Seminars in Nuclear Medicine
Volume 38, Issue 6 , Pages 418-431 , November 2008

The Role of Multidetector Computed Tomography Angiography for the Diagnosis of Pulmonary Embolism

  • Paul Cronin, MD, MS

      Affiliations

    • Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan Medical Center, Ann Arbor, MI
    • Corresponding Author InformationAddress reprint requests to Paul Cronin, MD, MS, Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan Hospitals, B1 132G Taubman Center/0302, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5030
    • ,
  • John G. Weg, MD

      Affiliations

    • Department Internal Medicine, Division Pulmonary & Critical Care Medicine, University of Michigan Medical Center, Ann Arbor, MI
    • ,
  • Ella A. Kazerooni, MD, MS

      Affiliations

    • Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan Medical Center, Ann Arbor, MI

References 

  1. Dalen JE, Alpert JS. Natural history of pulmonary embolism. Prog Cardiovasc Dis. 1975;17:257–270
  2. The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism (Results of the prospective investigation of PE diagnosis (PIOPED)). JAMA. 1990;263:2753–2759
  3. Stein PD, Fowler SE, Goodman LR, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med. 2006;354:2317–2327
  4. Silverstein MD, Heit JA, Mohr DN, et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: A 25-year population-based study. Arch Intern Med. 1998;158:585–593
  5. Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979-1998: An analysis using multiple-cause mortality data. Arch Intern Med. 2003;163:1711–1717
  6. Price DG. Pulmonary embolism (Prophylaxis diagnosis and treatment). Anaesthesia. 1976;31:925–932
  7. Wagner HN, Strauss HW. Radioactive tracers in the differential diagnosis of pulmonary embolism. Prog Cardiovasc Dis. 1975;17:271–282
  8. Webber MM, Gomes AS, Roe D, et al. Comparison of Biello, McNeil, and PIOPED criteria for the diagnosis of pulmonary emboli on lung scans. AJR Am J Roentgenol. 1990;154:975–981
  9. Worsley DF, Alavi A. Comprehensive analysis of the results of the PIOPED Study (Prospective Investigation of Pulmonary Embolism Diagnosis Study). J Nucl Med. 1995;36:2380–2387
  10. Remy-Jardin M, Remy J, Deschildre F, et al. Diagnosis of pulmonary embolism with spiral CT: Comparison with pulmonary angiography and scintigraphy. Radiology. 1996;200:699–706
  11. Williams JR, Wilcox C, Andrews GJ, et al. Angiography in pulmonary embolism. JAMA. 1963;184:473–476
  12. Dalen JE, Brooks HL, Johnson LW, et al. Pulmonary angiography in acute pulmonary embolism: Indications, techniques, and results in 367 patients. Am Heart J. 1971;81:175–185
  13. Hudson ER, Smith TP, McDermott VG, et al. Pulmonary angiography performed with iopamidol: Complications in 1,434 patients. Radiology. 1996;198:61–65
  14. van Beek EJ, Reekers JA, Batchelor DA, et al. Feasibility, safety and clinical utility of angiography in patients with suspected pulmonary embolism. Eur Radiol. 1996;6:415–419
  15. Schluger N, Henschke C, King T, et al. Diagnosis of pulmonary embolism at a large teaching hospital. J Thorac Imaging. 1994;9:180–184
  16. Sostman HD, Ravin CE, Sullivan DC, et al. Use of pulmonary angiography for suspected pulmonary embolism: Influence of scintigraphic diagnosis. AJR Am J Roentgenol. 1982;139:673–677
  17. Sinner WN. Computed tomography of pulmonary thromboembolism. Eur J Radiol. 1982;2:8–13
  18. Shah HR, Buckner CB, Purnell GL, et al. Computed tomography and magnetic resonance imaging in the diagnosis of pulmonary thromboembolic disease. J Thorac Imaging. 1989;4:58–61
  19. Kalebo P, Wallin J. Computed tomography in massive pulmonary embolism. Acta Radiol. 1989;30:105–107
  20. Chintapalli K, Thorsen MK, Olson DL, et al. Computed tomography of pulmonary thromboembolism and infarction. J Comput Assist Tomogr. 1988;12:553–559
  21. Allen BT, Day DL, Dehner LP. CT demonstration of asymptomatic pulmonary emboli after bone marrow transplantation: Case report. Pediatr Radiol. 1987;17:65–67
  22. Breatnach E, Stanley RJ. CT diagnosis of segmental pulmonary artery embolus. J Comput Assist Tomogr. 1984;8:762–764
  23. Verschakelen JA, Vanwijck E, Bogaert J, et al. Detection of unsuspected central pulmonary embolism with conventional contrast-enhanced CT. Radiology. 1993;188:847–850
  24. Remy-Jardin M, Remy J, Wattinne L, et al. Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the single-breath-hold technique—comparison with pulmonary angiography. Radiology. 1992;185:381–387
