OBJECTIVE: In this article, we review the current role of CT pulmonary angiography and indirect CT venography for the evaluation of pulmonary thromboembolic disease. CONCLUSION: With advances in MDCT technology, evaluation of pulmonary thromboembolic disease can now be performed with combined CT pulmonary angiography and CT venography as a "one-stop-shopping" test. CT pulmonary angiography is cost-effective, is accurate, has high interobserver agreement, and has an added advantage of detecting other life-threatening diseases in the chest that mimic pulmonary embolism.
"The CT findings that were diagnostic for DVT were complete or partial filling defects with enlargement of the vein (5). The CT venography was considered nondiagnostic if the venous enhancement was insufficient to visualize a clot, or if artifacts from orthopedic materials prevented proper visualization (6). "
[Show abstract][Hide abstract] ABSTRACT: We wanted to prospectively evaluate the interobserver agreement between radiology residents and expert radiologists for interpreting CT images for making the diagnosis of pulmonary embolism (PE).
We assessed 112 consecutive patients, from April 2007 to August 2007, who were referred for combined CT pulmonary angiography and indirect CT venography for clinically suspected acute PE. CT scanning was performed with a 64x0.5 collimation multi-detector CT scanner. The CT studies were initially interpreted by the radiology residents alone and then the CT images were subsequently interpreted by a consensus of the resident plus an experienced general radiologist and an experienced chest radiologist.
Two of the 112 CTs were unable to be interpreted (1.7%). Pulmonary artery clots were seen on 36 of the thoracic CT angiographies (32%). The interobserver agreement between the radiology residents and the consensus interpretation was good (a kappa index of 0.73). All of the disagreements (15 cases) were instances of overcall by the resident on the initial interpretation. Deep venous thrombosis was detected in 72% (26 of 36) of the patients who had PE seen on thoracic CT. The initial and consensus interpretations of the CT venography images disagreed for two cases (kappa statistic: 0.96).
It does not seem adequate to base the final long-term treatment of PE on only the resident's reading, as false positives occurred in 13% of such cases. Timely interpretation of the CT pulmonary angiography and CT venography images should be performed by experienced radiologists for the patients with suspected PE.
Korean Journal of Radiology 12/2008; 9(6):498-502. DOI:10.3348/kjr.2008.9.6.498 · 1.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to assess the interobserver agreement between on-call radiology residents and radiology specialists in the evaluation of pulmonary embolism (PE) using computed tomographic pulmonary angiography (CTPA).
Single center, prospective cohort study of 119 consecutive inpatients and outpatients with clinically suspected PE in whom CTPA was performed during out-of-office hours and weekends. The on-call radiology resident interpreted the CTPA for the presence of PE. An experienced radiology specialist, without knowledge of earlier reading, reviewed the CTPA the following morning. In discordant cases, a consensus reading was conducted. The radiology specialists' assessment and the consensus reading in case of discordance were considered as the gold standard.
Five CTPA studies were excluded from the analysis. In the remaining cases, radiology residents and radiology specialists agreed on the interpretations of CTPAs (no PE vs PE present) in 106 (93%) of the 114 cases, with a kappa value of 0.84 (95% confidence interval, 0.74-0.95). The consensus reading equally disagreed with both radiology resident and radiology specialist in 8 (7%) of the 114 discordant cases. Seven out of 8 discordant cases had suboptimal scan quality.
The assessment of CTPA in patients with suspected PE by radiology residents seems reliable during out-of-office hours.
[Show abstract][Hide abstract] ABSTRACT: Purpose: Our purpose was to review the utility of multi-detector Computed Tomography pulmonary angiography in positive diagnosis of acute pulmonary embolism and prove the importance of negative CT findings for excluding the clinically suspected pulmonary embolism. Patients and methods: our study included 72 patients clinically suspected to have acute pulmonary embolism (clinical suspicious was based on physical examination, ECG findings and high plasma D – dimmer concentration). All patients underwent MDCT pulmonary angiography within the 1st 48 hours of the attack. Results: CT diagnosis of PE was positive in 36% of clinically suspected cases, indeterminate for PE in 6.9% and negative for PE in 56.9% of our cases. Conclusion: MDCT is an accurate non invasive imaging modality for the diagnosis of pulmonary emboli. The negative predictive values of normal CT study is high and appear to be reliable for excluding clinical suspected PE, so CT provide an important information for the final diagnosis and exclusion of PE in clinical suspected patient who has no pulmonary emboli.
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