Lahham S, Fox JC, Thompson M, Nakornchai T, Alruwaili B, Doman G, May Lee S, Shafi A, Shniter I, Valdes V, Zhang L. J Ultrasound Med. Methodological challenges include the “gold standard” problem; spectrum and selection biases; “soft” measures (subjective phenomena); observer variability and bias; complex relations; clinical impact; sample size; and rapid progress of knowledge Clinical judgment is probably the most important consideration in the assessment of risk. Distribution of dose was compared for CT and digital angiography. To determine diagnostic accuracy of four-channel multi-detector row computed tomography (CT) in emergency room and inpatient populations suspected of having acute pulmonary embolism (PE) who prospectively underwent both CT and pulmonary arteriography (PA). Interrater agreement was substantially better with the use of 1-mm and 2-mm sections than with the use of 3-mm sections. A previously defined clinical decision rule, the Wells Criteria, may provide a reliable and reproducible means of determining this pretest probability. In the 921 patients without PE, the mean prevalences (ranges between sites) of concordant categorized non-PE findings were: A = 7% (range 3%–11%), B = 10% (7%–13%), C = 17% (10%–20%), D = 4% (0%–8%), and no ancillary finding = 41% (29% to 45%). Thrombolytic therapy, in the opinion of most investigators, should be reserved for unstable patients or patients who remain hypoxic while receiving oxygen. Eleven of the 20 patients had proved pulmonary embolism (seven in central vessels and four in subsegmental vessels only). Clinically apparent pulmonary embolism recurred in 33 patients (8.3 percent), of whom 45 percent died during follow-up. The reported sensitivity for the diagnosis of PE with CT-PA varies from 45 to 100% and the specificity from 78 to 100%. There are still concerns with regards to the increased risk of thromboembolic events with the use of TA. Three-month follow-up for the diagnosis of pulmonary embolism was performed. Despite anticoagulant therapy, VTE recurs frequently in the first few months after the initial event, with a recurrence rate of approximately 7% at 6 months. Methods: Patients who were on chemotherapy also had a higher risk of coincidental PE (P=0.019). Conclusions: The epidemiology and symptomology of this disorder, including common symptoms such as fever, chest pain, dyspnea, edema, and syncope, are reviewed. Materials and methods: Peripheral pulmonary embolism on multidetector CT pulmonary angiography. Ventilation-Perfusion Scanning Is Alive and Well in the Diagnosis of Pulmonary Embolism, Suspected Pulmonary Embolism: Prevalence and Anatomic Distribution in 487 Consecutive Patients1, Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton III LJTrends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Conclusion: 28 CT pulmonary angiography has become the de facto clinical gold standard for the diagnosis of acute PE and has replaced catheter-based pulmonary angiography and ventilation-perfusion scintigraphy as the first-line imaging method. Patients received a diagnosis of pulmonary embolism if they had a high-probability ventilation-perfusion scan, an abnormal result on ultrasonography or pulmonary angiography, or a venous thromboembolic event during follow-up. Special attention was focused on symptoms indicating recurrent PE, as well as later confirmation and therapy of PE. Further, we derived a threshold of cerebral blood flow for ischemia as measured by DSC. Diagnosis of pulmonary embolism with spiral volumetric CT was based on the direct visualization of intraluminal clots: partial filling defects (n = 41; 37%), complete filling defects (n = 51; 46%), "railway track" signs (n = 6; 5%), and mural defects (n = 14; 12%). Those exams were excluded. 13 Gaps in the evidence. The ventilation/perfusion lung scan remains the primary noninvasive diagnostic test. Materials and methods: The most frequent causes of death in patients with pulmonary embolism were cancer (in 34.7 percent), infection (22.1 percent), and cardiac disease (16.8 percent). 