Diagnostic value of computed tomography (CT) angiography in patients with acute pulmonary embolism
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II Department of Radiology, Medical University, Lublin, Poland
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Witold Krupski   

II Department of Radiology, Medical University, Staszica 16, 20-081 Lublin, Poland.
J Pre Clin Clin Res. 2009;3(1):5-10
Computed tomography angiography (CTA) is an accurate test for the detection of pulmonary embolism (PE) and is gaining increased acceptance as a fi rst-line study for diagnosing acute pulmonary embolism. Prompt and accurate diagnosis of PE is of great importance because treatment reduces mortality from 30% to < 10%. Recent advances in single-detector row helical CT pulmonary angiography include improvements in x-ray tube technology and faster gantry rotation, which allow for increased body coverage by using narrower collimation. These advances have been associated with an improved sensitivity and specifi city of the technique, from more than 80% to more than 90% in recent series. The most important advantage of CT over other imaging modalities is that both madiastinal and parenchymal structures can be evaluated, and thrombus can be directly visualized. Investigators have reported that subsegmental emboli can be missed; however, visualization of smaller arterial branches, and therefore detection of small emboli, have improved with the availability of multidetector scanners. PE being a pathologic condition causes both partial and complete intarluminal fi lling defects, which should have a sharp interfece with intravascular contrast material. In acute pulmonary embolism that manifestes as complete arterial occlusion, the aff ected artery may be enlarged. Partial fi lling defects due to acute pulmonary embolism are often centrally located, but when eccentrically located they form acute angles with the vessel wall. Some factors that cause misdiagnosis of pulmonary embolism may be patient-related, technical, anatomical or pathological. The radiologist needs to determine the quality of a CT pulmonary angiography study and whether pulmonary embolism is present. If the quality of the study is poor, the radiologist should identify which pulmonary arteries have been rendered indeterminate, and whether additional imaging is necessary. The aim of this study was to introduce the current views for diagnosing PE in CTA.
Dalen JE, Alpert JS: Natural history of pulmonary embolism. Prog Cardiovasc Dis 1975, 17, 259-270.
Patel S, Kazerooni E: Helical CT for the evaluation of acute pulmonary embolism. Am J Roentgenol 2005, 185, 135-149.
Gerg K, Macey L: Helical CT scaning in the diagnosis of pulmonary embolism. Respiration 2003, 70, 231-237.
Nijkeuter M, Huisman MV: The role of helical CT in the diagnosis of pulmonary embolism. Pathophysiol Haemost Thromb 2003/2004, 33, 319-326.
The PIOPED Investigators: value of the ventilation/perfusion scan in acute pulmonary embolism.Results of the prospective investigation of PE diagnosis(PIOPED). JAMA 1990, 263, 2753-2759.
Silverstein M, Heit JA, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ 3rd: Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998, 158, 585-593.
Horlander K, Mannino DM, Leeper KV: Pulmonary embolism mortality in the United States, 1979-1998: An analysis using multiple-cause mortality data. Arch Intern Med 2003, 163, 1711-1717.
Cronin P, Weg JG, Kazerooni EA: The role of multidetector computed tomography angiography for the diagnosis of pulmonary embolism. Semin Nucl Med 2008, 38, 418-431.
Subramaniam RM, Blair D, Gilbert K, Sleigh J, Karalus N: Computed tomography pulmonary angiogram diagnosis of pulmonary embolism. Australas Radiol 2006, 50, 193-200.
Sagel SS, Greenspan RH: Nonuniform pulmonary arterial perfusion: pulmonary embolism? Radiology 1971, 3, 518-541.
Dalen JE, Brooks HL, Johnson LW: Pulmonary angiography in acute pulmonary embolism: Indications, techniques, and results in 367 patients. Am Heart J 1991, 81, 175-185.
Gottschalk A, Stein PD, Goodman LR, Sostman HD: Overview of prospective investigation of pulmonary embolism diagnosis II. Semin Nucl Med 2002, 32, 173-182.
Miller GA, Sutton GC, Kerr IH, Gibson RV, Honey M: Comparison of streptokinase and heparin in treatment of isolated acute massive pulmonary embolism. Br Med J 1971, 2, 681-684.
