Computed tomographic pulmonary angiography: Difference between revisions

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Standards for reporting of the findings of CTPA have been studied.<ref name="pmid19692272">{{cite journal| author=Abujudeh HH, Kaewlai R, Farsad K, Orr E, Gilman M, Shepard JA| title=Computed tomography pulmonary angiography: an assessment of the radiology report. | journal=Acad Radiol | year= 2009 | volume= 16 | issue= 11 | pages= 1309-15 | pmid=19692272 | doi=10.1016/j.acra.2009.06.012 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19692272  }} </ref>
Standards for reporting of the findings of CTPA have been studied.<ref name="pmid19692272">{{cite journal| author=Abujudeh HH, Kaewlai R, Farsad K, Orr E, Gilman M, Shepard JA| title=Computed tomography pulmonary angiography: an assessment of the radiology report. | journal=Acad Radiol | year= 2009 | volume= 16 | issue= 11 | pages= 1309-15 | pmid=19692272 | doi=10.1016/j.acra.2009.06.012 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19692272  }} </ref>


The [[inter-rater reliability]] of interpretations of the CTPA by radiologists has been studied.<ref name="pmid16021452">{{cite journal| author=Brunot S, Corneloup O, Latrabe V, Montaudon M, Laurent F| title=Reproducibility of multi-detector spiral computed tomography in detection of sub-segmental acute pulmonary embolism. | journal=Eur Radiol | year= 2005 | volume= 15 | issue= 10 | pages= 2057-63 | pmid=16021452 | doi=10.1007/s00330-005-2844-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16021452  }} </ref><ref name="pmid23245652">{{cite journal| author=Lucassen WA, Beenen LF, Büller HR, Erkens PM, Schaefer-Prokop CM, van den Berk IA et al.| title=Concerns in using multi-detector computed tomography for diagnosing pulmonary embolism in daily practice. A cross-sectional analysis using expert opinion as reference standard. | journal=Thromb Res | year= 2013 | volume= 131 | issue= 2 | pages= 145-9 | pmid=23245652 | doi=10.1016/j.thromres.2012.11.027 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23245652  }} </ref><ref name="pmid19931759">{{cite journal| author=Costantino G, Norsa AH, Amadori R, Ippolito S, Resta F, Bianco R et al.| title=Interobserver agreement in the interpretation of computed tomography in acute pulmonary embolism. | journal=Am J Emerg Med | year= 2009 | volume= 27 | issue= 9 | pages= 1109-11 | pmid=19931759 | doi=10.1016/j.ajem.2008.08.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19931759  }} </ref> While there is excellent [[inter-rater reliability]] between radiologists in detecting massive pulmonary emboli, the [[inter-rater reliability]] is only moderate for segmental or smaller emboli.<ref name="pmid19931759"/>
The inter-rater reliability (ameasure of the extent to which raters or scorers agree) of interpretations of the CTPA by radiologists has been studied.<ref name="pmid16021452">{{cite journal| author=Brunot S, Corneloup O, Latrabe V, Montaudon M, Laurent F| title=Reproducibility of multi-detector spiral computed tomography in detection of sub-segmental acute pulmonary embolism. | journal=Eur Radiol | year= 2005 | volume= 15 | issue= 10 | pages= 2057-63 | pmid=16021452 | doi=10.1007/s00330-005-2844-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16021452  }} </ref><ref name="pmid23245652">{{cite journal| author=Lucassen WA, Beenen LF, Büller HR, Erkens PM, Schaefer-Prokop CM, van den Berk IA et al.| title=Concerns in using multi-detector computed tomography for diagnosing pulmonary embolism in daily practice. A cross-sectional analysis using expert opinion as reference standard. | journal=Thromb Res | year= 2013 | volume= 131 | issue= 2 | pages= 145-9 | pmid=23245652 | doi=10.1016/j.thromres.2012.11.027 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23245652  }} </ref><ref name="pmid19931759">{{cite journal| author=Costantino G, Norsa AH, Amadori R, Ippolito S, Resta F, Bianco R et al.| title=Interobserver agreement in the interpretation of computed tomography in acute pulmonary embolism. | journal=Am J Emerg Med | year= 2009 | volume= 27 | issue= 9 | pages= 1109-11 | pmid=19931759 | doi=10.1016/j.ajem.2008.08.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19931759  }} </ref> While there is excellent [[inter-rater reliability]] between radiologists in detecting massive pulmonary emboli, the [[inter-rater reliability]] is only moderate for segmental or smaller emboli.<ref name="pmid19931759"/>


