Imaging of Pulmonary Embolism

Glassroth, Jeffrey

doi:10.1001/jama.298.23.2788

Cited by 31 publications

(3 citation statements)

References 19 publications

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“…This method has wide applicability to address increasing concerns about both overtesting and overdiagnosis of PE. The increase in the incidence of PE accompanying the increased use of CTPA [ 15 ] has been associated with a decrease in the PE case mortality [ 16 , 17 ]. Physicians are testing more for PE and seem to be finding and treating clinically insignificant PEs.…”

Section: Discussionmentioning

confidence: 99%

A Computerized Method for Measuring Computed Tomography Pulmonary Angiography Yield in the Emergency Department: Validation Study

et al. 2018

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BackgroundUse of computed tomography pulmonary angiography (CTPA) in the assessment of pulmonary embolism (PE) has markedly increased over the past two decades. While this technology has improved the accuracy of radiological testing for PE, CTPA also carries the risk of substantial iatrogenic harm. Each CTPA carries a 14% risk of contrast-induced nephropathy and a lifetime malignancy risk that can be as high as 2.76%. The appropriate use of CTPA can be estimated by monitoring the CTPA yield, the percentage of tests positive for PE. This is the first study to propose and validate a computerized method for measuring the CTPA yield in the emergency department (ED).ObjectiveThe objective of our study was to assess the validity of a novel computerized method of calculating the CTPA yield in the ED.MethodsThe electronic health record databases at two tertiary care academic hospitals were queried for CTPA orders completed in the ED over 1-month periods. These visits were linked with an inpatient admission with a discharge diagnosis of PE based on the International Classification of Diseases codes. The computerized the CTPA yield was calculated as the number of CTPA orders with an associated inpatient discharge diagnosis of PE divided by the total number of orders for completed CTPA. This computerized method was then validated by 2 independent reviewers performing a manual chart review, which included reading the free-text radiology reports for each CTPA.ResultsA total of 349 CTPA orders were completed during the 1-month periods at the two institutions. Of them, acute PE was diagnosed on CTPA in 28 studies, with a CTPA yield of 7.7%. The computerized method correctly identified 27 of 28 scans positive for PE. The one discordant scan was tied to a patient who was discharged directly from the ED and, as a result, never received an inpatient discharge diagnosis.ConclusionsThis is the first successful validation study of a computerized method for calculating the CTPA yield in the ED. This method for data extraction allows for an accurate determination of the CTPA yield and is more efficient than manual chart review. With this ability, health care systems can monitor the appropriate use of CTPA and the effect of interventions to reduce overuse and decrease preventable iatrogenic harm.

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Section: Discussionmentioning

confidence: 99%

A Computerized Method for Measuring Computed Tomography Pulmonary Angiography Yield in the Emergency Department: Validation Study

et al. 2018

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“…Advances in the technological aspects of CTPA has made it possible to see very small subsegmental emboli. This has led to a considerable increase in the number of pulmonary embolisms being diagnosed, but without a corresponding decrease in mortality due to this condition [[23], [24], [25], [26]]. There are still questions to the clinical significance and benefit in finding or treating these subsegmental emboli with anticoagulation.…”

Section: Introductionmentioning

confidence: 99%

“…There are still questions to the clinical significance and benefit in finding or treating these subsegmental emboli with anticoagulation. On the one hand, we have the proposed increased risk for future VTE and development of Chronic Thromboembolic Pulmonary Hypertension (CTEPH) and on the other hand the risk of bleeding complications that is estimated to be as high as 8% [23,24,[27], [28], [29], [30]]. Moreover, there is also some reader disagreement in CT angiographies, which is estimated to be at 30–37% in different studies [28].…”

Section: Introductionmentioning

confidence: 99%

Primary diagnosis of pulmonary embolism with unenhanced MRI for patients not eligible for CTPA: Clinical outcome

Medson

Vargas-Paris

Nordgren‐Rogberg

et al. 2019

European Journal of Radiology Open

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PurposeTo follow up the clinical outcome of patients with suspected pulmonary embolism (PE), in those only imaged using unenhanced, free-breathing magnetic resonance imaging (MRI).Methods and materialsFifty-seven patients aged 29–99 years (mean 70, SD 18) that could not undergo Computed Tomography Pulmonary Angiography (CTPA) were offered alternative imaging diagnostics in parallel with ongoing methodological studies validating MRI vs CTPA. Contraindications included renal failure (n = 44), severe iodine contrast allergy (n = 10), pregnancy (n = 2) and radioactive iodine therapy (n = 1). The unenhanced MRI protocol was based on free-breathing, steady-state free precession with no cardiac or respiratory gating. Retrospective review of the electronic medical record (EMR) was made of 0–12 months post-imaging and was collected during 2012–2018.ResultsAll 57 MRIs were of diagnostic quality and 12 pulmonary embolisms were diagnosed. Of the 57 patients, 44 were already on, or had started anticoagulation therapy due to clinical suspicion of PE. Four of the patients were put on anticoagulation after the positive MRI and 13 were taken off anticoagulation after a negative MRI report. Other diagnoses reported (considering dyspnea) were pleural effusion (n = 24), consolidation (n = 12) and pericardial effusion (n = 2). One patient had a deep vein thrombosis (DVT) within three months of our negative MRI result and then had a stroke within one year. Another patient suffered a stroke within three months of being diagnosed (by MRI) with PE and given anticoagulation as treatment.ConclusionsOur method supported or altered clinical decision-making and treatment in this cohort. A diagnostic tool for PE without intravenous contrast agent or radiation is of great benefit for certain patients.

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Evaluation of Suspected Pulmonary Embolism During Pregnancy

Siegel

2008

JAMA

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Imaging of Pulmonary Embolism

Cited by 31 publications

References 19 publications

A Computerized Method for Measuring Computed Tomography Pulmonary Angiography Yield in the Emergency Department: Validation Study

A Computerized Method for Measuring Computed Tomography Pulmonary Angiography Yield in the Emergency Department: Validation Study

Primary diagnosis of pulmonary embolism with unenhanced MRI for patients not eligible for CTPA: Clinical outcome

Evaluation of Suspected Pulmonary Embolism During Pregnancy

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