Pulmonary embolism CT: Difference between revisions
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Recent improvement in technology has changed the value of CT angiography for decision making in suspected PE patients. Wide variations regarding both sensitivity (53-100%) and specificity (73-100%) was reported in studies about single detector spiral CT in suspected PE cases.<ref name="pmid10668830">{{cite journal |author=Mullins MD, Becker DM, Hagspiel KD, Philbrick JT |title=The role of spiral volumetric computed tomography in the diagnosis of pulmonary embolism |journal=Arch. Intern. Med. |volume=160 |issue=3 |pages=293–8 |year=2000 |month=February |pmid=10668830 |doi= |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=10668830 |accessdate=2012-04-30}}</ref><ref name="pmid10651604">{{cite journal |author=Rathbun SW, Raskob GE, Whitsett TL |title=Sensitivity and specificity of helical computed tomography in the diagnosis of pulmonary embolism: a systematic review |journal=Ann. Intern. Med. |volume=132 |issue=3 |pages=227–32 |year=2000 |month=February |pmid=10651604 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=10651604 |accessdate=2012-04-30}}</ref> | Recent improvement in technology has changed the value of CT angiography for decision making in suspected PE patients. Wide variations regarding both sensitivity (53-100%) and specificity (73-100%) was reported in studies about single detector spiral CT in suspected PE cases.<ref name="pmid10668830">{{cite journal |author=Mullins MD, Becker DM, Hagspiel KD, Philbrick JT |title=The role of spiral volumetric computed tomography in the diagnosis of pulmonary embolism |journal=Arch. Intern. Med. |volume=160 |issue=3 |pages=293–8 |year=2000 |month=February |pmid=10668830 |doi= |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=10668830 |accessdate=2012-04-30}}</ref><ref name="pmid10651604">{{cite journal |author=Rathbun SW, Raskob GE, Whitsett TL |title=Sensitivity and specificity of helical computed tomography in the diagnosis of pulmonary embolism: a systematic review |journal=Ann. Intern. Med. |volume=132 |issue=3 |pages=227–32 |year=2000 |month=February |pmid=10651604 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=10651604 |accessdate=2012-04-30}}</ref> | ||
Two large multicentric robust clinical studies including more than 1000 patients reported a sensitivity around 70% and a specificity of 90% for single-detector CT.<ref name="pmid11453707">{{cite journal |author=Perrier A, Howarth N, Didier D, Loubeyre P, Unger PF, de Moerloose P, Slosman D, Junod A, Bounameaux H |title=Performance of helical computed tomography in unselected outpatients with suspected pulmonary embolism |journal=Ann. Intern. Med. |volume=135 |issue=2 |pages=88–97 |year=2001 |month=July |pmid=11453707 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=11453707 |accessdate=2012-04-30}}</ref><ref name="pmid15634261">{{cite journal |author=Van Strijen MJ, De Monye W, Kieft GJ, Pattynama PM, Prins MH, Huisman MV |title=Accuracy of single-detector spiral CT in the diagnosis of pulmonary embolism: a prospective multicenter cohort study of consecutive patients with abnormal perfusion scintigraphy |journal=J. Thromb. Haemost. |volume=3 |issue=1 |pages=17–25 |year=2005 |month=January |pmid=15634261 |doi=10.1111/j.1538-7836.2004.01064.x |url=http://dx.doi.org/10.1111/j.1538-7836.2004.01064.x |accessdate=2012-04-30}}</ref> | Two large multicentric robust clinical studies including more than 1000 patients reported a sensitivity around 70% and a specificity of 90% for single-detector CT.<ref name="pmid11453707">{{cite journal |author=Perrier A, Howarth N, Didier D, Loubeyre P, Unger PF, de Moerloose P, Slosman D, Junod A, Bounameaux H |title=Performance of helical computed tomography in unselected outpatients with suspected pulmonary embolism |journal=Ann. Intern. Med. |volume=135 |issue=2 |pages=88–97 |year=2001 |month=July |pmid=11453707 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=11453707 |accessdate=2012-04-30}}</ref><ref name="pmid15634261">{{cite journal |author=Van Strijen MJ, De Monye W, Kieft GJ, Pattynama PM, Prins MH, Huisman MV |title=Accuracy of single-detector spiral CT in the diagnosis of pulmonary embolism: a prospective multicenter cohort study of consecutive patients with abnormal perfusion scintigraphy |journal=J. Thromb. Haemost. |volume=3 |issue=1 |pages=17–25 |year=2005 |month=January |pmid=15634261 |doi=10.1111/j.1538-7836.2004.01064.x |url=http://dx.doi.org/10.1111/j.1538-7836.2004.01064.x |accessdate=2012-04-30}}</ref> Due to motion artifacts and insufficient opacification, the rate of technical inadequacy of CT was 5-8%. | ||
