Purpose
Computed tomography pulmonary angiography (CTPA) is the gold standard in the diagnosis of acute pulmonary embolism (PE) with sensitivity and specificity between 96 – 100% and 89 – 98% respectively.1Although a very commonly performed investigation;guidance from the Royal College of Radiologists advises that CTPA should detect pulmonary emboli in between 15.4 – 37.4% of patients.2 The additional value of modern imaging is the opportunity to risk stratify patients to guide appropriate therapeutic management. In particular, evidence of right heart dysfunction on CTPA has been correlated...
Methods and materials
We identified all patients who underwent CTPA at a tertiary hospital in January 2019 via a retrospective review of the hospital’s radiology information system (CRIS). A total of 216 cases were identified. Patients were excluded if they underwent CTPA to investigate suspected or confirmed chronic pulmonary embolic disease. Acute pulmonary embolism was diagnosed in 50 cases (23%) and for these patients the RV:LV diameter was measured (using reformatted long axis views) and the text of the radiology report was analysed.
Results
Patient Demographics
Of the 216 cases in the entire cohort, 90 were male (42%). The median age was 66 years (range 19 – 93). Of the patients who were diagnosed with pulmonary embolism; 23 were male (46%) and were slightly younger with a median age of 63 years (range 19 – 91).
Clinical information provided on the CTPA request
In patients diagnosed with pulmonary embolus, information regarding cardiac biomarkers (troponin T and NTPro BNP) was rarely included. BNP was never stated; likely reflecting limited use...
Conclusion
Radiologists within our organisation are reasonably accurate in the recognition of right ventricular dysfunction on CTPA in acute pulmonary embolus, however we use inconsistent and controversial methods in diagnosis. The language used in our reports is also highly variable and therefore confusing for clinicians. More rigorous and accurate assessment using the RV:LV ratio would assist clinicians in appropriately risk-stratifying these patients.
Personal information and conflict of interest
C. Fee; Bristol/UK - nothing to disclose S. Glenn-Cox; Bristol/UK - nothing to disclose P. McCoubrie; Bristol/UK - nothing to disclose
References
Wiener RS et al. When a test is too good: how CT pulmonary angiograms find pulmonary emboli that do not need to be found. BMJ. 2013.
Quigley A, Brown K. Appropriateness of usage of computed tomography pulmonary angiography (CTPA) investigation of suspected pulmonary embolism. RCR Audit Live 2010.
BecattiniC et al. Computed tomography for acute pulmonary embolism: diagnosis and risk stratification in a single test.Eur Heart J2011;32:1657–1663.
Konstantinides S et al.(2019) ESC Scientific Document Group, 2019 ESC Guidelines for the diagnosis and management of acute...