Seminars in Roentgenology
Volume 40, Issue 1 , Pages 11-19 , January 2005

CT angiography with multidetector-row CT for detection of acute pulmonary embolus

  • James G. Ravenel

      Affiliations

    • Department of Radiology, Medical University of South Carolina, Charleston, SC, USA.
    • Corresponding Author InformationAddress reprint requests to: James G. Ravenel, MD, Department of Radiology, Medical University of South Carolina, 169 Ashley Avenue, Charleston, SC.
    • ,
  • Florian Kipfmueller

      Affiliations

    • Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA.
    • ,
  • U. Joseph Schoepf

      Affiliations

    • Department of Radiology, Medical University of South Carolina, Charleston, SC, USA.

References 

  1. Goldhaber SZ , Elliott CG . Acute pulmonary embolism: Part I: Epidemiology, pathophysiology, and diagnosis . Circulation . 2003;108:2726–2729
  2. Carson JL , Kelley MA , Duff A , et al.   The clinical course of pulmonary embolism . N Engl J Med . 1992;326:1240–1245
  3. Stein PD , Henry JW , Relyea B . Untreated patients with pulmonary embolism. Outcome, clinical, and laboratory assessment . Chest . 1995;107:931–935
  4. Smith TP . Pulmonary embolism (What’s wrong with this diagnosis?) . AJR Am J Roentgenol . 2000;174:1489–1497
  5. Robin ED . Overdiagnosis and overtreatment of pulmonary embolism (The emperor may have no clothes) . Ann Intern Med . 1977;87:775–781
  6. Egermayer P . Follow-up for death or recurrence is not a reliable way of assessing the accuracy of diagnostic tests for thromboembolic disease . Chest . 1997;111:1410–1413
  7. Wells PS , Anderson DR , Rodger M , et al.   Derivation of a simple clinical model to categorize patients probability of pulmonary embolism (Increasing the models utility with the simplired d-dimer) . Thromb Haemost . 2000;83:416–420
  8. American College of Emergency Physicians Clinical Policies Committee Clinical Policies Committee Subcommittee on Suspected Pulmonary Embolism . Clinical policy (Critical issues in the evaluation and management of adult patients presenting with suspected pulmonary embolism) . Ann Emerg Med . 2003;41:257–270
  9. Kline JA , Wells PS . Methodology for a rapid protocol to rule out pulmonary embolism in the emergency department . Ann Emerg Med . 2003;42:266–275
  10. Dunn KL , Wolf JP , Dorfman DM , Fitzpatrick P , Baker JL , Goldhaber SZ . Normal d-dimer levels in emergency department patients suspected of acute pulmonary embolism . J Am Coll Cardiol . 2002;40:1475–1478
  11. Abcarian PW , Sweet JD , Watabe JT , Yoon HC . Role of a quantitative d-dimer assay in determining the need for CT angiography of acute pulmonary embolism . AJR Am J Roentgenol . 2004;182:1377–1381
  12. Rodger MA , Carrier M , Jones GN , et al.   Diagnostic value of arterial blood gas measurement in suspected pulmonary embolism . Am J Respir Crit Care Med . 2000;162:2105–2108
  13. Stein PD , Goldhaber SZ , Henry JW . Alveolar-arterial oxygen gradient in the assessment of acute pulmonary embolism . Chest . 1995;107:139–143
  14. Rodger M , Makropoulos D , Turek M , et al.   Diagnostic value of the electrocardiogram in suspected pulmonary embolism . Am J Cardiol . 2000;86:807–809 A810
  15. Daniel KR , Courtney DM , Kline JA . Assessment of cardiac stress from massive pulmonary embolism with 12-lead ecg . Chest . 2001;120:474–481
  16. Elliott CG , Goldhaber SZ , Visani L , DeRosa M . Chest radiographs in acute pulmonary embolism. Results from the international cooperative pulmonary embolism registry . Chest . 2000;118:33–38
