Clinical studyThe effect of helical computed tomography on diagnostic and treatment strategies in patients with suspected pulmonary embolism☆
Section snippets
Study design and sample
We performed a retrospective investigation of patients referred for radiographic evaluation of pulmonary embolism over a 4-year period (1997 to 2000) at Moffitt-Long Hospital, a 535-bed academic medical center affiliated with the University of California, San Francisco. In 1997, the Department of Radiology at the hospital began to offer helical CT scanning for the diagnosis of pulmonary embolism. Throughout the study period, CT scans were available 24 hours a day; all scans were read by a core
Results
A total of 410 charts were identified and reviewed to reach our goal of 360 charts. Of the 50 charts excluded, 25 (6%) were baseline or follow-up examinations without clinical suspicion for acute pulmonary embolism, 23 (6%) were incomplete, and 2 (<1%) pertained to tests that were not the initial investigation for pulmonary embolism. There were no statistical differences in the number of charts excluded or reasons for exclusion across study periods. Results of blinded rereading of initial CT
Discussion
In our study, introduction of the helical CT scan had a profound effect on diagnostic strategies and test utilization in patients with suspected pulmonary embolism. The helical CT scan almost completely replaced the ventilation-perfusion scan as the first-line test and led to a substantial increase in the total number of evaluations for pulmonary embolism. This shift occurred without any change in the likelihood of pulmonary embolism among patients referred for testing and may have resulted in
Acknowledgements
The authors gratefully acknowledge Erin Hartman for editorial assistance in the preparation of this manuscript, and Alan Bostrom, PhD, for his statistical expertise.
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2022, Clinical ImagingCitation Excerpt :Although prophylactic anti-coagulation therapy should be offered to asymptomatic patients as well, this is often not performed in clinical routine. Chest computed tomography (CT) with pulmonary angiography protocol is the gold standard for evaluation of PE worldwide,11,16–19 and standard chest CT's are also frequently obtained in patients with MM both for primary staging and follow-up.20 Although the technique used for routine chest CT in oncologic staging and follow-up is different from dedicated CT pulmonary angiography, unexpected PE is often detected on routine chest CT staging and follow-up examinations.11,21–23
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2020, Seminars in Nuclear MedicineCitation Excerpt :The late 1990s saw a rapid adoption of CTPA for the investigation of PE, largely at the expense of V/Q scintigraphy. Data from USCF (Fig. 5) show that the increased use of CTPA in the period 1997-2000 resulted in a slow decline in the number of V/Q scans performed, the virtual obsolescence of pulmonary angiography as an imaging study, and an overall marked increase in the number of patients being imaged for suspected, or known, PE.34 The emergence of CTPA as the primary imaging test for the investigation of PE in many centres has no doubt being multifactorial, but key contributors have been the more ready availability of CT (including outside of routine operating hours), rapid acquisition times, the ability to detect other pathologies which may be accounting for patient symptoms, a “binary” reporting culture (either positive or negative), and the frustration with the probabilistic reporting promulgated by PIOPED.26
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2009, Journal of the American College of RadiologyCitation Excerpt :The importance of accurate diagnosis is highlighted by the fact that PE can have a mortality rate as high as 30% without treatment, whereas proper diagnosis and subsequent treatment with anticoagulants decreases the mortality rate to between 2% and 8% [3-8]. Although the gold-standard test for diagnosing acute PE has been invasive pulmonary angiography, computed tomographic (CT) pulmonary angiography using intravenous contrast has increasingly replaced this test [9-11]. Benefits cited by many studies for the use of CT pulmonary angiography over other diagnostic modalities include its ability to examine the entire pulmonary system for abnormalities that may be causing a patient's symptoms [12-14], as well as its safety, speed, and high sensitivity and specificity.
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Dr. Trowbridge's work was supported in part by a grant from the Josiah Macy Jr Foundation.