==Pulmonary embolism==
==Pulmonary embolism==
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;Role in Prognosis
;Role in Prognosis
Two [[systematic review]]s<ref name="pmid15855435">{{cite journal |author=Quiroz R, Kucher N, Zou KH, ''et al'' |title=Clinical validity of a negative computed tomography scan in patients with suspected pulmonary embolism: a systematic review |journal=JAMA : the journal of the American Medical Association |volume=293 |issue=16 |pages=2012–7 |year=2005 |month=April |pmid=15855435 |doi=10.1001/jama.293.16.2012 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=15855435 |issn=}}</ref><ref name="pmid15583229">{{cite journal |author=Moores LK, Jackson WL, Shorr AF, Jackson JL |title=Meta-analysis: outcomes in patients with suspected pulmonary embolism managed with computed tomographic pulmonary angiography |journal=Annals of internal medicine |volume=141 |issue=11 |pages=866–74 |year=2004 |month=December |pmid=15583229 |doi= |url= |issn=}}</ref> and two more recent [[randomized controlled trial]]s<ref name="pmid18424324">{{cite journal |author=Righini M, Le Gal G, Aujesky D, ''et al'' |title=Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial |journal=Lancet |volume=371 |issue=9621 |pages=1343–52 |year=2008 |month=April |pmid=18424324 |doi=10.1016/S0140-6736(08)60594-2 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(08)60594-2 |issn=}}</ref><ref name="pmid18165667">{{cite journal |author=Anderson DR, Kahn SR, Rodger MA, Kovacs MJ, Morris T, Hirsch A, Lang E, Stiell I, Kovacs G, Dreyer J, Dennie C, Cartier Y, Barnes D, Burton E, Pleasance S, Skedgel C, O'Rouke K, Wells PS |title=Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial |journal=JAMA |volume=298 |issue=23 |pages=2743-53 |year=2007 |pmid=18165667 |doi=10.1001/jama.298.23.2743 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=18165667 |issn=}}</ref> have studied ''prognosis'' after a negative CTPA.
Two [[systematic review]]s<ref name="pmid15855435">{{cite journal |author=Quiroz R, Kucher N, Zou KH, ''et al'' |title=Clinical validity of a negative computed tomography scan in patients with suspected pulmonary embolism: a systematic review |journal=JAMA : the journal of the American Medical Association |volume=293 |issue=16 |pages=2012–7 |year=2005 |month=April |pmid=15855435 |doi=10.1001/jama.293.16.2012 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=15855435 |issn=}}</ref><ref name="pmid15583229">{{cite journal |author=Moores LK, Jackson WL, Shorr AF, Jackson JL |title=Meta-analysis: outcomes in patients with suspected pulmonary embolism managed with computed tomographic pulmonary angiography |journal=Annals of internal medicine |volume=141 |issue=11 |pages=866–74 |year=2004 |month=December |pmid=15583229 |doi= |url= |issn=}}</ref> and two more recent [[randomized controlled trial]]s<ref name="pmid18424324">{{cite journal |author=Righini M, Le Gal G, Aujesky D, ''et al'' |title=Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial |journal=Lancet |volume=371 |issue=9621 |pages=1343–52 |year=2008 |month=April |pmid=18424324 |doi=10.1016/S0140-6736(08)60594-2 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(08)60594-2 |issn=}}</ref><ref name="pmid18165667"/> have studied ''prognosis'' after a negative CTPA.


;Overuse
;Overuse
The test may be overused.<ref name="pmid23167851">{{cite journal| author=Crichlow A, Cuker A, Mills AM| title=Overuse of computed tomography pulmonary angiography in the evaluation of patients with suspected pulmonary embolism in the emergency department. | journal=Acad Emerg Med | year= 2012 | volume= 19 | issue= 11 | pages= 1219-26 | pmid=23167851 | doi=10.1111/acem.12012 | pmc=PMC3506180 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23167851  }} </ref>
The test may be overused.<ref name="pmid23167851">{{cite journal| author=Crichlow A, Cuker A, Mills AM| title=Overuse of computed tomography pulmonary angiography in the evaluation of patients with suspected pulmonary embolism in the emergency department. | journal=Acad Emerg Med | year= 2012 | volume= 19 | issue= 11 | pages= 1219-26 | pmid=23167851 | doi=10.1111/acem.12012 | pmc=PMC3506180 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23167851  }} </ref>


==References==
==Footnotes==
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In diagnostic imaging, computed tomographic pulmonary angiography, also called CT pulmonary angiography (CTPA), is a form of x-ray computed tomography for examining the pulmonary vessels.[1]

Introduction of computed tomographic pulmonary angiography may have led to overdiagnosis of pulmonary embolism.[2]

Methods

Standards for reporting of the findings of CTPA have been studied.[3]

