Increasing use of CTPA for the investigation of suspected pulmonary embolism

Sharma, Sumit; Lucas, Christopher D.

doi:10.1080/00325481.2017.1281084

Cited by 17 publications

(22 citation statements)

References 17 publications

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“…Current evidence suggests that sensitive D‐dimer testing can be combined with clinical findings and decision rules to exclude PE safely, thus circumventing some avoidable costs and unnecessary imaging . Despite this, there is an increasing use of CTPA in the assessment of patients with cardiorespiratory symptoms . The primary objective of this study was to establish if there was any association between the clinical parameters and biomarkers that influence the decision to order a CTPA and the presence or absence of PE on that test.…”

Section: Introductioncontrasting

confidence: 99%

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Predictive value of symptoms, signs and biomarkers on computed tomography pulmonary angiogram results

Sethwala

Wang

Sturm

et al. 2018

Internal Medicine Journal

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Section: Introductioncontrasting

confidence: 99%

“…14,15 Despite this, there is an increasing use of CTPA in the assessment of patients with cardiorespiratory symptoms. 16 The primary objective of this study was to establish if there was any association between the clinical parameters and biomarkers that influence the decision to order a CTPA and the presence or absence of PE on that test.…”

Section: Introductionmentioning

confidence: 99%

Predictive value of symptoms, signs and biomarkers on computed tomography pulmonary angiogram results

Sethwala

Wang

Sturm

et al. 2018

Internal Medicine Journal

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“…Authors found a direct correlation between increased number of CTPA scans and percentage of positive pulmonary embolism (the positive diagnostic yield ranges from 12% to 28.1%), suggesting that the use of CTPA is clinically appropriate. 11 Mountain and colleagues in their multi-center study showed similar findings with association of increasing use of CTPA with increased rates of pulmonary embolism diagnosis. Their study involved 14 clinical sites (15 emergency departments) across Australia and New Zealand consisting of more than 7000 CTPA scans with >94% performed on ≥64-slice CT.…”

supporting

confidence: 59%

“…9 Increased detection of pulmonary embolism seems to be associated with increased use of CTPA, in particular in the emergency department. [11][12][13][14][15][16][17] Although there are no guidelines available about the minimum acceptable yield of CTPA, it is generally agreed that a diagnostic yield of CTPA less than 10% indicates overuse of CTPA as a diagnostic tool. 18,19 Sharma and Lucas recently reported their single center experience of CTPA in the diagnosis of pulmonary embolism over a period of 8 years.…”

mentioning

confidence: 99%

Double-Low Dose Protocol of Computed Tomography Pulmonary Angiography (CTPA) in the Diagnosis of Pulmonary Embolism: A Feasible Approach for Reduction of Both Contrast Medium and Radiation Doses

Aldosari¹,

Moudi²,

Sun³

2017

Heart Res Open J

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CitationAldosari S, Al Moudi M, Sun Z. Doublelow dose protocol of computed tomography pulmonary angiography (CTPA) in the diagnosis of pulmonary embolism: A feasible approach for reduction of both contrast medium and radiation doses. ABSTRACTThis article discusses a hot topic on double low-dose protocol of computed tomography pulmonary angiography (CTPA) in the diagnosis of pulmonary embolism, with a special focus on a recent paper published in the British Journal of Radiology about the feasibility of this technique. Three aspects will be discussed in this review: First, both kVp and contrast medium can be reduced without affecting image quality when compared to the standard CTPA protocol; second, a low-pitch protocol is comparable to the high-pitch spiral image acquisition with similar image quality achieved, but at lower radiation dose; and finally, the double low-dose CTPA protocol can achieve diagnostic images in patients with body mass index up to 35 kg/m 2 .

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“…Further, no guidelines Research Article Sun, Lei are available about the minimum acceptable diagnostic yield of CTPA, thus leading to overuse of CTPA as a routine diagnostic tool [17,18]. Sharma and Lucas reported the direct correlation between CTPA and positive rates of PE detection with results justifying the increased use of CTPA [19]. However, Mountain et al in their multi-center study showed significant variations in the diagnostic yield of CTPA with some clinical sites producing lower diagnostic yield of less than 15.3% [20].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic yield of CT pulmonary angiography in the diagnosis of pulmonary embolism: A single center experience

Sun¹,

Lei²

2017

Interventional-Cardiology

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The purpose of this study was to investigate the clinical application of computed tomography pulmonary angiography (CTPA) in patients with suspected pulmonary embolism (PE) based on a single-center experience. Medical records and radiological reports of 450 patients (272 men and 178 women; mean age 58.9 years; range 14-95 years) with suspected PE who underwent CTPA and triple rule-out CT scans over a period of 6 months were retrospectively reviewed. Prevalence of PE was analysed to determine the diagnostic yield of CT in these two scanning protocols. Of 450 patient records, the positive rate of PE was 30.7%. Triple rule-out CT protocol was performed in 75 out of 450 patients with the diagnostic yield of PE being only 8% (6 out of 75 patients had PE), which is significantly lower than the 35.2% as shown in the CTPA group (132 out of 375 had PE). Mean effective dose was 2.8±2.6 mSv and 13.5±7.8 mSv for CTPA and triple rule-out protocols, respectively. This study shows that CTPA has high diagnostic yield in the diagnosis of pulmonary embolism, hence justifying its appropriateness as a routine imaging modality. However, triple rule-out CT is not recommended due to the low diagnostic yield. Further reduction in radiation and contrast medium doses is necessary.

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Increasing use of CTPA for the investigation of suspected pulmonary embolism

Abstract: Although CTPA use is increasing, so is the diagnostic yield of PE. In contrast, the rate of incidental PE in those undergoing a CT chest scan for non-PE diagnosis remains relatively low and stable. This suggests that our observed increased use of CTPA is clinically appropriate.

Cited by 17 publications

References 17 publications

Predictive value of symptoms, signs and biomarkers on computed tomography pulmonary angiogram results

Predictive value of symptoms, signs and biomarkers on computed tomography pulmonary angiogram results

Double-Low Dose Protocol of Computed Tomography Pulmonary Angiography (CTPA) in the Diagnosis of Pulmonary Embolism: A Feasible Approach for Reduction of Both Contrast Medium and Radiation Doses

Diagnostic yield of CT pulmonary angiography in the diagnosis of pulmonary embolism: A single center experience

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