 6). The prognosis of acute PE mainly depends on residual pulmonary circulation and the severity of right ventricular (RV) dysfunction (7). Recent studies have shown that CT permits the assessment of acute right-sided heart failure. Furthermore, CT can predict adverse clinical outcome by using the RV/left ventricular (LV) diameter ratio (8, 9) or RV ejection fraction in patients with PE (10).The aim of this review is to discuss the developments of CT in PE diagnosis, and to analyze the added value of CT in estimating PE severity and prognosis. Furthermore, CT findings of chronic thromboembolic pulmonary arterial hypertension (CTEPH) as a complication of acute PE will be discussed. CT developments in PE diagnosisHistorically, pulmonary angiography and nuclear planar V/Q-imaging were the main imaging methods used for diagnosing PE. Both methods have recognized limitations. Pulmonary angiography has previously been regarded as reference standard, but the method CHEST IMAGING REVIEW ABSTRACT Pulmonary embolism (PE) is a potentially life threatening condition requiring adequate diagnosis and treatment. Computed tomography pulmonary angiography (CTPA) is excellent for including and excluding PE, therefore CT is the first-choice diagnostic imaging technique in patients suspected of having acute PE. Due to its wide availability and low invasiveness, CTPA tends to be overused. Correct implementation of clinical decision rules in diagnostic workup for PE improves adequate use of CT. Also, CT adds prognostic value by evaluating right ventricular (RV) function. CT-assessed RV dysfunction and to lesser extent central emboli location predicts PE-related mortality in normotensive and hypotensive patients, while PE embolic obstruction index has limited prognostic value. Simple RV/left ventricular (LV) diameter ratio measures >1.0 already predict risk for adverse outcome, whereas ratios <1.0 can safely exclude adverse outcome. Con...

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mentioning

confidence: 99%

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Doğan

A²,

Geleijins³

et al. 2015

Diagn Interv Radiol

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“…Мелкие тромбы размерами 1-2 мм в субсегментар ных артериях можно обнаружить с помощью цифро Клинические рекомендации вой субтракционной ангиографии, но при оценке артерий такого уровня мнения исследователей не редко расходятся [164,165]. Косвенные признаки ТЭЛА, такие как медленная скорость продвижения контраста, регионарная гипоперфузия и замедлен ный или сниженный кровоток в легочных венах, не валидизированы и, следовательно, не могут расце ниваться как диагностически значимые.…”

Section: ангиопульмонографияunclassified

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014).The Task Force of the European Society of Cardiology for diagnosis and management of pulmonary embolism

Редакционная¹

2015

Pulʹmonologiâ (Mosk.)

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РезюмеВ данных Клинических рекомендациях суммированы все современные доказательства по диагностике и лечению тромбоэмболии легочной артерии (ТЭЛА). В отличие от предыдущей версии рекомендаций, в данном документе представлены упрощенные варианты клинических прогностических шкал, подробно рассмотрена стратификация риска летального исхода, включая промежуточные степени риска, представлены новые подходы к АКТ, в т. ч. системному тромболизису и катетерным методам лечения, терапии антагонистом витамина К, определено место новых пероральных антикоагулянтов в терапии ТЭЛА. Ключевые слова: рекомендации, тромбоэмболия легочной артерии, венозный тромбоз, шок, гипотензия, торакалгия, одышка, сердеч ная недостаточность, диагностика, антикоагулянты, тромболизис. SummaryThese clinical recommendations summarized currently available evidence on diagnosis and management of patients with pulmonary embolism. When compared to previous version of recommendations, this document has introduced simplified clinical prognostic scales and a new risk stratifi cation system including intermediate risk. Novel approach to anticoagulant therapy have been also reviewed including systemic thrombolysis, catheter directed treatment, vitamin K antagonists and new oral anticoagulants. Key words: recommendations, pulmonary embolism, venous thromboembolism, shock, hypotension, chest pain, dyspnea, heart failure, diagnosis, anticoagulants, thrombolysis.Тромбоэмболия легочной артерии: клинические рекомендации Европейского общества кардиологов (2014) 526Пульмонология. 2015; 25 (5): 525-552 возникавших в ходе работы над Рекомендациями, надлежало информировать ЕОК и вносить соответ ствующие поправки. Финансирование Рабочей груп пы проводилось за счет средств ЕОК полностью, без участия представителей медицинской промышлен ности.Комитетом ЕОК по Практическим рекомендаци ям проведены наблюдение за процессом подготовки новых Клинических рекомендаций и его координа ция. Члены Комитета также несли ответственность за утверждение новых Клинических рекомендаций. Клинические рекомендации ЕОК активно проана лизированы Комитетом по Практическим рекомен дациям и внешними экспертами. После соответст вующих поправок Рекомендации были одобрены всеми экспертами Рабочей группы. Окончательный документ был утвержден Комитетом по Практичес ким рекомендациям для публикации в журнале European Heart Journal.Задача написания Клинических рекомендаций ЕОК заключается не только в объединении результа тов исследований последних лет, но также и в разра ботке образовательных методик и программ внедре ния Рекомендаций в практическое здравоохранение.Для практического использования Рекоменда ций готовится их краткая («карманная») версия, а также слайды, буклеты с ключевыми положения ми, листовки для неспециалистов и электронная версия для смартфонов и других гаджетов (сокра щенные варианты); с полным текст Рекомендаций опубликован на сайте ЕОК и находится в свободном доступе. Национальным обществам рекомендуется утверждать, переводить на национальные языки и внедрять Клинические рекоме...

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“…APE tanısı iki projeksiyonda trombüsün direkt bulgusu olan dolma defekti ya da arter dalının ampütasyonun görülmesi ile konur. Alt segmental arterlerin içerisindeki 1-2 mm boyutunda trombüs dijital substraksiyon anjiyografi (DSA) tarafından görüntülenir, ancak bu düzeyde gözlemciler arası önemli değişkenlik vardır (10,11). Yavaş kontrast akımı, bölgesel hipoperfüzyon ve gecikmiş ya da azalmış pulmoner venöz APE'nin indirekt bulgularıdır.…”

Section: Direkt Katater Pulmoner Anjiografiunclassified

Diagnostic Imaging in Acute Pulmonary Embolism

Christiansen

2014

J Chest Dis Crit Care

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The clinical diagnosis of acute pulmonary embolism (APE) is difficult because of the variable and non-specific symptoms. Diagnosis is made together by clinics and imaging methods. Rapid and accurate diagnosis is important in preventing mortality and also complications related to anticoagulant therapy as well. Computed tomography (CT) pulmonary angiography and ventilation / perfusion scintigraphy are the most commonly used diagnostic imaging methods. Nowadays, new diagnostic methods like dualenergy CT pulmonary angiography, single photon emission computed tomography (SPECT) and SPECT-CT are increasingly used in clinical practice. The purpose of this paper is to discuss the advantages and disadvantages of imaging methods in the diagnosis of acute PE and assess their clinical use.

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Reassessment of Pulmonary Angiography for the Diagnosis of Pulmonary Embolism: Relation of Interpreter Agreement to the Order of the Involved Pulmonary Arterial Branch

Cited by 204 publications

References 12 publications

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014).The Task Force of the European Society of Cardiology for diagnosis and management of pulmonary embolism

Diagnostic Imaging in Acute Pulmonary Embolism

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