Use of pulmonary angiography for suspected pulmonary embolism: influence of scintigraphic diagnosis

Sostman, Henry Dirk; Ravin, Carl E.; Sullivan, Daniel C.; Mills, Steven R.; Glickman, Morton G.; Dorfman, G. S.

doi:10.2214/ajr.139.4.673

Cited by 66 publications

(23 citation statements)

References 7 publications

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“…The data presented by Ost et al [20]demonstrate that only a minority of patients undergoes conventional angiography when initial modality is nondiagnostic which is in good agreement with observations by others [21]. This restrictive usage of conventional pulmonary angiography may explain the incomplete diagnostic process in patients with suspected PE during the past decades.…”

Section: Demand For Other Diagnostic Techniquessupporting

confidence: 69%

Computed Tomography Imaging in Pulmonary Embolism – The Other Side of the Medal

Kroegel¹,

Reißig²

2004

Respiration

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Section: Demand For Other Diagnostic Techniquessupporting

confidence: 69%

Computed Tomography Imaging in Pulmonary Embolism – The Other Side of the Medal

Kroegel¹,

Reißig²

2004

Respiration

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“…However, scintigraphy provides a reliable diagnosis in only about one third of patients [1], and pulmonary an giography is frequently not performed be cause of limited availability and concerns regarding safety, patient acceptance, and cost. In 1982, Sostman et al [2] described finding that only 50 (12%) of 434 patients underwent pulmonary angiography despite unresolved diagnosis after scintigraphy. More recently, Khorasani et al [3] found that 63% of patients with lung scansshowing in termediate probability of embolism had treatment decisions made without benefit of a definitive imaging diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosis of pulmonary embolism is basedlargely on noninvasiveimaging such as ventilationâ€"perfusion scintigraphy and lower extremity venous sonography, with a limited useof pulmonaryangiography [2,3]. Despite excellent results for helical and elec tron beam CT in central or segmental yes sels, with a sensitivity of 86â€"100% and a specificityof 78â€"95% [5, 7, 8], andcompara ble results for gadolinium-enhanced MR an giography (sensitivity, 75â€"100%; specificity, 95â€"100%) [9], little change has occurred in the diagnostic algorithm for pulmonary em bolism.…”

Section: Discussionmentioning

confidence: 99%

Effect of anatomic distribution of pulmonary emboli on interobserver agreement in the interpretation of pulmonary angiography.

Diffin

Leyendecker

Johnson

et al. 1998

American Journal of Roentgenology

207

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Oanie@ C.Diffin1 JohnR.Leyendecker1'2 Stephen R Johnson1 RyanJ. Zucker1 Paul J.Grebe3 OBJECTIVE.This study examines the anatomic distribution of emboli on pulmonary an giography and attempts to determine the relationship of vessel size to interobserver agree ment, two factors having important implications in comparing pulmonary angiography with cross-sectional imaging for pulmonary embolism. MATERIALS AND METHODS.One hundred twenty-five consecutive pulmonary an giograms were reviewed retrospectively by three interventional radiologists. Initial interpreta tions were recorded and compared to determine interobserver agreementon a per-patient and per-embolus basis. Discordant interpretations were reviewed by all radiologists for a consen sus interpretation. RESULTS. Unanimous per-patient agreement occurred in 91 % ( I 14/I 25) of initial inter

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“…It has long been recognized that physicians underutilize conventional angiography when evaluating patients for pulmonary embolism (PE) because it is perceived as invasive and expensive [1, 2]. Recent advances in spiral computed tomography (CT) have led to the introduction of fast scanning techniques for the diagnosis of PE [3,4,5,6,7,8,9,10].…”

Section: Introductionmentioning

confidence: 99%

Impact of Spiral Computed Tomography on the Diagnosis of Pulmonary Embolism in a Community Hospital Setting

et al. 2004

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Background: While the optimal role of spiral CT angiography (CTA) in the diagnosis of pulmonary embolism (PE) remains controversial, this technology is already being widely utilized in the community setting. Objectives: To assess the impact CTA has had on angiography utilization rates and the overall diagnostic rate of PE. Methods: All patients evaluated for PE during a 4-year period were studied. PE was defined as either a high-probability V/Q scan, a positive conventional angiogram, or a CTA with emboli in the segmental or larger pulmonary vessels. Diagnostic rates of PE per 1,000 hospital admissions were determined and analyzed for time periods before and after the introduction of CTA. CT reports were compared with their concurrent chest radiograph (CXR) reports and additional findings that were not apparent on CXR were abstracted. Results: The diagnostic rate of PE per 1,000 hospital admissions was 1.8 prior to the introduction of CTA and increased to 2.8 per 1,000 admissions after the introduction of CTA (p < 0.0001). Total costs for diagnostic testing per PE diagnosis made went from $2,518 to $2,572. While the number of PE diagnosed by V/Q scan remained constant, the number of PE diagnosed by conventional angiography decreased while the number diagnosed by CTA increased. In patients with intermediate probability V/Q scan results, the percentage of patients receiving subsequent angiography (conventional or CTA) increased from 17 to 26% (p = 0.043). When conventional angiography was performed, CT imaging of the chest still had to be ordered for other reasons 38% of the time. Additional information was obtained in 78% of cases when CTA was performed. Conclusions: Increased utilization of CTA was associated with an increase in angiography utilization rates and diagnostic rates of PE, was cost effective, and often provided additional, useful, and unanticipated diagnostic information.

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Use of pulmonary angiography for suspected pulmonary embolism: influence of scintigraphic diagnosis

Cited by 66 publications

References 7 publications

Computed Tomography Imaging in Pulmonary Embolism – The Other Side of the Medal

Computed Tomography Imaging in Pulmonary Embolism – The Other Side of the Medal

Effect of anatomic distribution of pulmonary emboli on interobserver agreement in the interpretation of pulmonary angiography.

Impact of Spiral Computed Tomography on the Diagnosis of Pulmonary Embolism in a Community Hospital Setting

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