The inter-rater reliability (ameasure of the extent to which raters or scorers agree) of interpretations of the CTPA by radiologists has been studied.[4][5][6] While there is excellent inter-rater reliability between radiologists in detecting massive pulmonary emboli, the inter-rater reliability is only moderate for segmental or smaller emboli.[6]

Pulmonary embolism

Role in diagnosis

Assessing the accuracy of CT pulmonary angiography is hindered by the rapid changes in the number of rows of detectors available in multidetector CT (MDCT) machines.[7] The PIOPED II study used a mixture of 4 slice and 16 slice scanners and reported a sensitivity of 83% and a specificity of 96%. This study noted that additional testing is necessary when the clinical probability is inconsistent with the imaging results.[8]

Role in Prognosis

Two systematic reviews[9][10] and two more recent randomized controlled trials[11][1] have studied prognosis after a negative CTPA.

Overuse

The test may be overused.[12]

Footnotes

  1. ↑ 1.0 1.1 Anderson DR, Kahn SR, Rodger MA, et al (December 2007). "Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial". JAMA : the journal of the American Medical Association 298 (23): 2743–53. DOI:10.1001/jama.298.23.2743. PMID 18165667. Research Blogging.
  2. ↑ Wiener RS, Schwartz LM, Woloshin S (2011). "Time trends in pulmonary embolism in the United States: evidence of overdiagnosis.". Arch Intern Med 171 (9): 831-7. DOI:10.1001/archinternmed.2011.178. PMID 21555660. PMC PMC3140219. Research Blogging.
  3. ↑ Abujudeh HH, Kaewlai R, Farsad K, Orr E, Gilman M, Shepard JA (2009). "Computed tomography pulmonary angiography: an assessment of the radiology report.". Acad Radiol 16 (11): 1309-15. DOI:10.1016/j.acra.2009.06.012. PMID 19692272. Research Blogging.
  4. ↑ Brunot S, Corneloup O, Latrabe V, Montaudon M, Laurent F (2005). "Reproducibility of multi-detector spiral computed tomography in detection of sub-segmental acute pulmonary embolism.". Eur Radiol 15 (10): 2057-63. DOI:10.1007/s00330-005-2844-4. PMID 16021452. Research Blogging.
  5. ↑ Lucassen WA, Beenen LF, Büller HR, Erkens PM, Schaefer-Prokop CM, van den Berk IA et al. (2013). "Concerns in using multi-detector computed tomography for diagnosing pulmonary embolism in daily practice. A cross-sectional analysis using expert opinion as reference standard.". Thromb Res 131 (2): 145-9. DOI:10.1016/j.thromres.2012.11.027. PMID 23245652. Research Blogging.
  6. ↑ 6.0 6.1 Costantino G, Norsa AH, Amadori R, Ippolito S, Resta F, Bianco R et al. (2009). "Interobserver agreement in the interpretation of computed tomography in acute pulmonary embolism.". Am J Emerg Med 27 (9): 1109-11. DOI:10.1016/j.ajem.2008.08.019. PMID 19931759. Research Blogging.
  7. ↑ Schaefer-Prokop C, Prokop M (2005). "MDCT for the diagnosis of acute pulmonary embolism". European radiology 15 Suppl 4: D37-41. PMID 16479644. [e]
  8. ↑ Stein PD, Fowler SE, Goodman LR, et al (2006). "Multidetector computed tomography for acute pulmonary embolism". N. Engl. J. Med. 354 (22): 2317-27. DOI:10.1056/NEJMoa052367. PMID 16738268. Research Blogging.
  9. ↑ Quiroz R, Kucher N, Zou KH, et al (April 2005). "Clinical validity of a negative computed tomography scan in patients with suspected pulmonary embolism: a systematic review". JAMA : the journal of the American Medical Association 293 (16): 2012–7. DOI:10.1001/jama.293.16.2012. PMID 15855435. Research Blogging.
  10. ↑ Moores LK, Jackson WL, Shorr AF, Jackson JL (December 2004). "Meta-analysis: outcomes in patients with suspected pulmonary embolism managed with computed tomographic pulmonary angiography". Annals of internal medicine 141 (11): 866–74. PMID 15583229. [e]
  11. ↑ Righini M, Le Gal G, Aujesky D, et al (April 2008). "Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial". Lancet 371 (9621): 1343–52. DOI:10.1016/S0140-6736(08)60594-2. PMID 18424324. Research Blogging.
  12. ↑ Crichlow A, Cuker A, Mills AM (2012). "Overuse of computed tomography pulmonary angiography in the evaluation of patients with suspected pulmonary embolism in the emergency department.". Acad Emerg Med 19 (11): 1219-26. DOI:10.1111/acem.12012. PMID 23167851. PMC PMC3506180. Research Blogging.

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