3D visualization CAD performance was examined by an experienced radiologist. Of patients with PE, 15 (65%) were found to have a clinically significant acute PE. This collaboration allows different methodologies to be used to assess PE-CAD performance, by comparison with the common method in which radiologists are prompted with CAD stimuli directly on the CTPA views. Gold standard for diagnosis pulmonary embolism - 1) Ventilation perfusion scan All reports of chest CT scans performed during a 12-month period were searched for keywords indicative of PE. It is now considered to be the gold standard for diagnosis and risk stratification of pulmonary embolism, as it has a very high sensitivity and specificity. Would you like email updates of new search results? In coordination with a SPECT pulmonary ventilation exam, a diagnosis of PE can be considered(64). Dual-section helical CT is an improvement in helical CT that offers a high sensitivity and specificity for the depiction of PE, including at the subsegmental level. Patient outcome and recurrence of PE was evaluated retrospectively during a period of 6 months after the initial SCTA, and included a review of computerized patient records, and interviews with physicians and patients. Estrada-Y-Martin RM, Oldham SA. Conversely, PE can be over-diagnosed, with the concomitant risks associated with unnecessary anticoagulation. To formulate comprehensive recommendations for the diagnostic approach to patients with suspected pulmonary embolism, based on randomized trials. Access scientific knowledge from anywhere. This study was designed to prospectively compare helical CT with pulmonary angiography in the detection of pulmonary embolism in patients with an unresolved clinical and scintigraphic diagnosis. In 1982, the per-capita dose was estimated to be 0.54 mSv and the collective dose 124,000 person-Sv. CT better demonstrated large-level vessel involvement (P < .01), while PA better demonstrated small-level vessel involvement (P < .01). At CT, 26 patients (28%) had PE at 71 vessel levels (24 main and/or interlobar, 33 segmental, and 14 subsegmental). CR considered CTPA the gold standard for the diagnosis of PE, OR 3.3 (1.8-6.1). New imaging studies have been developed during the past decade. There was a 25% to 30% disagreement rate in the interpretation of low- versus intermediate-probability V/Q scans.2, 23 Angiographers agreed in 81% of cases overall and in only 66% of cases with isolated subsegmental pulmonary emboli, making the gold standard less than perfect. 2011; 6(4):557-63 (ISSN: 1861-6429) Estrada-Y-Martin RM; … Characteristics with evidence of association with recommendation (defined as P<0.10) were included in the multiple-variable analysis. Binary logistic regression analysis for both groups demonstrated that the only variable associated with CTPA as gold standard for the diagnosis of PE was being a chest radiologist. Information about the outcome of clinically recognized pulmonary embolism is sparse, particularly given that new treatments for more seriously ill patients are now available. -. 5 Also, D-dimer assay can be used for risk stratification in the case of a normotensive patient with PE. Conclusion: © 2008-2021 ResearchGate GmbH. Patients who underwent imaging for pulmonary embolism after a medical history, physical examination, and chest radiograph were enrolled. Venous thromboembolism (VTE) occurs for the first time in approximately 100 persons per 100,000 each year in the United States, and rises exponentially from <5 cases per 100,000 persons <15 years old to approximately 500 cases (0.5%) per 100,000 persons at age 80 years. Because this is an invasive test, other methods of diagnosing the disease are desirable. Angiograms, interpreted on the basis of consensus readings, resulted in an unchallenged diagnosis in 96%. Epub 2019 May 9. The abdominal CT on which PE was overlooked was obtained for a variety of reasons, most commonly because of abdominal pain or to follow up a preexisting condition. All patients underwent dual-section helical CT (2.7-mm effective section thickness) and selective pulmonary arteriography within 12 hours of each other. In ED patients with suspected PE, the CT angiogram frequently provides evidence suggesting an important alternative diagnosis to PE. The annual incidence of pulmonary embolism in the United States is probably in excess of 630,000. The contrast enhancement of the reconstructed images was increased via a post-processing tool (vContrast). All patients who presented with a DVT were on LMWH prophylaxis. Measurements: Patients received instructions to report any symptoms or signs of PE or deep venous thrombosis (DVT) during the 3-month follow-up period. Early mortality after VTE is strongly associated with presentation as PE, advanced age, cancer, and underlying cardiovascular disease. Purpose: The prevalence of PE was 27% (130 of 487 patients). The pretest probability of pulmonary embolism was low, moderate, and high in 527, 339, and 64 patients (1.3%, 16.2%, and 37.5% had pulmonary embolism), respectively. Conclusions: In patients with suspected PE, helical CT can be used safely as the primary diagnostic test to rule out PE. For each set of images, each subsegmental artery was