Unenhanced multidetector computed tomography findings in acute central pulmonary embolism

Chiao-Hsuan Chien,Chin-Yu Chen,Chee-Wai Mak,Fu-Chieh Shih,Chia-Hui Chen,Wan-Ling Wu

doi:10.1186/s12880-019-0364-y

Chiao-Hsuan Chien, Chin-Yu Chen + Show 4 more

Open Access

https://doi.org/10.1186/s12880-019-0364-y

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Abstract

BackgroundComputed tomography pulmonary angiography (CTPA) is the gold standard for the diagnosis of pulmonary embolism (PE). However, contrast is contraindicated in some patients. The purpose of this study was to determine the diagnostic accuracy of unenhanced multidetector CT (MDCT) for diagnosis of central PE using CTPA as the gold standard.MethodsThe records of patients with suspected PE seen between 2010 and 2013 were retrospectively reviewed. Inclusion criteria were an acute, central PE confirmed by CTPA and non-enhanced MDCT before contrast injection. Patients with a PE ruled out by CTPA served as a control group. MDCT findings studied were high-attenuation emboli in pulmonary artery (PA), main PA dilatation > 33.2 mm, and peripheral wedge-shaped consolidation. Receiver operating characteristic (ROC) analysis was used to determine the sensitivity and specificity of unenhanced MDCT to detect PE. Wells score of all patients were calculated using data extracted from medical records prior to imaging analysis.ResultsThirty-two patients with a PE confirmed by CTPA and 32 with a PE ruled out by CTPA were included. Among the three main MDCT findings, high-attenuation emboli in the PA showed best diagnostic performance (Sensitivity 72.9%; Specificity 100%), followed by main PA dilatation > 33.2 mm (sensitivity 46.9%; specificity 90.6%), and peripheral wedge-shaped consolidation (sensitivity 43.8%; specificity 78.1%). Given any one or more positive findings on unenhanced MDCT, the sensitivity was 96.9% and specificity was 71.9% for a diagnosis of PE in patients. The area under the curve (AUC) of a composite measure of unenhanced MDCT findings (0.909) was significantly higher than that of the Wells score (0.688), indicating unenhanced MDCT was reliable for detecting PE than Wells score.ConclusionsUnenhanced MDCT is an alternative for the diagnosis of acute central PE when CTPA is not available.

Highlights

Computed tomography pulmonary angiography (CTPA) is the gold standard for the diagnosis of pulmonary embolism (PE)
Acute central PE was the focus of this study because it is associated with more severe hemodynamic changes and higher mortality, and requires prompt intervention to have a good outcome as compared to distal PE and chronic PE [26]
After applying the exclusion criteria, 32 patients with an acute central PE confirmed by CTPA, and 32 patients with a PE ruled-out by CTPA

Summary

Introduction

Computed tomography pulmonary angiography (CTPA) is the gold standard for the diagnosis of pulmonary embolism (PE). The diagnostic strategy of PE mainly evaluates the hemodynamic status first, followed by clinical risk assessment system (Wells score and Geneva score). After confirmation of PE or ruling out non-PE patients using hemodynamic and clinical risk assessment test, the suspected PE patients may perform radiological assessment using multi-detector contrastenhanced computed tomography angiography (CTPA), which is the gold standard for the imaging diagnosis of PE [6,7,8,9,10]. Even though Wells score and revised Geneva score. The Wells score-revised Geneva score stratification method can be further combined with the D-dimer test [18], which is a useful, non-invasive approach for the diagnosis of PE. The predictive value of the D-dimer test depends greatly on the clinical pretest probability estimated by the Wells score [2, 6, 7, 19,20,21,22]

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