Clinical consequences of an indeterminate CT pulmonary angiogram in cancer patients

Abstract

Our aim was to evaluate clinical management and outcomes in cancer patients who had an indeterminate Computed Tomographic Pulmonary Angiogram (CTPA) for the assessment of pulmonary embolus. We reviewed 1000 CTPA studies and identified 251 limited (indeterminate) CTPA. We examined follow-up imaging and reviewed clinical management decisions and any positive diagnosis of venous thromboembolic disease (VTE) within the subsequent 90 days. 60 patients (23.9%) had a follow-up imaging study within five days. 8 had a positive study for VTE disease within 5 days. 3 patients (1.2%) were placed on anticoagulation therapy based on the limited CT result.

Indeterminate CT pulmonary angiogram: Why and does it matter?

“…Most of these patients had no further investigation as the referring clinicians treated indeterminate CTPA as an endpoint in their investigation. Hayes et al . with population group of oncology patients demonstrated that overall 82.5% of the indeterminate CTPA studies were interpreted as a negative result by the clinicians with only 23.9% undergoing further imaging to examine for venous thromboembolic disease within a 5‐day period.…”

“…Most of these patients had no further investigation as the referring clinicians treated indeterminate CTPA as an endpoint in their investigation. Hayes et al 9 with population group of oncology patients demonstrated that overall 82.5% of the indeterminate CTPA studies were interpreted as a negative result by the clinicians with only 23.9% undergoing further imaging to examine for venous thromboembolic disease within a 5-day period. It may be useful to gain insight into the clinician's understanding of 'indeterminate CTPAs' by conducting a survey among clinicians whether the decision to treat the CTPA as negative is due to clinical factors, or a misinterpretation of the radiology report.…”

“…Although potential clinical outcome from such indeterminate studies has not yet fully explored, referring clinicians often regard indeterminate studies as a negative conclusion rather than an inconclusive result, potentially resulting in compromised patient outcomes …”

“…Although potential clinical outcome from such indeterminate studies has not yet fully explored, referring clinicians often regard indeterminate studies as a negative conclusion rather than an inconclusive result, potentially resulting in compromised patient outcomes. 5,8,9 The purpose of this study is, therefore, to assess the rate of indeterminate study in Waitemata district heath board (WDHB) and retrospectively evaluate the imaging characteristics and possible causes for indeterminate CTPA in detecting pulmonary embolism. Clinical outcomes of the indeterminate studies were also investigated.…”

Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism

“…37 In the case of the V/Q scan, the degradation of the clinical utility of the test in the context of pre-existing or co-evolving lung disease presents a significant limitation. 38 This is further complicated by the significant presence of renal disease for CT angiography and lung disease for V/Q scans in the most at-risk populations for PE. Thus, in addition to improving these techniques, there remains significant interest in developing additional modalities for detection of clot.…”