  25. Kelly AM, Patel S, Carlos RC, et al. Multidetector row CT pulmonary angiography and indirect venography for the diagnosis of venous thromboembolic disease in intensive care unit patients. Acad Radiol. 2006;13:486–495
  26. Ferretti GR, Bosson JL, Buffaz PD, et al. Acute pulmonary embolism: role of helical CT in 164 patients with intermediate probability at ventilation-perfusion scintigraphy and normal results at duplex US of the legs. Radiology. 1997;205:453–458
  27. Garg K, Welsh CH, Feyerabend AJ, et al. Pulmonary embolism: diagnosis with spiral CT and ventilation-perfusion scanning—correlation with pulmonary angiographic results or clinical outcome. [see comments] Radiology. 1998;208:201–208
  28. Kim KI, Muller NL, Mayo JR. Clinically suspected pulmonary embolism: Utility of spiral CT. Radiology. 1999;210:693–697
  29. Remy-Jardin M, Remy J, Baghaie F, et al. Clinical value of thin collimation in the diagnostic workup of pulmonary embolism. AJR Am J Roentgenol. 2000;175:407–411
  30. Garg K, Sieler H, Welsh CH, et al. Clinical validity of helical CT being interpreted as negative for pulmonary embolism: implications for patient treatment. [see comments] AJR Am J Roentgenol. 1999;172:1627–1631
  31. Patel S, Kazerooni EA, Cascade PN. Pulmonary embolism: Optimization of small pulmonary artery visualization at multi-detector row CT. Radiology. 2003;227:455–460
  32. Shah AA, Davis SD, Gamsu G, et al. Parenchymal and pleural findings in patients with and patients without acute pulmonary embolism detected at spiral CT. Radiology. 1999;211:147–153
  33. Blachere H, Latrabe V, Montaudon M, et al. Pulmonary embolism revealed on helical CT angiography: Comparison with ventilation-perfusion radionuclide lung scanning. AJR Am J Roentgenol. 2000;174:1041–1047
  34. Goodman LR, Curtin JJ, Mewissen MW, et al. Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: Helical CT versus angiography. AJR Am J Roentgenol. 1995;164:1369–1374
  35. Perrier A, Howarth N, Didier D, et al. Performance of helical computed tomography in unselected outpatients with suspected pulmonary embolism. Ann Intern Med. 2001;135:88–97
  36. Blum AG, Delfau F, Grignon B, et al. Spiral-computed tomography versus pulmonary angiography in the diagnosis of acute massive pulmonary embolism. Am J Cardiol. 1994;74:96–98
  37. Drucker EA, Rivitz SM, Shepard JA, et al. Acute pulmonary embolism: assessment of helical CT for diagnosis. [see comments] Radiology. 1998;209:235–241
  38. van Rossum AB, Pattynama PM, Ton ER, et al. Pulmonary embolism: Validation of spiral CT angiography in 149 patients. Radiology. 1996;201:467–470
  39. Mayo JR, Remy-Jardin M, Muller NL, et al. Pulmonary embolism: Prospective comparison of spiral CT with ventilation-perfusion scintigraphy. Radiology. 1997;205:447–452
  40. Pruszczyk P, Torbicki A, Pacho R, et al. Noninvasive diagnosis of suspected severe pulmonary embolism: transesophageal echocardiography vs spiral CT. [see comments] Chest. 1997;112:722–728
  41. Qanadli SD, Hajjam ME, Mesurolle B, et al. Pulmonary embolism detection: Prospective evaluation of dual-section helical CT versus selective pulmonary arteriography in 157 patients. Radiology. 2000;217:447–455
  42. Dresel S, Stabler A, Scheidler J, et al. Diagnostic approach in acute pulmonary embolism: Perfusion scintigraphy versus spiral computed tomography. Nucl Med Commun. 1995;16:1009–1015
  43. Coche E, Verschuren F, Keyeux A, et al. Diagnosis of acute pulmonary embolism in outpatients: comparison of thin-collimation multi-detector row spiral CT and planar ventilation-perfusion scintigraphy. Radiology. 2003;229:757–765
  44. Remy-Jardin M, Baghaie F, Bonnel F, et al. Thoracic helical CT: influence of subsecond scan time and thin collimation on evaluation of peripheral pulmonary arteries. Eur Radiol. 2000;10:1297–1303
  45. van Strijen MJ, de Monye W, Kieft GJ, et al. Diagnosis of pulmonary embolism with spiral CT as a second procedure following scintigraphy. Eur Radiol. 2003;13:1501–1507
  46. Teigen CL, Maus TP, Sheedy PF, et al. Pulmonary embolism: Diagnosis with contrast-enhanced electron-beam CT and comparison with pulmonary angiography. Radiology. 1995;194:313–319
  47. Safriel Y, Zinn H. CT pulmonary angiography in the detection of pulmonary emboli: A meta-analysis of sensitivities and specificities. Clin Imaging. 2002;26:101–105
