Assessing the Prevalence of Incidental Findings Identified by CTPA in Women of Reproductive Age.

Nigel Champion,Jeffery Flemming,Sarah Hogan

doi:10.1155/2018/4630945

Nigel Champion, Jeffery Flemming + Show 1 more

Open Access

https://doi.org/10.1155/2018/4630945

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Abstract

Background and Objective Though multiple studies have evaluated the prevalence of incidental findings identified by CTPA, none have done so with a focus on reproductive-age females with normal chest X-ray (CXR). Due to a comparatively lower breast radiation dose, the oft-recommended alternative to CTPA in this patient group is a V/Q scan. However, these are limited in their assessment of these alternate findings; therefore, it is of particular importance to evaluate the likelihood of these findings on CT in this patient group, which is the goal of this study. Methods Through a review of our PACS system, female patients aged 18-50 years who underwent diagnostic CTPA prior to April 1, 2017, were identified. The 100 most recent cases which had a normal CXR within 48 hours of CTPA were included. Incidental/non-PE findings were then divided into PE-positive (PE+) and PE-negative (PE-), and subcategorized into types I, II, III, and nil non-PE finding groups. Type I findings required immediate follow-up or intervention, type II findings required outpatient follow-up, and type III findings required no follow-up or were previously known. Results PE was detected in 15% of scans. Type I findings were found in 8% of patients (0% of PE+, 9.4% of PE-), type II findings in 10% of patients (13.3% of PE+, 9.4% of PE-), type III findings in 34% of patients (40% of PE+, 32.9% of PE-), and nil non-PE finding in 48% of patients (46.7% PE+, 48.2% of PE-). Conclusion While CTPA identifies incidental findings in the majority of patients, a small minority of these findings are likely to alter immediate management. In the context in increased radiation risk, this strengthens the argument that alternate imaging modalities such as V/Q should be strongly considered for the investigation of potential PE in women of reproductive age with normal CXR.

Highlights

Computed tomographic pulmonary angiography (CTPA) is the most commonly used imaging modality for the identification of pulmonary embolism (PE) [1, 2]
As access and accuracy have increased, there has been a steady rise in the popularity amongst ordering physicians [1,2,3], as well as the number of incidental findings made by CTPA [1, 3]
Though CTPA may offer an alternate explanation for patient symptoms, it comes with the risk of potentially unnecessary follow-up procedures and contrast nephrotoxicity, as well as the risk of increased ionizing radiation exposure as compared to alternative imaging modalities [4,5,6]

Summary

Introduction

Computed tomographic pulmonary angiography (CTPA) is the most commonly used imaging modality for the identification of pulmonary embolism (PE) [1, 2]. There is evidence demonstrating a heightened radiosensitivity in this denser breast tissue, conferring added risk for excessive CT use in women of reproductive age [4, 6]. For this reason, ventilation-perfusion (V/Q) scanning has remained an oft-favored imaging modality in this patient population [4, 7]. In the context in increased radiation risk, this strengthens the argument that alternate imaging modalities such as V/Q should be strongly considered for the investigation of potential PE in women of reproductive age with normal CXR

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