scholarly journals Gallium-68 Ventilation/Perfusion PET-CT and CT Pulmonary Angiography for Pulmonary Embolism Diagnosis: An Interobserver Agreement Study

2021 ◽  
Vol 7 ◽  
Author(s):  
Romain Le Pennec ◽  
Amir Iravani ◽  
Beverley Woon ◽  
Brieg Dissaux ◽  
Bibiche Gest ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Interobserver Agreement ◽  
Clinical Information ◽  
Filling Defect ◽  
Pulmonary Angiography ◽  
Ct Scans ◽  
Imaging Tool ◽  
Pet Ct ◽  
Pulmonary Embolism Diagnosis ◽  
Acute Pe

Objectives:68Ga Ventilation/Perfusion V/Q PET-CT is a promising imaging tool for pulmonary embolism diagnosis. However, no study has verified whether the interpretation is reproducible between different observers. The aim of this study was to assess the interobserver agreement in the interpretation of V/Q PET-CT for the diagnosis of acute PE, and to compare it to the interobserver agreement of CTPA interpretation.Methods: Twenty-four cancer patients with suspected acute PE underwent V/Q PET-CT and CTPA within 24 h as part of a prospective pilot study evaluating V/Q PET-CT for the management of patients with suspected PE. V/Q PET-CT and CTPA scans were reassessed independently by four nuclear medicine physicians and four radiologists, respectively. Physicians had different levels of expertise in reading V/Q scintigraphy and CTPA. Interpretation was blinded to the initial interpretation and any clinical information or imaging test result. For each modality, results were reported on a binary fashion. V/Q PET/CT scans were read as positive if there was at least one segmental or two subsegmental mismatched perfusion defects. CTPA scans were interpreted as positive if there was a constant intraluminal filling defect. Interobserver agreement was assessed by calculating kappa (κ) coefficients.Results: Out of the 24 V/Q PET-CT scans, the diagnostic conclusion was concordantly negative in 22 patients and concordantly positive in one patient. The remaining scan was interpreted as positive by one reader and negative by three readers. Out of the 24 CTPA scans, the diagnostic conclusion was concordantly negative in 16 and concordantly positive in one. Out of the seven remaining scans, PE was reported by one reader in four cases, by two readers in two cases, by three readers in one case. Most of discordant results on CTPA were related to clots reported on subsegmental arteries. Mean kappa coefficient was 0.79 for V/Q PET-CT interpretation and 0.39 for CTPA interpretation.Conclusions: Interobserver agreement in the interpretation of V/Q PET-CT for PE diagnosis was substantial (kappa 0.79) in a population with a low prevalence of significant PE. Agreement was lower with CTPA, mainly as a result of discrepancies at the level of the subsegmental arteries.

Incidence and Management of Isolated Subsegmental Pulmonary Embolism.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2989-2989
Author(s):  
Yi-Hao Shen ◽  
Phil Wells ◽  
Carole Dennie ◽  
Marc Carrier
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Clinical Management ◽  
High Probability ◽  
Conflicts Of Interest ◽  
Anticoagulation Therapy ◽  
Pulmonary Arteries ◽  
Filling Defect ◽  
Pulmonary Angiography ◽  
Acute Pe

