Competitive assessments of pulmonary embolism: Noninvasiveness versus the golden standard

Ma, Yuxia; Shi, Yan; Zhou, Lin; Yuan, Dongtang

doi:10.1177/1708538115589893

Cited by 4 publications

(3 citation statements)

References 83 publications

(94 reference statements)

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“…Acute pulmonary embolism (PE) has an annual incidence of approximately 3–6 cases per 10,000 persons in the general population [1, 2], and is the third leading cause of death responsible for an average of 650,000 deaths annually in the United States [3–5].…”

Section: Introductionmentioning

confidence: 99%

Unenhanced multidetector computed tomography findings in acute central pulmonary embolism

et al. 2019

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Background Computed tomography pulmonary angiography (CTPA) is the gold standard for the diagnosis of pulmonary embolism (PE). However, contrast is contraindicated in some patients. The purpose of this study was to determine the diagnostic accuracy of unenhanced multidetector CT (MDCT) for diagnosis of central PE using CTPA as the gold standard. Methods The records of patients with suspected PE seen between 2010 and 2013 were retrospectively reviewed. Inclusion criteria were an acute, central PE confirmed by CTPA and non-enhanced MDCT before contrast injection. Patients with a PE ruled out by CTPA served as a control group. MDCT findings studied were high-attenuation emboli in pulmonary artery (PA), main PA dilatation > 33.2 mm, and peripheral wedge-shaped consolidation. Receiver operating characteristic (ROC) analysis was used to determine the sensitivity and specificity of unenhanced MDCT to detect PE. Wells score of all patients were calculated using data extracted from medical records prior to imaging analysis. Results Thirty-two patients with a PE confirmed by CTPA and 32 with a PE ruled out by CTPA were included. Among the three main MDCT findings, high-attenuation emboli in the PA showed best diagnostic performance (Sensitivity 72.9%; Specificity 100%), followed by main PA dilatation > 33.2 mm (sensitivity 46.9%; specificity 90.6%), and peripheral wedge-shaped consolidation (sensitivity 43.8%; specificity 78.1%). Given any one or more positive findings on unenhanced MDCT, the sensitivity was 96.9% and specificity was 71.9% for a diagnosis of PE in patients. The area under the curve (AUC) of a composite measure of unenhanced MDCT findings (0.909) was significantly higher than that of the Wells score (0.688), indicating unenhanced MDCT was reliable for detecting PE than Wells score. Conclusions Unenhanced MDCT is an alternative for the diagnosis of acute central PE when CTPA is not available.

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Section: Introductionmentioning

confidence: 99%

Unenhanced multidetector computed tomography findings in acute central pulmonary embolism

et al. 2019

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“… 15 , 16 Computed Tomography Pulmonary Angiography (CTPA) is reported as the “gold standard” for the diagnosis of APE. 17 However, patients with renal insufficiency and iodine-containing contrast agents hypersensitivity often limit its use. Moreover, the use of CTPA also has the problem of radiation exposure.…”

Section: Introductionmentioning

confidence: 99%

<p>The Predictive Value of microRNA-134 and microRNA-1233 for the Early Diagnosis of Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Acute Pulmonary Embolism</p>

