Pulmonary Embolism at CT Angiography: Implications for Appropriateness, Cost, and Radiation Exposure in 2003 Patients

Mamlouk, Mark D.; vanSonnenberg, Eric; Gosalia, Rishi; Drachman, David A.; Gridley, Daniel; Zamora, Jesus G; Casola, Giovanna; Ornstein, Sanford

doi:10.1148/radiol.10091624

Cited by 118 publications

(106 citation statements)

References 24 publications

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“…In recent years, MD-CTA has become the imaging modality of choice for PE in most hospitals worldwide. Mamlouk et al evaluated retrospectively the medical records of 2003 consecutive patients who underwent MD-CTA for possible PE over a 1.5-year period [14]. The overall prevalence of PE was only 9.8 % (197/2003), and in particular, the occurrence of a positive angiogram in the patients with no risk factors for PE was as low as 1 % (5/520) [14].…”

Section: Discussionmentioning

confidence: 99%

“…Mamlouk et al evaluated retrospectively the medical records of 2003 consecutive patients who underwent MD-CTA for possible PE over a 1.5-year period [14]. The overall prevalence of PE was only 9.8 % (197/2003), and in particular, the occurrence of a positive angiogram in the patients with no risk factors for PE was as low as 1 % (5/520) [14]. It seems, therefore, that MD-CTA is increasingly used as a screening method rather than as a means to confirm or exclude clinically suspected PE.…”

Section: Discussionmentioning

confidence: 99%

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Perfusion SPECT in patients with suspected pulmonary embolism

Bajc

Miniati

Jögi

et al. 2013

Eur J Nucl Med Mol Imaging

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Purpose Ventilation/perfusion tomography (V/P SPECT ), with new interpretation criteria and newer tracers for ventilation imaging, has markedly improved the diagnostic yield in acute pulmonary embolism (PE). Here, we evaluated the diagnostic performance of perfusion SPECT (P SPECT ) without ventilation imaging. Methods We studied 152 patients with clinically suspected PE who had been examined with both V/P SPECT and multidetector computed tomographic angiography (MD-CTA). The diagnosis or exclusion of PE was decided by the referring clinician based on both the V/P SPECT and/or MD-CTA findings in combination with the clinical findings. P SPECT images were retrospectively examined by a physician with experience in the interpretation of planar perfusion scans who was blinded to clinical, V/P SPECT and MD-CTA data. P SPECT images were interpreted without the aid of chest radiography. All the patients who were deemed to have PE were given anticoagulant therapy. Results Of the 152 patients, 59 (39 %) received a final diagnosis of PE, and 19 (32 %) had associated cardiopulmonary diseases such as pneumonia, COPD, or left heart failure. P SPECT correctly identified 53 (90 %) of the 59 patients with PE. The specificity was 88 of 93 (95 %). None of the P SPECT images was rated nondiagnostic. P SPECT yielded an overall diagnostic accuracy of 93 % (95 % confidence interval, CI, 87-96 %). At the observed PE prevalence of 39 %, the positive and negative predictive values of P SPECT were 91 % (95 % CI, 80-97 %) and 94 % (95 % CI, 86-97 %), respectively. Conclusion In managing critically ill patients, P SPECT might be a valid alternative to V/P SPECT or MD-CTA since it was able to identify most patients with PE with a low falsepositive rate and no inconclusive results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Perfusion SPECT in patients with suspected pulmonary embolism

Bajc

Miniati

Jögi

et al. 2013

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

show abstract

“…Differentiating asthma from PE, in the absence of pleuritic chest pain, is very difficult. However, computed tomographic pulmonary angiography is usually recommended for the diagnosis of PE [29]. A blood D-dimer test can be useful [30].…”

Section: Pulmonary Embolism (Pe)mentioning

confidence: 99%

Allergic Asthma and Aging

Lorenzo¹,

Bona²,

Piana³

et al. 2012

Bronchial Asthma - Emerging Therapeutic Strategies

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“…Increased use of CTPA in the diagnosis of PE has raised concerns in the literature due to radiation exposure associated with CT and potential risk of contrast-induced nephropathy [15,16]. 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].…”

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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Pulmonary Embolism at CT Angiography: Implications for Appropriateness, Cost, and Radiation Exposure in 2003 Patients

Abstract: In the setting of no risk factors, it is extraordinarily unlikely (0.95% chance) to have a CT angiogram positive for PE. This selectivity and triage step should help reduce current costs and radiation exposure to patients.

Cited by 118 publications

References 24 publications

Perfusion SPECT in patients with suspected pulmonary embolism

Perfusion SPECT in patients with suspected pulmonary embolism

Allergic Asthma and Aging

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

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