Walsh PN, Greenspan RH, Simon M. Anangiographic severity index for pulmonary embolism. Circulation 1973, 47-48(suppl), 101-108.
Qanadli SD, El Hajjam M, Vieillard-Baron A, Joseph T, Mesurolle B, Oliva VL, Barrẻ O, Bruckert F, Dubourg O, Lacombe P: New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. Am J Roentgenol 2001, 176, 1415-1420.
Mastora I, Remy-Jardin M, Masson P, Galland E, Dellanoy V, Bauchart JJ, Remy J: Severity of acute pulmonary embolism; evaluation of a new spiral CT angiographic score in correlation with echocardiographic data. Eur Radiol 2003, 13, 29-35.
Sinner WN: Computed tomographic patterns of pulmonary thromboembolism and infarction. J Comput Assist Tomogr 1978, 2, 395-399.
Godwin JD, Webb WR, Gamsu G, Ovenfors CO: Computed tomography of pulmonary embolism. Am J Roentgenol 1980, 135, 691-695.
Breatnach E, Stanley RJ: CT diagnosis of segmental pulmonary artery embolus. J Comput Assist Tomogr 1984, 8, 762-764.
Remy-Jardin M, Remy J, Wattinne L, Giraud F: Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the singlebreath- hold-technique-comparison with pulmonary angiography. Radiology 1992, 185, 381-387.
Teigen CL, Maus TP, Sheedy PF 2nd, Stanson AW, Johnson CM, Breen JF, McKusick MA: Pulmonary embolism: diagnosis with contarst-enhanced electron-beam CT and comparison with pulmonary angiography. Radiology 1995, 194, 313-319.
Teigen CL, Maus TP, Sheedy PF 2nd, Johnson CM, Stanson AW, Welch TJ: Pulmonary embolism: diagnosis with electron-beam CT. Radiology 1993, 188, 839-845.
Safriel Y, Zinn H: CT pulmonary angiography in the detection of pulmonary emboli: a meta-analysis of sensitivities and specifi cities. Clin Imaging 2002, 26, 101-105 .
Ruiz Y, Caballero P, Caniego JL, Friera A, Olivera MJ, Tagarro D, Alvarez-Sala R. Prospactive comparison of helical CT with angiography in pulmonary embolism: global and selective vascular territory in analysis -interobserver agreement. Eur Radiol 2003, 13, 823-829.
Diederich S: Radiation dose in helical CT for detection of pulmonary embolism. Eur Radiol 2003, 13, 1491-1493.
Resten A, Mausoleo F, Valero M, Musset D: Comparison of doses for pulmonary embolism detection with helical CT and pulmonary angiography. Eur Radiol 2003, 13, 1515-1521.
Kelly AM, Patel S, Carlos RC, Cronin P, Kazerooni EA: Multidetector row CT pulmonary angiography and indirect venography for the diagnosis of venous thromboembolic disease in intensive care unit patients. Acad Radiol 2006, 13, 486-495.
Ghaye B, Szapiro D, Mastora I, Delannoy V, Duhamel A, Remy J, Remy-Jardin M.Peripheral pulmonary arteries: how far in the lung does multi-detector row spiral CT allow analysis? Radiology 2001, 219, 629-636.
Coche E, Pawlak S, Dechambre S, Maldague B: Peripheral pulmonary arteries: identifi cation at multi-slice spiral CT with 3D reconstruction. Eur Radiol 2003, 13, 815-822.
Ferretti GR, Bosson JL, Buff az PD, Ayanian D, Pison C, Blanc F, Carpentier F, Carpentier P, Coulomb M: Acute pulmonary embolism: role of helical CT in 164 patients with intermediate probability at ventilation-perfusion scintigraphy and normal results at duplex US of the legs. Radiology 1997, 205, 453-458.
Garg K, Walsh CH, Feyerabend AJ, Subber SW, Russ PD, Johnston RJ, Durham JD, Lynch DA: Pulmonary embolism: diagnosis with spiral CT and ventilation-perfusion scanning-correlation with pulmonary angiographic results or clinical outcome. Radiology 1998, 208, 201- 208.