Abstract Abstract 2989 Poster Board II-965 Introduction: The use of computed tomographic pulmonary angiography (CTPA) in patients with suspected pulmonary embolism (PE) has improved the visualization of subsegmental pulmonary arteries. However, the clinical significance of subsegmental PE is unclear. In the PIOPED Study, PE limited to subsegmental pulmonary arteries was most prevalent among patients with low-probability ventilation/perfusion (V/Q) scans. Patients with non-diagnostic (low or intermediate) V/Q scans can be safely managed without anticoagulation. The incidence and clinical management of subsegmental PE remains uncertain. Objective: To evaluate the incidence and clinical management of subsegmental PE in patients with suspected acute PE. Methods: This is a retrospective cohort study of consecutive patients with suspected acute PE undergoing CTPA at the Ottawa Hospital from Jan 1, 2007 to Dec 31, 2008. Subsegmental PE was defined as one or more pulmonary artery filling defects located in the subsegmental level, with no filling defects visualized at more proximal pulmonary artery levels. All patients were followed for a minimum of 6 months after the index PE. Results: A total of 78 (10.4%, 95% CI: 8.4 to 12.8%) cases of subsegmental PE were identified out of 748 cases of PE diagnosed by CTPA. Forty-three (77%) of these had a single isolated subsegmental filling defect. Data could be extracted in 56 (72%) of the 78 cases. Among these 56 patients, 18 (32%) had unprovoked PE. Further investigations were performed in 50 patients (Ultrasonography (U/S) of legs (n=38), U/S and V/Q scan (n=11) or V/Q scan alone (n=1)). Deep vein thrombosis was detected in 12 patients and two patients had a high probability V/Q scan. Forty-eight (86%) patients were anticoagulated. All patients with concurrent DVT or high probability V/Q scan were started on anticoagulation therapy. Two patients experienced a major bleeding episode after anticoagulation. Out of the 8 patients left untreated, there were no recurrent VTE. Conclusion: Isolated subsegmental PE represents approximately 10% of all acute PE diagnosed by CTPA. Patients with subsegmental PE diagnosed on CTPA are more commonly receiving anticoagulation than not. Further studies are needed to establish the risk benefit ratio of anticoagulation therapy in patients with subsegmental PE diagnosed on CTPA. Disclosures: No relevant conflicts of interest to declare.

Incidence and Clinical Outcomes of Occult Malignancies Detected by Computed Tomographic Pulmonary Angiography in Patients with Acute Pulmonary Embolism.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2983-2983
Author(s):  
Yi-Hao Shen ◽  
Phil Wells ◽  
Carole Dennie ◽  
Marc Carrier
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Outcomes ◽  
Conflicts Of Interest ◽  
Filling Defect ◽  
Pulmonary Angiography ◽  
Advanced Stage ◽  
Ottawa Hospital ◽  
Computed Tomographic ◽  
Occult Malignancy ◽  
Acute Pe

Abstract Abstract 2983 Poster Board II-959 Introduction: Venous thromboembolism (VTE) can be the earliest sign of malignancy. Approximately 10% of patients with unprovoked VTE will be diagnosed with cancer within the next 12 months. Diagnosis of pulmonary embolism (PE) using computed tomographic pulmonary angiograhy (CTPA) allows the visualization of anatomy in addition to thoracic vasculature. Hence, CTPA might be useful for detecting occult cancers in patients with PE. Objective: To evaluate the incidence and clinical outcomes of occult cancers detected by CTPA in patients with acute PE. Methods: This is a retrospective cohort study of consecutive patients with suspected PE undergoing CTPA at the Ottawa Hospital from Jan 1, 2007 to Dec 31, 2008. PE was defined as a subsegmental or larger pulmonary artery filling defect on CTPA. Occult malignancy was defined as any new cancer first detected by CTPA with index PE diagnosis in patients with no known history of malignancy. All patients were followed for a minimum of 6 months after the index PE. Results: A total of 4410 CTPA were reviewed and 748 (17%) were positive for acute PE. Of these, 57 (7.6%; 95% CI: 5.7 to 9.5) revealed abnormalities suggestive of possible occult cancers. Twenty-two (2.9%; 95% CI: 1.7 to 4.2) patients were diagnosed with occult cancers. Among these 22 patients with occult cancers, 20 (91%) had unprovoked PE. Thirteen (59%) patients had occult lung cancer and 16 (73%) had advanced stage (stage 3 or 4) cancers. Sixteen (73%) patients have died following the diagnosis of occult cancer, and their median survival following the diagnosis of PE was 51 days. Conclusion: CTPA detected occult cancers in approximately 3% of patients with acute PE. Most of these cancers were detected at an advanced stage and were associated with high mortality and short survival. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Capability of CT pulmonary angiography in pulmonary embolism diagnosis

2012 ◽  
Vol 11 (6) ◽  
pp. 149-152
Author(s):  
A. N. Soloshenko ◽  
O. Yu. Kilina ◽  
S. N. Ivanova ◽  
N. V. Khanarin ◽  
A. L. Kiselyova ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
Ct Pulmonary Angiography ◽  
Pulmonary Embolism Diagnosis

scholarly journals In-hospital and short-term predictors of mortality in patients with intermediate-high risk pulmonary embolism