  17. Novelline RA , Baltarowich OH , Athanasoulis CA , Waltman AC , Greenfield AJ , McKusick KA . The clinical course of patients with suspected pulmonary embolism and a negative pulmonary arteriogram . Radiology . 1978;126:561–567
  18. Stein PD , Athanasoulis C , Alavi A , et al.   Complications and validity of pulmonary angiography in acute pulmonary embolism . Circulation . 1992;85:462–468
  19. Henry JW , Relyea B , Stein PD . Continuing risk of thromboemboli among patients with normal pulmonary angiograms . Chest . 1995;107:1375–1378
  20. Forauer AR , McLean GK , Wallace LP . Clinical follow-up of patients after a negative digital subtraction pulmonary arteriogram in the evaluation of pulmonary embolism . J Vasc Interv Radiol . 1998;9:903–908
  21. Cheely R , McCartney WH , Perry JR , et al.   The role of noninvasive tests versus pulmonary angiography in the diagnosis of pulmonary embolism . Am J Med . 1981;70:17–22
  22. Zuckerman DA , Sterling KM , Oser RF . Safety of pulmonary angiography in the 1990s . J Vasc Interv Radiol . 1996;7:199–205
  23. Diffin DC , Leyendecker JR , Johnson SP , Zucker RJ , Grebe PJ . Effect of anatomic distribution of pulmonary emboli on interobserver agreement in the interpretation of pulmonary angiography . AJR Am J Roentgenol . 1998;171:1085–1089
  24. Stein PD , Henry JW , Gottschalk A . Reassessment of pulmonary angiography for the diagnosis of pulmonary embolism (Relation of interpreter agreement to the order of the involved pulmonary arterial branch) . Radiology . 1999;210:689–691
  25. Trowbridge RL , Araoz PA , Gotway MB , Bailey RA , Auerbach AD . The effect of helical computed tomography on diagnostic and treatment strategies in patients with suspected pulmonary embolism . Am J Med . 2004;116:84–90
  26. Rubboli A , Leonardi G , de Castro U , Bracchetti D . Diagnostic approach to acute pulmonary embolism in a general hospital. A two-year analysis . G Ital Cardiol . 1998;28:123–130
  27. The PIOPED investigators (Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED)) . JAMA . 1990;263:2753–2759
  28. Blachere H , Latrabe V , Montaudon M , et al.   Pulmonary embolism revealed on helical ct angiography (Comparison with ventilation-perfusion radionuclide lung scanning) . AJR Am J Roentgenol . 2000;174:1041–1047
  29. Stein PD , Kayali F , Olson RE . Trends in the use of diagnostic imaging in patients hospitalized with acute pulmonary embolism . Am J Cardiol . 2004;93:1316–1317
  30. Beecham RP , Dorfman GS , Cronan JJ , Spearman MP , Murphy TP , Scola FH . Is bilateral lower extremity compression sonography useful and cost-effective in the evaluation of suspected pulmonary embolism? . AJR Am J Roentgenol . 1993;161:1289–1292
  31. Lipski DA , Shepard AD , McCarthy BD , Ernst CB . Noninvasive venous testing in the diagnosis of pulmonary embolism (The impact on decisionmaking) . J Vasc Surg . 1997;26:757–763
  32. Killewich LA , Nunnelee JD , Auer AI . Value of lower extremity venous duplex examination in the diagnosis of pulmonary embolism . J Vasc Surg . 1993;17:934–938 discussion 938–939
  33. Cronan JJ . Venous thromboembolic disease (The role of us) . Radiology . 1993;186:619–630
  34. Matteson B , Langsfeld M , Schermer C , Johnson W , Weinstein E . Role of venous duplex scanning in patients with suspected pulmonary embolism . J Vasc Surg . 1996;24:768–773
  35. Gupta A , Frazer CK , Ferguson JM , et al.   Acute pulmonary embolism (Diagnosis with MR angiography) . Radiology . 1999;210:353–359
  36. Hurst DR , Kazerooni EA , Stafford-Johnson D , et al.   Diagnosis of pulmonary embolism (Comparison of CT angiography and MR angiography in canines) . J Vasc Interv Radiol . 1999;10:309–318
