Clinical prediction rules for the diagnosis of pulmonary embolism

Detection of simulated pulmonary embolism in a porcine model using hyperpolarized 3He MRI

“…The imaging techniques most commonly used to diagnose PE are the nuclear medicine ventilation‐perfusion (VP) scan (13–19) via single photon‐emission computed tomography (VP‐SPECT), computed tomography (CT) (13–15, 18, 20–25), magnetic resonance angiography (MRA) (15, 20, 24, 26, 27), and the gold standard, conventional pulmonary angiography (PA) (1, 14–17, 19–22, 24, 28–31).…”

“…It results in fewer complications (18, 19) and shorter procedure times, and is less invasive and easier to perform. However, CT is a semiquantitative technique that involves the use of ionizing radiation (14, 20), and its diagnostic value for subsegmental emboli is limited (13, 15, 34). CT is also potentially limited for critically ill and/or older patients because its iodinated contrast agents are associated with anaphylaxis and contrast‐induced nephropathy.…”

“…MRA is a minimally invasive procedure (15, 20, 24) with high interobserver agreement. It uses safer contrast agents (15, 20, 24), no ionizing radiation (20, 24), and is faster and less difficult to perform than PA (20).…”

“…MRA is a minimally invasive procedure (15, 20, 24) with high interobserver agreement. It uses safer contrast agents (15, 20, 24), no ionizing radiation (20, 24), and is faster and less difficult to perform than PA (20). Advances in the technique now permit simultaneous ventilation and perfusion imaging (20, 24); however, like CT, MRA has been shown to have poor sensitivity in detecting subsegmental emboli (15).…”

Comparison of Percutaneous Ultrasound-Accelerated Thrombolysis Versus Catheter-Directed Thrombolysis in Patients with Acute Massive Pulmonary Embolism

“…3,4 Massive PE, in contrast, is characterized by circulatory collapse or hemodynamic instability, which is associated with a threefold increased inpatient mortality compared with those patients without hemodynamic instability. 5,6 Although the lethality data of this devastating condition are comparable to those of acute myocardial infarction, the overall mortality rates associated with PE have not improved significantly over the past three decades. 3,[7][8][9] The ideal treatment strategies for patients with massive PE have been a subject of controversy as no randomized controlled trials exist to support an optimal therapeutic modality.…”