independently graded by three radiologists as open, containing emboli, or indeterminate. CT is one of the most reliable and effective methods in the diagnosis is PE, with the advantage of being extremely fast and providing alternative diagnoses. We evaluated the CT examinations of 41 patients who underwent CTA for evaluation of the pulmonary arteries which suffered from suboptimal contrast enhancement. The largest pulmonary arterial branch with PE was central or lobar in 66 (51%), segmental in 35 (27%), and isolated subsegmental in 29 (22%) patients. Moreover MDCT has enabled radiologists to understand better the functional information contained within CT images of DILD. Four hundred eighty-seven consecutive patients clinically suspected of having PE were examined in six Dutch hospitals from May 1997 through March 1998. We evaluate the interrater agreement and external validity of Wells Criteria in determining pretest probability in patients suspected of having pulmonary embolism. Twenty-nine (22%) of 130 patients had subsegmental PE; 23 of these 29 patients had a high-probability V-P scan. Many recommendations have been retained or their validity has been reinforced; however, new data have extended or modified our … A minimum monitoring with an ECG, a pulse oximeter Image noise and contrast-to-noise ratio (CNR) were assessed in eight different regions: main pulmonary artery, right and left pulmonary arteries, right and left segment arteries, muscle, subcutaneous fat, and bone. Zhou C, Chan HP, Patel S, Cascade PN, Sahiner B, Hadjiiski LM, Kazerooni EA. Result: An aorto-pulmonary ratio > 1 with still contrast inflow being visible within the superior vena cava was defined as TIC. Introduction: Tranexamic Acid (TA) has been shown to decrease peri-operative bleeding in primary lower limb arthroplasty surgery. The authors performed compression ultrasonography or phlebography for suspected DVT and pulmonary angiography for suspected PE. Of the 153 eligible patients, 3 patients were missed, 16 patients declined, and 134 (88%) patients were enrolled. 2-SpSCT and 4-SpSCT showed higher values for sensitivity, specificity, accuracy, and the area under the curve at all DL compared with FS. In those patients not receiving TA, 6 had a DVT and 4 had a PE, a total of 10 (2.6%). Results: The pretest probability of pulmonary embolism was low, moderate, and high in 527, 339, and 64 patients (1.3%, 16.2%, and 37.5% had pulmonary embolism), respectively. Low-molecular-weight heparins for the initial period of anticoagulation appear to be efficacious, easier to use than unfractionated heparin, and associated with less heparin-induced thrombocytopenia. Patients who underwent imaging for pulmonary embolism after a medical history, physical examination, and chest radiograph were enrolled. Serial compression ultrasonography has limited additional value. This analysis was carried out for each question. Ultrasonography has shown promise in obtaining the tricuspid annular plane systolic excursion (TAPSE) measurements, which may be of clinical importance in patients with acute PE. In the patients with alternative diagnoses, 1 patient had DVT on objective testing during follow-up. The estimated annual incidence of pulmonary embolism (PE) is between 69 to 205 cases per 100,000 persons-years. In light of these elements, the performance of modern diagnostic strategies for PE is most often presented as their ability to safely exclude PE. HHS DVT was diagnosed on Duplex Ultrasound Scan and PE on CT Pulmonary Angiogram. Three readers independently evaluated each study for PE presence. Imaging plays a central role in CTEPH diagnosis. chi2 Tests were used for statistical analysis. -, Eur Radiol. After embolization spiral CT (3 mm and 1 mm collimation), and pulmonary angiography were performed. Anticoagulation was not started when results of CT were negative for PE or indicated an alternative diagnosis that explained the clinical signs and symptoms, or when results on serial compression ultrasonography were normal. Compression duplex ultrasonography (CDUS) and computed tomography angiography are the reference standard diagnostic tools for evaluating deep vein thrombosis (DVT) and pulmonary embolism (PE). We then compared their responses with the published guidelines set forth by the Fleischner Society. Pulmonary catheter angiography is still considered the gold standard and final imaging method in many diagnostic algorithms. Three of 161 professionals were able to answer all eight questions correctly. The lungs were divided into three zones: central, middle, and peripheral. Two hundred twenty-nine patients had CTPA, and 27 (11.8%) of them were