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Unsuspected Pulmonary Embolism: Prospective Detection On Routine Helical CT Scans.

M. Gosselin, G. Rubin, A. Leung, J. Huang, N. Rizk
Published 1998 · Medicine

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PURPOSE To determine the prevalence of unsuspected pulmonary embolism (PE) on routine thoracic helical computed tomographic (CT) scans and to quantify the improvement in PE detection by using a cine-paging mode on a workstation instead of hard-copy review. MATERIALS AND METHODS Seven hundred eighty-five patients referred for routine contrast medium-enhanced thoracic CT within 9 months were prospectively recruited. Helical CT was performed. Studies were prospectively interpreted by four radiologists. Two radiologists performed routine, undirected, hard-copy consensus review for official interpretation; two of three thoracic radiologists independently performed a dedicated workstation-based search for PE. The presence of PE involving the main, lobar, or segmental pulmonary arteries was assigned a score of 1-5 (1 = definitely negative, 5 = definitely positive) by each independent reviewer. Patients with a score of 4 or 5 underwent lower-extremity ultrasound, ventilation-perfusion scintigraphy, or both, followed by pulmonary CT angiography if the findings were still equivocal. RESULTS Twelve (1.5%) of the 785 patients had unsuspected PE, with an inpatient prevalence of 5% (eight of 160) and an outpatient prevalence of 0.6% (four of 625). Of the 12 patients with unsuspected PE, 10 (83%) had cancer. Of the 81 inpatients with cancer, seven (9%) had unsuspected PE. A dedicated workstation-based search resulted in detection of PE in three more patients (25%) than did hard-copy interpretation. CONCLUSION The prevalence of unsuspected PE was highest among inpatients with cancer. A directed, workstation-based search can improve the PE detection rate over that with hard-copy review.

This paper is referenced by
Role of Multislice Computed Tomography of the Thorax for the Evaluation of Suspected Pulmonary Embolism
B. Elicker (2007)
Radiologic diagnoses of patients who received imaging for venous thromboembolism despite negative D-dimer tests.
K. Nordenholz (2007)
Venous thromboembolism prophylaxis and treatment in cancer: a consensus statement of major guidelines panels and call to action.
A. Khorana (2009)
Thrombosis and cancer: A pictorial guide through a multiface occurrence
O. Catalano (2010)
Diagnosis of pulmonary embolism: Advances and pitfalls.
P. D. den Exter (2012)
Subsegmental pulmonary embolism: is the emperor still naked?
M. Zompatori (2013)
Suspected and incidental pulmonary embolism on multidetector-row CT: analysis of technical and morphological factors influencing the diagnosis in a cross-sectional cancer centre patient cohort.
C. Engelke (2006)
Pulmonary vascular diseases and pulmonary edema
D. Hansell (2010)
Incidence of pulmonary embolism in oncologic outpatients at a tertiary cancer center
A. Shinagare (2011)
Multidetector CT pulmonary angiography features of pulmonary embolus
J. Hoang (2008)
Diagnosis of pulmonary embolism with use of computed tomographic angiography.
J. Ryu (2001)
Clinical Probability and D-Dimer Testing
P. Wells (2007)
Best Clinical Practice: Current Controversies in Pulmonary Embolism Imaging and Treatment of Subsegmental Thromboembolic Disease.
Brit Long (2017)
Advances in the Diagnosis of Venous Thromboembolism
P. Wells (2006)
Practical Fluoroscopy of the GI and GU Tracts: Esophagus
M. Levine (2012)
Imaging of acute pulmonary embolism
Maria Komissarova (2012)
Pitfalls in the diagnosis of acute pulmonary embolism on spiral computer tomography.
G. Aviram (2004)
Capítulo doce – Enfermedades embólicas y trombóticas de los pulmones
R. Fraser (2006)
64-Multidetector-row spiral CT in pulmonary embolism with emphasis on incidental findings.
C. Sohns (2008)
Diagnosis, management and prognosis of symptomatic and incidental pulmonary embolism
den Exter (2016)
Spiral computed tomography for pulmonary embolism.
S. Howling (2000)
Dots are not clots: the over-diagnosis and over-treatment of PE
Jane M. Suh (2010)
Late onset of pulmonary embolism caused by lymphocyst following pelvic lymphadenectomy
Y. Tsuji (2007)
Non-traumatic thoracic emergencies: CT diagnosis of acute pulmonary embolism: the first 10 years
B. Ghaye (2002)
Unsuspected pulmonary emboli in lung cancer patients: the impact on survival and the significance of anticoagulation therapy.
Jong-Mu Sun (2010)
CT for Thromboembolic Disease: It's Here Now
J. Fishman (2001)
Incidence of asymptomatic pulmonary embolism in moderately to severely injured trauma patients.
D. J. Schultz (2004)
Prevalence and clinical history of incidental, asymptomatic pulmonary embolism: a meta-analysis.
F. Dentali (2010)
Computer-aided detection of pulmonary embolism at CT pulmonary angiography: can it improve performance of inexperienced readers?
Kevin N. Blackmon (2010)
MDCT of the abdomen: common misdiagnoses at a busy academic center.
K. Horton (2010)
Venous filling defects on portal venous phase CT of the abdomen and pelvis: clinical implications and positive predictive value for diagnosing deep venous thrombosis
Jeffrey J. Horvath (2014)
MSCT-Darstellung der Lungenembolie
A. Kuettner (2008)
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