Comparative Study of Diagnostic Efficacy of Single Phase-Computed Tomography Pulmonary Angiography and Dual Phase-Computed Tomography Pulmonary Angiography in the Diagnosis of Pulmonary Embolism

Abstract

ObjectiveWe compared the efficacy of single phase-computed tomography pulmonary angiography (SP-CTPA) and dual phase-computed tomography pulmonary angiography (DP-CTPA) for the diagnosis of pulmonary embolism (PE).MethodsWe recruited 1,019 consecutive patients (359 with PE) who underwent DP-CTPA (phase I: pulmonary artery phase; phase II: aortic phase) for suspected PE between January and October 2021. Phase I of DP-CTPA was used as SP-CTPA, and the final clinical diagnosis (FCD) was used as the gold standard.ResultsThree hundred fifty-two cases of PE were detected by both methods, with the same sensitivity of 98.1% (99.6–99.5%). Using SP-CTPA, 142 cases [13 pulmonary insufficiency artifacts (PIA) and 129 systemic-pulmonary shunt artifacts (S-PSA)] were false-positive with specificity of 78.5% (75.3–81.6%). No false-positive was found with DP-CTPA, with specificity of 100%, positive predictive value of 1, and negative predictive value of 0.990 (Net Reclassification Improvement = 0.215; P < 0.05). According to FCD, the positive results of SP-CTPA were divided into PIA, S-PSA, and true-positive (TPSP−CTPA) groups, and pairwise comparisons were performed. The bronchiectasis and hemoptysis rate in S-PSA group was higher than that in PIA and TP groups (P < 0.001), and the pulmonary hypertension (PH) rate in PIA group was higher than that in S-PSA and TP groups (P < 0.001).ConclusionThe diagnostic efficiency of DP-CTPA for the diagnosis of PE was high. SP-CTPA may misdiagnose PIA (common in patients with PH) and S-PSA (common in patients with bronchiectasis and hemoptysis) as PE.

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“…Due to the lack of specific clinical symptoms and signs, diagnosing PE remains a clinical challenge ( 13 ). Computed tomography pulmonary angiography (CTPA), which requires the injection of iodinated contrast material, has been widely used as a gold-standard diagnostic modality in patients with suspected PE ( 14 ). However, CTPA exposes patients to risks of false-positive result, allergic reaction, renal failure and cumulative radiation-induced cancer ( 13 , 14 ).…”

“…Computed tomography pulmonary angiography (CTPA), which requires the injection of iodinated contrast material, has been widely used as a gold-standard diagnostic modality in patients with suspected PE ( 14 ). However, CTPA exposes patients to risks of false-positive result, allergic reaction, renal failure and cumulative radiation-induced cancer ( 13 , 14 ). Moreover, CTPA was found to be overused, leading to ineffective utilization of hospital resources ( 15 ).…”