Comparative Study of Diagnostic Efficacy of Single Phase-Computed Tomography Pulmonary Angiography and Dual Phase-Computed Tomography Pulmonary Angiography in the Diagnosis of Pulmonary Embolism.

Xuechun Guan,Liling Long,Yi Liang,Siqi Chen,Honghong Ke,Qiaoqing Lan

doi:10.3389/fcvm.2022.846805

Abstract

ObjectiveWe compared the efficacy of single phase-computed tomography pulmonary angiography (SP-CTPA) and dual phase-computed tomography pulmonary angiography (DP-CTPA) for the diagnosis of pulmonary embolism (PE).MethodsWe recruited 1,019 consecutive patients (359 with PE) who underwent DP-CTPA (phase I: pulmonary artery phase; phase II: aortic phase) for suspected PE between January and October 2021. Phase I of DP-CTPA was used as SP-CTPA, and the final clinical diagnosis (FCD) was used as the gold standard.ResultsThree hundred fifty-two cases of PE were detected by both methods, with the same sensitivity of 98.1% (99.6–99.5%). Using SP-CTPA, 142 cases [13 pulmonary insufficiency artifacts (PIA) and 129 systemic-pulmonary shunt artifacts (S-PSA)] were false-positive with specificity of 78.5% (75.3–81.6%). No false-positive was found with DP-CTPA, with specificity of 100%, positive predictive value of 1, and negative predictive value of 0.990 (Net Reclassification Improvement = 0.215; P < 0.05). According to FCD, the positive results of SP-CTPA were divided into PIA, S-PSA, and true-positive (TPSP−CTPA) groups, and pairwise comparisons were performed. The bronchiectasis and hemoptysis rate in S-PSA group was higher than that in PIA and TP groups (P < 0.001), and the pulmonary hypertension (PH) rate in PIA group was higher than that in S-PSA and TP groups (P < 0.001).ConclusionThe diagnostic efficiency of DP-CTPA for the diagnosis of PE was high. SP-CTPA may misdiagnose PIA (common in patients with PH) and S-PSA (common in patients with bronchiectasis and hemoptysis) as PE.

Highlights

Pulmonary embolism (PE) is a common and potentially fatal disorder [1–4]
Patients in the nonPE group were more likely to be complicated with bronchiectasis (16.21 vs. 0.84%, P < 0.001), chronic lung infection (11.82 vs. 2.79%, P < 0.001), pulmonary hypertension (7.73 vs. 4.18%, P < 0.05), pleural effusion (13.79 vs. 0.84%, P < 0.001) and lung cancer (9.97 vs. 2.23%, P < 0.001) than those in the PE group
Two experienced doctors evaluated SP-Computed tomography pulmonary angiography (CTPA) and dual phase CTPA (DP-CTPA) to diagnose patients with a good consistency (Kappa index: 0.919 and 0.916, respectively), and the test results were obtained after discussion

Summary

Introduction

Pulmonary embolism (PE) is a common and potentially fatal disorder [1–4]. PE is one of the major causes of cardiovascular mortality in the United States, accounting for more than 250,000 deaths per year [5]. Timely diagnosis is very important for the clinical treatment of patients with PE. Computed tomography pulmonary angiography (CTPA) is the first choice for the diagnosis of pulmonary embolism [8–10]. Both single phase CTPA (SP-CTPA) and dual phase CTPA (DP-CTPA) are used in clinical settings. DP-CTPA is adopted by some cardiovascular specialist medical centers because the comparative observation of pulmonary circulation and systemic circulation can help avoid false-positive diagnosis of PE, as SP-CTPA only captures the pulmonary artery images quickly [12]. We compared the diagnostic efficacy of SP-CTPA and DPCTPA in the diagnosis of PE, so that the appropriate method can be chosen in clinical work

Methods

Results

Conclusion