Peng¹,

Han²,

Li³

et al. 2020

COPD

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Background: The differential diagnosis of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with acute pulmonary embolism (APE) complications are difficult because of the variability of clinical presentations and the shortage of an unfailing screening biomarkers or instruments. Objective: Aimed to detect and compare the expression of serum microRNAs (miR-1233, miR-134) in AECOPD patients complicated with APE. Patients/Methods: Blood samples were collected from 52 AECOPD patients (13 patients with APE complications, 39 patients without APE) and 10 patients with stable COPD. Serum miRNAs expression was detected with real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). The levels of plasma D-dimers were determined by detection with an enzyme-linked immunosorbent assay (ELISA). The receiver-operator characteristic (ROC) curve was used for evaluating the diagnostic accuracy of the studied miRNAs. Results: According to the Wells score, 42 of the 52 AECOPD patients were unlikely to have APE (≤4 points), whereas the remaining 10 (>4 points) were likely to have APE. There were 4 cases (4/13 30.8%) in the AECOPD combined with APE group with a Wells score of >4 points. The expression levels of miR-1233 and miR-134 in the serum were considerably upregulated in the AECOPD+APE group compared with the AECOPD group and the stable COPD group (P<0.05). The areas under the curve (AUCs) for miR-134 and miR-1233 were, respectively, 0.931 (95% CI 0.863-0.999) (P<0.05) and 0.884 (95% CI 0.79-0.978) (P<0.05) and were higher compared with the AUC for D-dimer of 0.628 (95% CI 0.447-0.809), the AUC for age-adjusted D-dimer of 0.705 (95% CI 0.525-0.885) and the AUC for Wells score of 0.577 (95% CI 0.389-0.765). Conclusion: Our study indicated that serum miR-1233 and miR-134 have high clinical value in the early diagnosis of AECOPD patients combined with APE, or could be used as potential biomarkers for clinical identification of AECOPD with or without APE complication.

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“…Individual analysis of the signs indicated that right heart thrombus was not statistically significant for sensitivity or specificity while both the 60/60 sign and the tricuspid annular plane systolic excursion were only significant for specificity (Fields et al, 2017). While TEE can be useful to further evaluate a clinician's suspicion of PE, clinicians cannot exclude PE based on a normal TTE since not all PE will cause RV strain (Fields et al, 2017;Ma, Yan, Zhou, & Yuan, 2016;. Furthermore, in the situation of a PE, the TTE can help the clinician to quantify the hemodynamic consequences of a PE, to classify the severity of PE and guide therapy (Weekes et al, 2017).…”

Section: Transthoracic Echocardiogrammentioning

confidence: 99%

End-tidal carbon dioxide in the diagnosis of acute pulmonary embolism in hospitalized adult patients

Prentice¹

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Pulmonary embolism (PE) causes 100,000 deaths and contributes to over 4 billion dollars of annual healthcare costs. Acute PE is a diagnostic challenge as symptoms vary widely and are often nonspecific. Definitive diagnosis requires costly confirmatory testing with computed tomography pulmonary angiogram (CTPA). CTPA risks include allergic reactions, contrast-induced nephropathy and radiation exposure. The purpose of this study is two-fold: 1) to examine the accuracy, financial impact, and harm avoidance of adding EtCO[2] to the PE diagnostic process and 2) to evaluate clinician adherence to national guidelines (BPA) for PE diagnosis. A single center prospective, descriptive, correlational design comparing EtCO[2] values to CTPA results. Medical records were reviewed to determine BPA adherence. A total of 111 patients had definitive CT results. Mean ([plus or minus]SD) EtCO[2] was higher for PE+ (28[plus or minus]7.8) versus PE- (33[plus or minus] 8.1) patients (p =.01). For PE exclusion, an EtCO[2] cutoff value of [greater than or equal to]42mmHg yielded a sensitivity of 100%, specificity of 12.2% and a negative predictive value of 100% and could safely eliminate 11 patients (9.9%) from receiving CTPA. For every 6 patients assessed with EtCO[2], one can be saved from CTPA. Overall BPA adherence was 0%. Partial adherence was observed with clinician recorded clinical decisions rules in 3.6% (4/111) and D-dimer was obtained in 10.2% (9/88). EtCO[2] cutoff value of [greater than or equal to]42mmHg could decrease CTPA scans use in [about]10% of adult inpatients suspected of PE eliminating exposure to CTPA risks. Lack of clinical decision support may contribute to low BPA compliance.

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Competitive assessments of pulmonary embolism: Noninvasiveness versus the golden standard

Cited by 4 publications

References 83 publications

Unenhanced multidetector computed tomography findings in acute central pulmonary embolism

Unenhanced multidetector computed tomography findings in acute central pulmonary embolism

<p>The Predictive Value of microRNA-134 and microRNA-1233 for the Early Diagnosis of Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Acute Pulmonary Embolism</p>

End-tidal carbon dioxide in the diagnosis of acute pulmonary embolism in hospitalized adult patients

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