Two large studies have shown that a combination of a negative SDCT and an absence of proximal lower limb DVT on lower limb venous ultrasonoagraphy in Non-high clinical probability patient was associated with a 3-month thromboembolic risk of 1%.<ref name="pmid12493257">{{cite journal |author=Musset D, Parent F, Meyer G, Maître S, Girard P, Leroyer C, Revel MP, Carette MF, Laurent M, Charbonnier B, Laurent F, Mal H, Nonent M, Lancar R, Grenier P, Simonneau G |title=Diagnostic strategy for patients with suspected pulmonary embolism: a prospective multicentre outcome study |journal=Lancet |volume=360 |issue=9349 |pages=1914–20 |year=2002 |month=December |pmid=12493257 |doi=10.1016/S0140-6736(02)11914-3 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(02)11914-3 |accessdate=2012-04-30}}</ref><ref name="pmid14984813">{{cite journal |author=Perrier A, Roy PM, Aujesky D, Chagnon I, Howarth N, Gourdier AL, Leftheriotis G, Barghouth G, Cornuz J, Hayoz D, Bounameaux H |title=Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study |journal=Am. J. Med. |volume=116 |issue=5 |pages=291–9 |year=2004 |month=March |pmid=14984813 |doi=10.1016/j.amjmed.2003.09.041 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002934303007174 |accessdate=2012-04-30}}</ref> | |||
==Advantage of MDCT over SDCT== | |||
*High spatial resolution. | |||
*High temporal resolution. | |||
*Quality of arterial opacification. | |||
*Adequate visualization of pulmonary arteries upto at least the segmental level. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 03:52, 1 May 2012
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Pulmonary embolism CT On the Web |
Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
The traditional gold standard for diagnosing PE is contrast pulmonary angiography. However, invasiveness, its high costs, limited availability and need of an expert radiologist are some of its negative aspects. This chapter deals with the advantages of multidetector CT over CTPA.
Single Detector CT
Recent improvement in technology has changed the value of CT angiography for decision making in suspected PE patients. Wide variations regarding both sensitivity (53-100%) and specificity (73-100%) was reported in studies about single detector spiral CT in suspected PE cases.[1][2]
Two large multicentric robust clinical studies including more than 1000 patients reported a sensitivity around 70% and a specificity of 90% for single-detector CT.[3][4] Due to motion artifacts and insufficient opacification, the rate of technical inadequacy of CT was 5-8%.
Two large studies have shown that a combination of a negative SDCT and an absence of proximal lower limb DVT on lower limb venous ultrasonoagraphy in Non-high clinical probability patient was associated with a 3-month thromboembolic risk of 1%.[5][6]
Advantage of MDCT over SDCT
- High spatial resolution.
- High temporal resolution.
- Quality of arterial opacification.
- Adequate visualization of pulmonary arteries upto at least the segmental level.
References
- ↑ Mullins MD, Becker DM, Hagspiel KD, Philbrick JT (2000). "The role of spiral volumetric computed tomography in the diagnosis of pulmonary embolism". Arch. Intern. Med. 160 (3): 293–8. PMID 10668830. Retrieved 2012-04-30. Unknown parameter
|month=ignored (help) - ↑ Rathbun SW, Raskob GE, Whitsett TL (2000). "Sensitivity and specificity of helical computed tomography in the diagnosis of pulmonary embolism: a systematic review". Ann. Intern. Med. 132 (3): 227–32. PMID 10651604. Retrieved 2012-04-30. Unknown parameter
|month=ignored (help) - ↑ Perrier A, Howarth N, Didier D, Loubeyre P, Unger PF, de Moerloose P, Slosman D, Junod A, Bounameaux H (2001). "Performance of helical computed tomography in unselected outpatients with suspected pulmonary embolism". Ann. Intern. Med. 135 (2): 88–97. PMID 11453707. Retrieved 2012-04-30. Unknown parameter
|month=ignored (help) - ↑ Van Strijen MJ, De Monye W, Kieft GJ, Pattynama PM, Prins MH, Huisman MV (2005). "Accuracy of single-detector spiral CT in the diagnosis of pulmonary embolism: a prospective multicenter cohort study of consecutive patients with abnormal perfusion scintigraphy". J. Thromb. Haemost. 3 (1): 17–25. doi:10.1111/j.1538-7836.2004.01064.x. PMID 15634261. Retrieved 2012-04-30. Unknown parameter
|month=ignored (help) - ↑ Musset D, Parent F, Meyer G, Maître S, Girard P, Leroyer C, Revel MP, Carette MF, Laurent M, Charbonnier B, Laurent F, Mal H, Nonent M, Lancar R, Grenier P, Simonneau G (2002). "Diagnostic strategy for patients with suspected pulmonary embolism: a prospective multicentre outcome study". Lancet. 360 (9349): 1914–20. doi:10.1016/S0140-6736(02)11914-3. PMID 12493257. Retrieved 2012-04-30. Unknown parameter
|month=ignored (help) - ↑ Perrier A, Roy PM, Aujesky D, Chagnon I, Howarth N, Gourdier AL, Leftheriotis G, Barghouth G, Cornuz J, Hayoz D, Bounameaux H (2004). "Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study". Am. J. Med. 116 (5): 291–9. doi:10.1016/j.amjmed.2003.09.041. PMID 14984813. Retrieved 2012-04-30. Unknown parameter
|month=ignored (help)