  37. Woodard PK , Yusen RD . Diagnosis of pulmonary embolism with spiral computed tomography and magnetic resonance angiography . Curr Opin Cardiol . 1999;14:442–447
  38. Oudkerk M , van Beek EJ , Wielopolski P , et al.   Comparison of contrast-enhanced magnetic resonance angiography and conventional pulmonary angiography for the diagnosis of pulmonary embolism (A prospective study) . Lancet . 2002;359:1643–1647
  39. Ohno Y , Higashino T , Takenaka D , et al.   MR angiography with sensitivity encoding (sense) for suspected pulmonary embolism (Comparison with MDCT and ventilation-perfusion scintigraphy) . AJR Am J Roentgenol . 2004;183:91–98
  40. Kluge A , Muller C , Hansel J , Gerriets T , Bachmann G . Real-time MR with truefisp for the detection of acute pulmonary embolism (Initial clinical experience) . Eur Radiol . 2004;14:709–718 Epub 2003 Dec 2005
  41. Seo JB , Im JG , Goo JM , et al.   Comparison of contrast-enhanced CT angiography and gadolinium-enhanced MR angiography in the detection of subsegmental-sized pulmonary embolism. An experimental study in a pig model . Acta Radiol . 2003;44:403–410
  42. Schoepf UJ , Costello P . CT angiography for diagnosis of pulmonary embolism (State of the art) . Radiology . 2004;230:329–337
  43. Remy-Jardin M , Tillie-Leblond I , Szapiro D , et al.   CT angiography of pulmonary embolism in patients with underlying respiratory disease (Impact of multislice CT on image quality and negative predictive value) . Eur Radiol . 2002;12:1971–1978 Epub 2002 Jun 1926
  44. Patel S , Kazerooni EA , Cascade PN . Pulmonary embolism (Optimization of small pulmonary artery visualization at multi-detector row CT) . Radiology . 2003;227:455–460
  45. Schoepf UJ , Holzknecht N , Helmberger TK , et al.   Subsegmental pulmonary emboli (Improved detection with thin-collimation multi-detector row spiral ct) . Radiology . 2002;222:483–490
  46. Wiest PW , Locken JA , Heintz PH , Mettler FA . CT scanning (A major source of radiation exposure) . Semin Ultrasound CT MR . 2002;23:402–410
  47. Miller AB , Howe GR , Sherman GJ , et al.   Mortality from breast cancer after irradiation during fluoroscopic examinations in patients being treated for tuberculosis . N Engl J Med . 1989;321:1285–1289
  48. Winer-Muram HT , Boone JM , Brown HL , Jennings SG , Mabie WC , Lombardo GT . Pulmonary embolism in pregnant patients (Fetal radiation dose with helical CT) . Radiology . 2002;224:487–492
  49. Kalra MK , Maher MM , Toth TL , et al.   Strategies for CT radiation dose optimization . Radiology . 2004;230:619–628 Epub 2004 Jan 2022
  50. Mullins MD , Becker DM , Hagspiel KD , Philbrick JT . The role of spiral volumetric computed tomography in the diagnosis of pulmonary embolism . Arch Intern Med . 2000;160:293–298
  51. Rathbun SW , Raskob GE , Whitsett TL . Sensitivity and specificity of helical computed tomography in the diagnosis of pulmonary embolism (A systematic review) . Ann Intern Med . 2000;132:227–232
  52. Bourriot K , Couffinhal T , Bernard V , Montaudon M , Bonnet J , Laurent F . Clinical outcome after a negative spiral CT pulmonary angiographic finding in an inpatient population from cardiology and pneumology wards . Chest . 2003;123:359–365
  53. Garg K , Sieler H , Welsh CH , Johnston RJ , Russ PD . Clinical validity of helical CT being interpreted as negative for pulmonary embolism (Implications for patient treatment) . AJR Am J Roentgenol . 1999;172:1627–1631
