Abstract
The purpose of this study was to investigate the clinical application of computed tomography pulmonary angiography (CTPA) in patients with suspected pulmonary embolism (PE) based on a single-center experience. Medical records and radiological reports of 450 patients (272 men and 178 women; mean age 58.9 years; range 14-95 years) with suspected PE who underwent CTPA and triple rule-out CT scans over a period of 6 months were retrospectively reviewed. Prevalence of PE was analysed to determine the diagnostic yield of CT in these two scanning protocols. Of 450 patient records, the positive rate of PE was 30.7%. Triple rule-out CT protocol was performed in 75 out of 450 patients with the diagnostic yield of PE being only 8% (6 out of 75 patients had PE), which is significantly lower than the 35.2% as shown in the CTPA group (132 out of 375 had PE). Mean effective dose was 2.8±2.6 mSv and 13.5±7.8 mSv for CTPA and triple rule-out protocols, respectively. This study shows that CTPA has high diagnostic yield in the diagnosis of pulmonary embolism, hence justifying its appropriateness as a routine imaging modality. However, triple rule-out CT is not recommended due to the low diagnostic yield. Further reduction in radiation and contrast medium doses is necessary.
Highlights
Computed tomography pulmonary angiography (CTPA) is currently the first line imaging technique as recommended by guidelines in the diagnosis of patients with suspected pulmonary embolism (PE) [1,2]
This study was conducted to determine the diagnostic yield of CT pulmonary angiography (CTPA) in the diagnosis of pulmonary embolism based on a single center experience
Prevalence of pulmonary embolism was more than 30% in patients undergoing CTPA which is above the acceptable diagnostic yield, while prevalence of pulmonary embolism was only 8% in patients undergoing triple rule-out CT
Summary
Computed tomography pulmonary angiography (CTPA) is currently the first line imaging technique as recommended by guidelines in the diagnosis of patients with suspected pulmonary embolism (PE) [1,2]. Estrada-Martin and Oldham developed surveys to determine different opinions among radiologists towards the use of CTPA for the diagnosis of PE, and their results showed that most radiologists chose CTPA as the gold standard to diagnose PE [3]. The agreement with this statement is based on the evidence available in many studies showing that high diagnostic accuracy has been achieved with CTPA in detecting thrombus in both main and side pulmonary artery branches due to rapid technological developments in CT scanning techniques [4,5,6,7,8,9,10,11].
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