The diagnostic yield of CTPA: pulmonary embolism, alternative diagnoses and incidental findings

The diagnostic yield of CTPA: pulmonary embolism, alternative diagnoses and incidental findings

Abstract

Aims: In this retrospective study we assess the diagnostic yield of computed tomography pulmonary angiogram (CTPA) and the incidence of alterative and incidental diagnoses.

Methods: The results of all CTPA scans performed in our trust over a period of 18 months were reviewed and all diagnoses noted. Data collected was descriptively analysed.

Results: A total of 1138 scans were performed (56.5% men, mean age 59 years). A diagnosis of pulmonary embolism (PE) was made in 20.2%, an alternative aetiology for presenting symptoms in 26.4% and incidental findings in 19.5%. The commonest alternative diagnosis was pneumonia (9.5%).

Conclusions: Significant numbers of CTPA yield unexpected findings, which may provide an explanation for the clinical presentation. Furthermore substantial numbers of incidental pathologies are also diagnosed which may lead to inappropriate resource utilization and increased patient anxiety.

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References

  1. Akram AR, Cowell GW, Logan LJ, Macdougall M, Reid JH, Murchison JT, Simpson AJ. Clinically suspected acute pulmonary embolism: a comparison of presentation, radiological features and outcome in patients with and without PE. QJM. 2009 Jun;102(6):407-14.
  2. Stein PD, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, Leeper KV Jr, Popovich J Jr, Quinn DA, Sos TA, Sostman HD, Tapson VF, Wakefield TW, Weg JG, Woodard PK; PIOPED II Investigators. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med. 2006 Jun 1;354(22):2317-27.
  3. Quiroz R, Kucher N, Zou KH, Kipfmueller F, Costello P, Goldhaber SZ, Schoepf UJ. Clinical validity of a negative computed tomography scan in patients with suspected pulmonary embolism: a systematic review. JAMA. 2005 Apr 27;293(16):2012-7.
  4. Mos IC, Klok FA, Kroft LJ, DE Roos A, Dekkers OM, Huisman MV. Safety of ruling out acute pulmonary embolism by normal computed tomography pulmonary angiography in patients with an indication for computed tomography: systematic review and metaanalysis. J Thromb Haemost. 2009 Sep;7(9):1491-8.
  5. van Es J, Douma RA, Schreuder SM, Middeldorp S, Kamphuisen PW, Gerdes VE, Beenen LF. Clinical impact of findings supporting an alternative diagnosis on CT pulmonary angiography in patients with suspected pulmonary embolism. Chest. 2013 Dec;144(6):1893-9.
  6. Hall WB, Truitt SG, Scheunemann LP, Shah SA, Rivera MP, Parker LA, Carson SS. The prevalence of clinically relevant incidental findings on chest computed tomographic angiograms ordered to diagnose pulmonary embolism. Arch Intern Med. 2009 Nov 23;169(21):1961-5.
  7. van Strijen MJ, Bloem JL, de Monyé W, Kieft GJ, Pattynama PM, van den Berg-Huijsmans A, Huisman MV; Antelope-Study Group. Helical computed tomography and alternative diagnosis in patients with excluded pulmonary embolism. J Thromb Haemost. 2005 Nov;3(11):2449-56.
  8. Richman PB, Courtney DM, Friese J, Matthews J, Field A, Petri R, Kline JA. Prevalence and significance of nonthromboembolic findings on chest computed tomography angiography performed to rule out pulmonary embolism: a multicenter study of 1,025 emergency department patients. Acad Emerg Med. 2004
    Jun;11(6):642-7.
  9. Douma RA, Mos IC, Erkens PM, Nizet TA, Durian MF, Hovens MM, van Houten AA, Hofstee HM, Klok FA, ten Cate H, Ullmann EF, Büller HR, Kamphuisen PW, Huisman MV; Prometheus Study Group. Performance of 4 clinical decision rules in the diagnostic management of acute pulmonary embolism: a prospective cohort study. Ann Intern Med. 2011 Jun 7;154(11):709- 18.
  10. British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax. 2003 Jun;58(6):470-83.
  11. David S, Beddy P, Babar J, Devaraj A. Evolution of CT pulmonary angiography: referral patterns and diagnostic yield in 2009 compared with 2006. Acta Radiol. 2012 Feb 1;53(1):39-43.
  12. Chandra S, Sarkar PK, Chandra D, Ginsberg NE, Cohen RI. Finding an alternative diagnosis does not justify increased use of CT-pulmonary angiography. BMC Pulm Med. 2013 Feb 7;13:9.