  54. Goodman LR , Lipchik RJ , Kuzo RS , Liu Y , McAuliffe TL , O’Brien DJ . Subsequent pulmonary embolism (Risk after a negative helical CT pulmonary angiogram—prospective comparison with scintigraphy) . Radiology . 2000;215:535–542
  55. Lomis NN , Yoon HC , Moran AG , Miller FJ . Clinical outcomes of patients after a negative spiral CT pulmonary arteriogram in the evaluation of acute pulmonary embolism . J Vasc Interv Radiol . 1999;10:707–712
  56. Ost D , Rozenshtein A , Saffran L , Snider A . The negative predictive value of spiral computed tomography for the diagnosis of pulmonary embolism in patients with nondiagnostic ventilation-perfusion scans . Am J Med . 2001;110:16–21
  57. Tillie-Leblond I , Mastora I , Radenne F , et al.   Risk of pulmonary embolism after a negative spiral ct angiogram in patients with pulmonary disease (1-year clinical follow-up study) . Radiology . 2002;223:461–467
  58. Coche E , Verschuren F , Keyeux A , et al.   Diagnosis of acute pulmonary embolism in outpatients (Comparison of thin-collimation multi-detector row spiral ct and planar ventilation-perfusion scintigraphy) . Radiology . 2003;229:757–765
  59. Kavanagh EC , O’Hare A , Hargaden G , Murray JG . Risk of pulmonary embolism after negative MDCT pulmonary angiography findings . AJR Am J Roentgenol . 2004;182:499–504
  60. Musset D , Parent F , Meyer G , et al.   Diagnostic strategy for patients with suspected pulmonary embolism (A prospective multicentre outcome study) . Lancet . 2002;360:1914–1920
  61. Qanadli SD , Hajjam ME , Mesurolle B , et al.   Pulmonary embolism detection (Prospective evaluation of dual-section helical CT versus selective pulmonary arteriography in 157 patients) . Radiology . 2000;217:447–455
  62. Swensen SJ , Sheedy PF , Ryu JH , et al.   Outcomes after withholding anticoagulation from patients with suspected acute pulmonary embolism and negative computed tomographic findings (A cohort study) . Mayo Clin Proc . 2002;77:130–138
  63. Nilsson T , Olausson A , Johnsson H , Nyman U , Aspelin P . Negative spiral CT in acute pulmonary embolism . Acta Radiol . 2002;43:486–491
  64. Krestan CR , Klein N , Fleischmann D , et al.   Value of negative spiral ct angiography in patients with suspected acute pe (Analysis of PE occurrence and outcome) . Eur Radiol . 2004;14:93–98 Epub 2003 Aug 2026
  65. Gottsater A , Berg A , Centergard J , Frennby B , Nirhov N , Nyman U . Clinically suspected pulmonary embolism (Is it safe to withhold anticoagulation after a negative spiral ct?) . Eur Radiol . 2001;11:65–72
  66. Remy-Jardin M , Remy J , Cauvain O , Petyt L , Wannebroucq J , Beregi JP . Diagnosis of central pulmonary embolism with helical CT (Role of two-dimensional multiplanar reformations) . AJR Am J Roentgenol . 1995;165:1131–1138
  67. Chiang EE , Boiselle PM , Raptopoulos V , Reynolds KF , Rosen MP , Simon M . Detection of pulmonary embolism (Comparison of paddlewheel and coronal ct reformations—initial experience) . Radiology . 2003;228:577–582 Epub 2003 Jun 2020
  68. Simon M , Chiang EE , Boiselle PM . Paddle-wheel multislice helical CT display of pulmonary vessels and other lung structures . Radiol Clin North Am . 2003;41:617–626
  69. Shah AA , Davis SD , Gamsu G , Intriere L . Parenchymal and pleural findings in patients with and patients without acute pulmonary embolism detected at spiral CT . Radiology . 1999;211:147–153
  70. van Rossum AB , Pattynama PM , Mallens WM , Hermans J , Heijerman HG . Can helical CT replace scintigraphy in the diagnostic process in suspected pulmonary embolism? A retrolective-prolective cohort study focusing on total diagnostic yield . Eur Radiol . 1998;8:90–96