Kim KI, Muller NI, Mayo JR: Clinically suspected pulmonary embolism: Utility of spiral CT. Radiology 1999, 210, 693-697.
Stein PD, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, Leeper KV Jr, Popovich J Jr, Quinn DA, Sos TA, Sostman HD, Tapson FV, Wakefi eld TW, Weg JG, Woodard PK, PIOPED II Investigators: Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 2006, 354, 2317-2327.
Qanadli SD, Hajjam ME, Mesurolle B, Barrẻ O, Bruckert F, Joseph T, Mignon F, Vieillard-Baron A, Dubourg O, Lacombe P: Pulmonary embolism detection: prospective evaluation of dual-section helical CT versus selective pulmonary arteriography in 157 patients. Radiology 2000, 217, 447-455.
Winer-Muram HT, Rydberg J, Johnson MS, Tarver RD, Williams MD, Shah A, Namyslowski J, Conces D, Jennings SD, Ying J, Trerotola SO, Kopecky KK: Suspected acute pulmonary embolism: evaluation with multi-detector row CT versus digital subtraction pulmonary arteriography. Radiology 2004, 233, 806-815.
Coche E, Verschuren F, Keyeux A, Goff ette P, Goncette L, Hainaut P, Hammer F, Lavenne E, Zech F, Meert P, Reynaert MS: Diagnosis of acute pulmonary embolism in outpatients: comparison of thin-collimation multi-detector row spiral CT and planar ventilation-perfusion scintigraphy. Radiology 2003, 229, 757-765.
Managing patient dose in computed tomography.A report of the International Commission on Radiological Protection.Ann ICRP 2000, 30, 7-45.
Hurwitz LM, Reiman RE, Yoshizumi TT, Goodman PC, Toncheva G, Nguyen G, Lowry C: Radiation dose from contemporary cardiothoracic multidetector CT protocols with an anthropomorphic female phantom: Implications for cancer induction. Radiology 2007, 245, 742-750.
Ritchman P, Wood J, Kasper DM, Collins JM, Petri RW, Field AG, Cowles DN, Kline JA: Contribution of indirect computed tomography venography to computed tomography angiography of the chest for the diagnosis of thromboembolic disease in two United States emergency departments. J Thromb Haemost 2003, 1, 652-657.
Coche EE, Hamoir XL, Hammer FD, Hainaut P, Goff ette PP: Usingdual-detector helical CT angiography to detect deep venous thrombosis in patients with suspiction of pulmonary embolism: diagnostic value and additional fi ndings. Am J Roentgenol 2001, 176, 1035-1039.
Peterson DA, Kazerooni EA, Wakefi eld TW, Knipp BS, Forauer AR, Bailey BJ, Sullivan VV, Proctor MC, Henke BK, Greenfi eld LJ, StanleyJC, Upchurch GR Jr: Computed tomographic venography is specifi c but not sensitive for diagnosis of acute lower-extremity deep venous thrombosis in patients with suspected pulmonary embolus. J Vasc Surg 2001, 34, 798-804.
Rademarker J, Griesshaber V, Hidajat N, Oestmann JW, Felix R: Combined CT pulmonary angiography and venography for diagnosis of pulmonary embolism and deep venous thrombosis: radiation dose. J Thorac Imaging 2001, 16, 297-299.
Ghaye B, Dondelinger RF: Non-tarumatic thoracic emergencies: CT venography in an integrated diagnostic strategy of acute pulmonary embolism and venous thrombosis. Eur Radiol 2002, 12, 1906-1921.
Cham MD, Yankelevitz DF, Henschke CI: Thromboembolic disease detection at indirect CT venography versus CT pulmonary angiography. Radiology 2005, 234, 591-594.
Ghaye B, Szapiro D Willems V, Dongelinger RF: Combined CT venography of the lower lims and spiral CT angiography of pulmonary arteries in acute pulmonary embolism: preliminary results of a prospective study. J Belge Radiol 2000, 83, 271-278.
Weiss CR, Scatarige JC, Diette GB, Haponik EF, Merriman B, Fishman EK: CT pulmonary angiography is the fi rst-line imaging test for acute pulmonary embolism: A survey of UC clinicians. Acad Radiol 2006, 13, 434-446.
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