Yield of chest computed tomography angiogram in cystic fibrosis patients with suspected pulmonary embolism

Abstract

Introduction Individuals with cystic fibrosis (CF) may be at increased risk of pulmonary embolism (PE). Symptoms of PE overlap substantially with those of CF respiratory exacerbations. CF patients commonly undergo chest computed tomography (CT) angiograms (CTPA) to evaluate for PE, but little is known about the clinical presentation and diagnosis of PE in this population. Objectives The objectives of this study are to determine the diagnostic yield of CTPA for PE in adult patients with CF and assess the utility of the Revised Geneva Score (RGS) in this population. Methods Retrospective review of all CTPA results was performed on CF patients with suspected PE at a large CF center from 1 January 2011 through 31 March 2017. Patient demographics, medical history, and presenting signs and symptoms were abstracted by chart review. Results A total of 103 unique CTPA studies were performed in 68 patients. Most were hospitalized at the time of CTPA, predominantly for respiratory manifestations of CF. CTPA identified four patients with PE. The small number of positive studies precluded analysis of predictors of PE. Fewer PE were diagnosed than predicted by the Revised Geneva Score, which was intermediate probability in 77/103 (75%) patients. Conclusion The prevalence of PE in CF patients undergoing CTPA for suspected PE was 4%, which is lower than predicted by the Revised Geneva Score. This may be due to a large overlap in the signs and symptoms of PE and exacerbations of CF lung disease.

Diagnostic Yield of CT Pulmonary Angiogram in the Diagnosis of Pulmonary Embolism and Its Predictive Factors

“…There is a wide range of diagnostic yields for CTPA for PE in the literature, ranging from 4.7% to 31% [3][4][5][6][7][8][9][10][11][12]. Despite using a lower cut-off (10%) as the acceptable threshold in North America, there are a few studies that report a yield lower than the threshold [3][4][5][6][7][8][9][10][11][12]. In Malaysia, we adopt the threshold of 15.4% as the acceptable rate for the yield of CTPA, as recommended by the Royal College of Radiologists [10,24].…”

“…In view of the high morbidity and mortality rate associated with PE, it is important to make a prompt diagnosis and initiate anticoagulant treatment in patients with PE [3][4][5]. With the advancement of medical technology, computed tomography pulmonary angiography (CTPA) has become the reference standard to diagnose PE [6][7][8][9][10]. CTPA can be performed in patients with suspected PE within minutes, and it has high sensitivity and specificity [11][12][13].…”

“…The sensitivity and specificity of CTPA in diagnosing PE range between 96% and 100% and between 89% and 98%, respectively [14]. Nevertheless, the advancement of medical imaging also comes with the problem that clinicians may be over-reliant on CTPA to rule out PE [6][7][8][9][10][11][12][13][14][15][16]. This is evidenced by the increasing number of CTPAs ordered and the decreasing yield of CTPAs performed [6][7][8][9][10][11][12][13][14][15][16].…”

Bibliometric Analysis of Diagnostic Yield of CT Pulmonary Angiogram (CTPA) in the Diagnosis of Pulmonary Embolism (PE)

“…Second, we did not delve into the citation analysis of the published articles, as our aim was to investigate the publication trends in this field. Besides that, we did not compare the yield rates of all the publications in this bibliometric analysis, as some of the studies focus on a small cluster of patients, such as pregnant patients or patients with cystic fibrosis [ 15 , 16 ]. Despite these limitations, this bibliometric analysis identifies the shortcomings in this field, which may prompt researchers and clinicians to collaborate more on this topic.…”