  71. Sostman HD , Ravin CE , Sullivan DC , Mills SR , Glickman MG , Dorfman GS . Use of pulmonary angiography for suspected pulmonary embolism (Influence of scintigraphic diagnosis) . AJR Am J Roentgenol . 1982;139:673–677
  72. Henschke CI , Mateescu I , Yankelevitz DF . Changing practice patterns in the workup of pulmonary embolism . Chest . 1995;107:940–945
  73. Remy-Jardin M , Remy J , Artaud D , Deschildre F , Duhamel A . Peripheral pulmonary arteries (Optimization of the spiral ct acquisition protocol) . Radiology . 1997;204:157–163
  74. Ghaye B , Szapiro D , Mastora I , et al.   Peripheral pulmonary arteries (How far in the lung does multi-detector row spiral CT allow analysis?) . Radiology . 2001;219:629–636
  75. Mansencal N , Redheuil A , Joseph T , et al.   Use of transthoracic echocardiography combined with venous ultrasonography in patients with pulmonary embolism . Int J Cardiol . 2004;96:59–63
  76. Quiroz R , Kucher N , Schoepf UJ , et al.   Right ventricular enlargement on chest computed tomography (Prognostic role in acute pulmonary embolism) . Circulation . 2004;109:2401–2404 Epub 2004 May 2417
  77. Reid JH , Murchison JT . Acute right ventricular dilatation (A new helical ct sign of massive pulmonary embolism) . Clin Radiol . 1998;53:694–698
  78. Araoz PA , Gotway MB , Trowbridge RL , et al.   Helical CT pulmonary angiography predictors of in-hospital morbidity and mortality in patients with acute pulmonary embolism . J Thorac Imaging . 2003;18:207–216
  79. Collomb D , Paramelle PJ , Calaque O , et al.   Severity assessment of acute pulmonary embolism (Evaluation using helical CT) . Eur Radiol . 2003;13:1508–1514 Epub 2003 Feb 1507
  80. Bankier AA , Janata K , Fleischmann D , et al.   Severity assessment of acute pulmonary embolism with spiral CT (Evaluation of two modified angiographic scores and comparison with clinical data) . J Thorac Imaging . 1997;12:150–158
  81. Qanadli SD , El Hajjam M , Vieillard-Baron A , et al.   New CT index to quantify arterial obstruction in pulmonary embolism (Comparison with angiographic index and echocardiography) . AJR Am J Roentgenol . 2001;176:1415–1420
  82. Miller GA , Sutton GC , Kerr IH , Gibson RV , Honey M . Comparison of streptokinase and heparin in treatment of isolated acute massive pulmonary embolism . Br Heart J . 1971;33:616
  83. Rubin GD , Lane MJ , Bloch DA , Leung AN , Stark P . Optimization of thoracic spiral CT (Effects of iodinated contrast medium concentration) . Radiology . 1996;201:785–791
  84. Cademartiri F , Mollet N , van der Lugt A , et al.   Non-invasive 16-row multislice CT coronary angiography (Usefulness of saline chaser) . Eur Radiol . 2004;14:178–183 Epub 2003 Dec 2019
  85. Remy-Jardin M , Duyck P , Remy J , et al.   Hilar lymph nodes (Identification with spiral CT and histologic correlation) . Radiology . 1995;196:387–394
  86. Flohr T , Prokop M , Becker C , et al.   A retrospectively ecg-gated multislice spiral CT scan and reconstruction technique with suppression of heart pulsation artifacts for cardio-thoracic imaging with extended volume coverage . Eur Radiol . 2002;12:1497–1503 Epub 2002 Apr 1425
  87. Schoepf UJ , Becker CR , Bruening RD , et al.   Electrocardiographically gated thin-section CT of the lung . Radiology . 1999;212:649–654
  88. van Erkel AR , van Rossum AB , Bloem JL , Kievit J , Pattynama PM . Spiral CT angiography for suspected pulmonary embolism (A cost-effectiveness analysis) . Radiology . 1996;201:29–36

PII: S0037-198X(04)00115-4

doi: 10.1053/j.ro.2004.09.012

Seminars in Roentgenology
Volume 40, Issue 1 , Pages 11-19 , January 2005

Article Tools

* Image Usage & Resolution