Accuracy of computed tomography angiography in the detection of pulmonary embolism in patients with high body weight

Megyeri, Boglarka; Christe, Andreas; Schindera, Sebastian T.; Horkay, Edit; Sikula, Judit; Cullmann, Jennifer; Kollár, Ján; Heverhagen, Johannes T.; Szücs-Farkas, Zsolt

doi:10.1016/j.ejim.2014.07.003

Cited by 9 publications

(3 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Additionally, we included 22 studies and 15 865 patients to inform estimates of effects of performing a test on patient important outcomes for patients suspected of having PE. The references for the included studies are as follows: CTPA, [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] D-dimer, 30,31,36,[38][39][40] age-adjusted D-dimer, 40 proximal compression ultrasound, 39,67-72 VQ. 28,30,34,68,71,[73][74][75][76][77][78][79][80] Low PTP/prevalence (£5%) Question: In a patient population with a low clinical probability of PE, what is the optimal diagnostic strategy to evaluate for suspected first episode PE?…”

Section: Summary Of Evidencementioning

confidence: 99%

American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism

et al. 2018

View full text Add to dashboard Cite

Background: Modern diagnostic strategies for venous thromboembolism (VTE) incorporate pretest probability (PTP; prevalence) assessment. The ability of diagnostic tests to correctly identify or exclude VTE is influenced by VTE prevalence and test accuracy characteristics. Objective: These evidence-based guidelines are intended to support patients, clinicians, and health care professionals in VTE diagnosis. Diagnostic strategies were evaluated for pulmonary embolism (PE), deep vein thrombosis (DVT) of the lower and upper extremity, and recurrent VTE. Methods: The American Society of Hematology (ASH) formed a multidisciplinary panel including patient representatives. The McMaster University GRADE Centre completed systematic reviews up to 1 October 2017. The panel prioritized questions and outcomes and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations. Test accuracy estimates and VTE population prevalence were used to model expected outcomes in diagnostic pathways. Where modeling was not feasible, management and accuracy studies were used to formulate recommendations. Results: Ten recommendations are presented, by PTP for patients with suspected PE and lower extremity DVT, and for recurrent VTE and upper extremity DVT. Conclusions: For patients at low (unlikely) VTE risk, using D-dimer as the initial test reduces the need for diagnostic imaging. For patients at high (likely) VTE risk, imaging is warranted. For PE diagnosis, ventilation-perfusion scanning and computed tomography pulmonary angiography are the most validated tests, whereas lower or upper extremity DVT diagnosis uses ultrasonography. Research is needed on new diagnostic modalities and to validate clinical decision rules for patients with suspected recurrent VTE.

show abstract

Section: Summary Of Evidencementioning

confidence: 99%

American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Some studies have shown no difference in subjective image quality, diagnostic confidence, or diagnostic accuracy between obese and non-obese patients. [39][40][41] Despite this reassuring data, however, there is evidence that obesity can still be a problem in CTPA examinations. Obesity was noted to be a cause of non-diagnostic CTPA examinations in several studies, and the increasing prevalence of obesity may play a role in the worsening diagnostic yield of CTPA.…”

Section: Challenges Of Imaging In Obesitymentioning

confidence: 99%

Imaging of suspected pulmonary embolism and deep venous thrombosis in obese patients

Cascio

Hon

Haramati

et al. 2018

BJR

View full text Add to dashboard Cite

Obesity is a growing problem around the world, and radiology departments frequently encounter difficulties related to large patient size. Diagnosis and management of suspected venous thromboembolism, in particular deep venous thrombosis (DVT) and pulmonary embolism (PE), are challenging even in some lean patients, and can become even more complicated in the setting of obesity. Many obstacles must be overcome to obtain imaging examinations in obese patients with suspected PE and/or DVT, and to ensure that these examinations are of sufficient quality to diagnose or exclude thromboembolic disease, or to establish an alternative diagnosis. Equipment limitations and technical issues both need to be acknowledged and addressed. Table weight limits and scanner sizes that readily accommodate obese and even morbidly obese patients are not in place at many clinical sites. There are also issues with image quality, which can be substantially compromised. We discuss current understanding of the effects of patient size on imaging in general and, more specifically, on the imaging modalities used for the diagnosis and treatment of DVT and PE. Emphasis will be placed on the technical parameters and protocol nuances, including contrast dosing, which are necessary to refine and optimize images for the diagnosis of DVT and PE in obese patients, while remaining cognizant of radiation exposure. More research is necessary to develop consistent high-level evidence regarding protocols to guide radiologists, and to help them effectively utilize emerging technology.

show abstract

“…La incidencia a nivel mundial es de aproximadamente de 100 a 200 casos por cada 100 mil habitantes; también es causante de aproximadamente 317 mil muertes anuales en la Unión Europea (3). Es importante destacar que más de la mitad de las muertes (59% aproximadamente) relacionadas a TEP se puede hacer el diagnóstico únicamente post mortem, por la clínica súbita y poco clara que produce la misma (4,5).…”

Section: Introductionunclassified

Tromboembolismo Pulmonar Agudo como reto diagnóstico: Reporte de caso

Villa Pallashco,

Fernandez Leon,

Barrera Saguay

et al. 2023

Tesla rev. cient.

View full text Add to dashboard Cite

Introducción: La tromboembolia pulmonar se considera una urgencia cardiovascular que conlleva una elevada morbilidad y mortalidad en pacientes hospitalizados. Su incidencia es elevada, aproximadamente de 100 a 200 casos por cada 100 mil habitantes. La clínica con el que debuta el paciente es generalmente la presencia de disnea. Para su diagnóstico se utilizan escalas de predicción clínica, entre ellas, la más utilizada es la escala de Wells. Exposición del caso: Paciente adulto mayor, encamado, con control inadecuado de sus enfermedades de base que ingresa por una descompensación de diabetes mellitus tipo 2 y que rápidamente evoluciona a un cuadro de insuficiencia respiratoria e inestabilidad hemodinámica sin causa aparente. Basados en su clínica y junto a los exámenes complementarios que se realizó, escala de Wells con un puntaje elevado, se diagnosticó una tromboembolia pulmonar fulminante. A pesar de todas las medidas al alcance que se pudieron utilizar para la estabilización del paciente, no se logró un resultado satisfactorio con el consiguiente fallecimiento del mismo. Conclusiones: El factor de riesgo primordial es la presencia de trombosis venosa profunda. Un diagnóstico oportuno y tratamiento adecuado, la individualización de cada caso para brindar la terapéutica más adecuada para salvaguardar la vida del paciente.

show abstract

Accuracy of computed tomography angiography in the detection of pulmonary embolism in patients with high body weight

Cited by 9 publications

References 42 publications

American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism

American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism

Imaging of suspected pulmonary embolism and deep venous thrombosis in obese patients

Tromboembolismo Pulmonar Agudo como reto diagnóstico: Reporte de caso

Contact Info

Product

Resources

About