positive for PE. Acute pulmonary embolism (PE) is a life-threatening condition that requires accurate diagnostic imaging. Can be therapeutic if direct intraluminal thrombolysis is indicated. Ninety-five patients with pulmonary embolism (23.8 percent) died within one year. To estimate cumulative radiation exposure and lifetime attributable risk (LAR) of radiation-induced cancer from computed tomographic (CT) scanning of adult patients at a tertiary care academic medical center. The per-caput effective dose increased to about 0.75 mSv and the collective dose to about 220,000 person Sv. The prevalence of symptomatic PE on dedicated CTPA was 11.8%, and the rate of coincidental PE on contrast-enhanced CT was 1.8%. Our results show that patients with suspected acute PE and negative CT results have acceptable clinical outcomes in the absence of anticoagulation treatment up to 6 months after acquisition of their initial scan. Radiol Med. On a per finding level, 1174 of 1352 findings marked as embolus by the algorithm were true emboli. Wells Criteria have a moderate to substantial interrater agreement and reliably risk stratify pretest probability in patients with suspected pulmonary embolism. Both 3D approaches are based on the voxel size of the CTPA examination, and consider the acquisition settings. Four (6%) of 62 patients had isolated subsegmental PE. Given the variable presentation and associated morbidity of this condition, an accurate and efficient diagnostic algorithm is required. In 7 of the patients who received a diagnosis of pulmonary embolism, the physician had performed more diagnostic tests than were called for by the algorithm. The gold standard diagnostic test for pulmonary embolism has historically been interventional pulmonary angiography. 14 ‘What to do’ and ‘what not to do’ messages from the Guidelines. Of the 437 patients with a negative D-dimer result and low clinical probability, only 1 developed pulmonary embolism during follow-up; thus, the negative predictive value for the combined strategy of using the clinical model with D-dimer testing in these patients was 99.5% (Cl, 99.1% to 100%). The aim of this study was to compare contrast-enhanced spiral CT to pulmonary angiography for the detection of subsegmental-sized pulmonary emboli by using a methacrylate cast of porcine pulmonary vessels as an independent gold standard. Multiple-variable logistic regression was used to assess the simultaneous effects of reader characteristics on recommendation. Sensitivity and specificity of CT were calculated by using PA as the reference standard. Mortality in this group was 21.5% (28 of 130 patients); in 1 of these patients, PE could not be confidently ruled out as a contributing cause of death. CT demonstrated central PE in two patients with normal V-P scans. It was trained and validated on 28,000 CTPAs acquired at other institutions. This paper reviews the most current literature on the diagnosis of pulmonary thromboembolism. The Prospective Investigation of Pulmonary Embolism Diagnosis II trial was a prospective, multicenter investigation of the accuracy of multidetector CTA alone and combined with venous-phase imaging (CTA-CTV) for the diagnosis of acute pulmonary embolism. Billing ICD9 codes and electronic order entry information were used to stratify patients with LAR greater than 1%. Of the 161 professionals surveyed, 93 (58%) appreciated correctly that V/Q scintigraphy delivers a higher fetal dose than does CT pulmonary angiography. This survey reveals that there is a lack of knowledge of fetal dosimetry in the imaging of pregnant women suspected of having pulmonary embolism. The CT scans were obtained during one 24-sec or two 12-sec breath-holds. Of this group 67,000 (11 per cent) die within one hour of the event before definitive diagnosis and management, and 563,000 (89 per cent) survive the event for at least one hour so that there may be sufficient opportunity for diagnosis and therapy. J Thromb Haemost. The negative predictive value of spiral CT angiography was 98% (175 of 178) in the study group in which follow-up was performed, with no significant difference between the values in groups 3 (98% [132 of 135]) and 4 (100% [50 of 50]). Take advantage of the diagnostic process largely determines quality of the 153 eligible patients, 3 patients were identified query... The literature, the CT scans was 4.1 % ( 13/85 ) almost 25 years central vessels were,... 5 % underwent between 22 and 132 examinations questions about their medical history physical. Various clinical scenarios there was no difference between spiral CT scans was 4.1 % 95! 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