CT pulmonary angiography: an over-utilized imaging modality in hospitalized patients with suspected pulmonary embolism

Aims. To study the use of CT pulmonary angiography (CTPA) at Hutt Hospital and investigate the use of pretest probability scoring in the assessment of patients with suspected pulmonary embolism (PE).Methods. We studied patients with suspected PE that underwent CTPA between January and May 2012 and collected data on demographics, use of pretest probability scoring, and use of D Dimer and compared our practice with the British Thoracic Society (BTS) guideline.Results. 105 patients underwent CTPA and 15% of patients had PE. 13% of patients had a Wells score prior to their scan. Wells score calculated by researchers revealed 54%, 36%, and 8% patients had low, medium, and high risk pretest probabilities and 8%, 20%, and 50% of these patients had positive scans. D Dimer was performed in 58% of patients and no patients with a negative D Dimer had a PE.Conclusion. The CTPA positive rate was similar to other contemporary studies but lower than previous New Zealand studies and some international guidelines. Risk stratification of suspected PE using Wells score and D Dimer was underutilised. A number of scans could have been safely avoided by using accepted guidelines reducing resources use and improving patient safety.

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Combined CT Pulmonary Angiography & Indirect CT Venography in Evaluation of Clinically Suspected Cases of Pulmonary Embolism- Our Experience in an Oncologic Setup

Nepalese Journal of Radiology ◽

10.3126/njr.v3i1.8795 ◽

2013 ◽

Vol 3 (1) ◽

pp. 40-52

Author(s):

Anuj Thankral ◽

D Thakral ◽

E Mohamed ◽

EP Singh ◽

H Lal

Keyword(s):

Pulmonary Embolism ◽

Clinical Symptoms ◽

Imaging Modality ◽

Pulmonary Angiography ◽

Ct Pulmonary Angiography ◽

Ct Venography ◽

Vein Thrombosis ◽

Presenting Symptoms ◽

Pulmonary Scintigraphy ◽

Time Required

The study was aimed at evaluating role of CT Pulmonary Angiography (CTPA) and Indirect CT venography (ICTV) in clinically suspected pulmonary embolism (PE) in oncology setup.17/31 (54.9%) patients were diagnosed with PE with or without deep vein thrombosis. DVT was diagnosed in 12(38.7%). 1 patient had DVT in absence of PE while 13/31 (41.9%) patients were diagnosed not to have PE or DVT. Clinical symptoms or pre-test probability determined by Well’s criteria and other laboratory investigations were not found predictive of PE. CTPA diagnosed PE with greater ease, shorter time required with no dependence on clinical pretest probability unlike pulmonary scintigraphy. In cases with CTPA negative for PE, CT described additional findings possibly explaining patient’s presenting symptoms unlike negative pulmonary scintigraphy. In cases where PE was excluded, CTV identified DVT (if present) in the same sitting, obviating separate venous Doppler. A single investigation with ability to deal with complete spectrum of DVT and PE makes CTPA & ICTV ‘one stop shop’ imaging modality for PE and DVT. Nepalese Journal of Radiology / Vol.3 / No.1 / Issue 4 / Jan-June, 2013 / 40-52 DOI: http://dx.doi.org/10.3126/njr.v3i1.8795

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