  13. Faruqi S, Thake F, Towers C, Kishore N, Thirumaran M, Johnson O. Management of suspected acute non-massive pulmonary embolism: how good are we at following management guidelines? Am J Respir Crit Care Med 183;2011:A3434. (http://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2011.183.1_
    MeetingAbstracts.A3434
    )
  14. Goodacre S., Nelson-Piercy C., Hunt B., Chan W., When should we use diagnostic imaging to investigate for pulmonary embolism in pregnant and postpartum women?, Emerg Med J 2015 Jan;32(1):78-82.
  15. McQueen AS, Worthy S, Keir MJ. Investigating suspected acute pulmonary embolism - what are hospital clinicians thinking? Clin Radiol. 2008 Jun;63(6):642-50.
  16. Weiss CR, Haponik EF, Diette GB, Merriman B, Scatarige JC, Fishman EK. Pretest risk assessment in suspected acute pulmonary embolism. Acad Radiol. 2008 Jan;15(1):3-14
  17. Gibson NS, Douma RA, Squizzato A, Söhne M, Büller HR, Gerdes VE. Application of a decision rule and a D-dimer assay in the diagnosis of pulmonary embolism. Thromb Haemost. 2010 Apr;103(4):849-54.
  18. Rohacek M, Buatsi J, Szucs-Farkas Z, Kleim B, Zimmermann H, Exadaktylos A, Stoupis C. Ordering CT pulmonary angiography to exclude pulmonary embolism: defense versus evidence in the emergency room. Intensive Care Med. 2012 Aug;38(8):1345-51.
  19. Donnellan E, Kevane B, Bird BR, Ainle FN. Cancer and venous thromboembolic disease: from molecular mechanisms to clinical management. Curr Oncol. 2014 Jun;21(3):134-43.
  20. National Lung Screening Trial Research Team, Church TR, Black WC, Aberle DR, Berg CD, Clingan KL, Duan F, Fagerstrom RM, Gareen IF, Gierada DS, Jones GC, Mahon I, Marcus PM, Sicks JD, Jain A, Baum S. Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med. 2013 May
    23;368(21):1980-91.
  21. MacMahon H, Austin JH, Gamsu G, Herold CJ, Jett JR, Naidich DP, Patz EF Jr, Swensen SJ; Fleischner Society. Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology. 2005 Nov;237(2):395-400.
  22. Bach PB1, Mirkin JN, Oliver TK, Azzoli CG, Berry DA, Brawley OW, Byers T, Colditz GA, Gould MK, Jett JR, Sabichi AL, Smith-Bindman R, Wood DE, Qaseem A, Detterbeck FC. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA. 2012 Jun 13;307(22):2418-29.
  23. Jacobs PC, Mali WP, Grobbee DE, van der Graaf Y. Prevalence of incidental findings in computed tomographic screening of the chest: a systematic review. J Comput Assist Tomogr. 2008 MarApr;32(2):214-21.
  24. Badiani S, Tomas-Hernandez S, Karandikar S, Roy-Choudhury S. Extracolonic findings (ECF) on CT colonography (CTC) in patients presenting with colorectal symptoms. Acta Radiol. 2013 Oct;54(8):851-62.
  25. van den Bergh KA1, Essink-Bot ML, Borsboom GJ, Th Scholten E, Prokop M, de Koning HJ, van Klaveren RJ. Short-term healthrelated quality of life consequences in a lung cancer CT screening trial (NELSON). Br J Cancer. 2010 Jan 5;102(1):27-34.
  26. Einstein AJ, Sanz J, Dellegrottaglie S, Milite M, Sirol M, Henzlova M, Rajagopalan S. Radiation dose and cancer risk estimates in 16-slice computed tomography coronary angiography. J Nucl Cardiol. 2008 Mar-Apr;15(2):232-40.

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The diagnostic yield of CTPA: pulmonary embolism, alternative diagnoses and incidental findings

21st October 2016
PMID: 27759747
Authors Affiliations
Shoaib Faruqi MD, Department of Respiratory Medicine, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefiled, WF1 4DG
Nalla Kishore MRCP, Department of Respiratory Medicine, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefiled, WF1 4DG.
Richard Bodington MBBS, University of Hull and the Hull York Medical School, Department of Respiratory Medicine, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ.
Salim Meghjee MRCP, Department of Respiratory Medicine, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefiled, WF1 4DG.
Muthu Thirumaran MRCP, Department of Respiratory Medicine, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefiled, WF1 4DG.

The diagnostic yield of CTPA: pulmonary embolism, alternative diagnoses and incidental findings

Cite this article as:

Faruqi S, Kishore N, Bodington R, Meghjee S, Thirumaran M. The diagnostic yield of CTPA: pulmonary embolism, alternative diagnoses and incidental findings. Acute Med. 2016;15(3):130-133. PMID: 27759747.

The diagnostic yield of CTPA: pulmonary embolism, alternative diagnoses and incidental findings

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