2020 ◽  
Vol 12 (4) ◽  
pp. 321-327
Author(s):  
Gulay Gök ◽  
Mehmet Karadağ ◽  
Tufan Çinar ◽  
Zekeriya Nurkalem ◽  
Dursun Duman
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Pulmonary Embolism ◽  
High Risk ◽  
Hospital Mortality ◽  
Medical Records ◽  
Pulmonary Angiography ◽  
Albumin Level ◽  
Short Term ◽  
Acute Pe

Introduction: The aim of this study was to evaluate the in-hospital and short-term predictive factors of mortality in intermediate-high risk acute pulmonary embolism (PE) patients with right ventricle (RV)dysfunction and myocardial injury. Methods: In this retrospective study, the medical records of 187 patients with a diagnosis of intermediate high risk acute PE were evaluated. A contrast-enhanced multi-detector pulmonary angiography was used to confirm diagnosis in all cases. All-cause mortality was determined by obtaining both in hospital and 30 days follow-up data of patients from medical records. Results: During the in-hospital stay (9.5±4.72 days), 7 patients died, resulting in an acute PE related in-hospital mortality of 3.2%. Admission heart rate (HR), (Odds ratio (OR), 1.028 95% Confidence interval (CI), 0.002-1.121; P = 0.048) and blood urea nitrogen (BUN) (OR, 1.028 95% CI, 0.002-1.016; P = 0.044) were found to be independent predictors for in-hospital mortality in a multi variate logistic regression analysis. In total, 32 patients (20.9%) died during 30 days follow-up.The presence of congestive heart failure (OR, 0.015, 95%CI, 0.001-0.211; P = 0.002) and dementia (OR, 0.029, 95%CI,0.002-0.516; P = 0.016) as well as low albumin level (OR, 0.049 95%CI, 0.006-0.383; P = 0.049) were associated with 30 days mortality. Conclusion: HR and BUN were independent predictors of in-hospital mortality and the presence of congestive heart failure, dementia, and low albumin levels were associated with higher 30 days mortality.

scholarly journals Right-to-left Ventricular Diameter Ratio At Computed Tomographic Pulmonary Angiography in Patients with Acute Pulmonary Embolism and Obstructive Sleep Apnea

2020 ◽  
Vol 14 ◽  
pp. 117954842097643
Author(s):  
Thomas M Berghaus ◽  
Fabian Geissenberger ◽  
Dinah Konnerth ◽  
Michael Probst ◽  
Thomas Kröncke ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Obstructive Sleep Apnea ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
Left Ventricular ◽  
Diameter Ratio ◽  
Computed Tomographic ◽  
Obstructive Sleep ◽  
Computed Tomographic Pulmonary Angiography ◽  
Acute Pe

Purpose: Right ventricular (RV) dysfunction in acute pulmonary embolism (PE) is a critical determinant of outcome. Obstructive sleep apnea (OSA) is a common comorbidity of PE and might also affect RV function. Therefore, we sought to investigate RV dysfunction in PE patients in proportion to the severity of OSA by evaluating the right-to-left ventricular (RV/LV) diameter ratio on computed tomographic pulmonary angiography (CTPA). Materials and Methods: 197 PE patients were evaluated for sleep-disordered breathing by portable monitoring and nocturnal polysomnography. RV dilatation was defined as an RV/LV diameter ratio of ⩾ 1.0. Results: RV dilatation was significantly more frequent in OSA patients compared to study participants without OSA (66.4% vs 49.1%, P = .036). Elevated troponin I values, indicating myocardial injury due to acute, PE-related RV strain, were significantly more frequent in OSA patients with an apnea-hypopnea index (AHI) ⩾ 15/h compared to those with an AHI < 15/h (62.1% vs 45.8%, P = .035). However, RV dysfunction documented by the RV/LV diameter ratio on CTPA was not significantly associated with the severity of OSA in multivariable regression analysis. Conclusion: Patients with moderate or severe OSA might compensate acute, PE-related RV strain better, as they are adapted to repetitive right heart pressure overloads during sleep.

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