  48. Eng J, Krishnan JA, Segal JB, et al. Accuracy of CT in the diagnosis of pulmonary embolism: A systematic literature review. AJR Am J Roentgenol. 2004;183:1819–1827
  49. Winer-Muram HT, Rydberg J, Johnson MS, et al. Suspected acute pulmonary embolism: Evaluation with multi-detector row CT versus digital subtraction pulmonary arteriography. Radiology. 2004;233:806–815
  50. Anderson DR, Kahn SR, Rodger MA. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: A randomized controlled trial. JAMA. 2007;298:2743–2753
  51. Grenier PA, Beigelman C. Spiral computed tomographic scanning and magnetic resonance angiography for the diagnosis of pulmonary embolism. Thorax. 1998;53:S25–S31
  52. Patel S, Kazerooni EA. Helical CT for the evaluation of acute pulmonary embolism. AJR Am J Roentgenol. 2005;185:135–149
  53. Sostman HD, Stein PD, Gottschalk A, et al. Acute pulmonary embolism: Sensitivity and specificity of ventilation-perfusion scintigraphy in PIOPED II Study. Radiology. 2008;246:941–946
  54. Gottschalk A, Stein PD, Sostman HD, et al. Very low probability interpretation of V/Q lung scans in combination with low probability objective clinical assessment reliably excludes pulmonary embolism: Data from PIOPED II. J Nucl Med. 2007;48:1411–1415
  55. Baile EM, King GG, Muller NL, et al. Spiral computed tomography is comparable to angiography for the diagnosis of pulmonary embolism. Am J Respir Crit Care Med. 2000;161:1010–1015
  56. Wittram C, Waltman AC, Shepard JA, et al. Discordance between CT and angiography in the PIOPED II study. Radiology. 2007;244:883–889
  57. Chartrand-Lefebvre C, Howarth N, Lucidarme O, et al. Contrast-enhanced helical CT for pulmonary embolism detection: Inter- and intraobserver agreement among radiologists with variable experience. AJR Am J Roentgenol. 1999;172:107–112
  58. Coche E, Pawlak S, Dechambre S, et al. Peripheral pulmonary arteries: Identification at multi-slice spiral CT with 3D reconstruction. Eur Radiol. 2003;13:815–822
  59. Domingo ML, Marti-Bonmati L, Dosda R, et al. Interobserver agreement in the diagnosis of pulmonary embolism with helical CT. Eur J Radiol. 2000;34:136–140
  60. Garg K, Kemp JL, Russ PD, et al. Thromboembolic disease: variability of interobserver agreement in the interpretation of CT venography with CT pulmonary angiography. AJR Am J Roentgenol. 2001;176:1043–1047
  61. Hurst DR, Kazerooni EA, Stafford-Johnson D, et al. Diagnosis of pulmonary embolism: Comparison of CT angiography and MR angiography in canines. J Vasc Interv Radiol. 1999;10:309–318
  62. Ruiz Y, Caballero P, Caniego JL, et al. Prospective comparison of helical CT with angiography in pulmonary embolism: Global and selective vascular territory analysis (Interobserver agreement). Eur Radiol. 2003;13:823–829
  63. Raptopoulos V, Boiselle PM. Multi-detector row spiral CT pulmonary angiography: Comparison with single-detector row spiral CT. Radiology. 2001;221:606–613
  64. Schoepf UJ, Holzknecht N, Helmberger TK, et al. Subsegmental pulmonary emboli: Improved detection with thin-collimation multi-detector row spiral CT. Radiology. 2002;222:483–490
  65. Hoey JR, Farrer PA, Rosenthall LJ, et al. Interobserver and intraobserver variability in lung scan reading in suspected pulmonary embolism. Clin Nucl Med. 1980;5:508–513
  66. Carter WD, Brady TM, Keyes JW, et al. Relative accuracy of two diagnostic schemes for detection of pulmonary embolism by ventilation-perfusion scintigraphy. Radiology. 1982;145:447–451
  67. Stein PD, Henry JW, Gottschalk A. Reassessment of pulmonary angiography for the diagnosis of pulmonary embolism: Relation of interpreter agreement to the order of the involved pulmonary arterial branch. Radiology. 1999;210:689–691
  68. Quinn MF, Lundell CJ, Klotz TA, et al. Reliability of selective pulmonary arteriography in the diagnosis of pulmonary embolism. AJR Am J Roentgenol. 1987;149:469–471
  69. Diffin DC, Leyendecker JR, Johnson SP, et al. Effect of anatomic distribution of pulmonary emboli on interobserver agreement in the interpretation of pulmonary angiography. AJR Am J Roentgenol. 1998;171:1085–1089
  70. Loud PA, Grossman ZD, Klippenstein DL, et al. Combined CT venography and pulmonary angiography: A new diagnostic technique for suspected thromboembolic disease. AJR Am J Roentgenol. 1998;170:951–954
  71. Loud PA, Katz DS, Klippenstein DL, et al. Combined CT venography and pulmonary angiography in suspected thromboembolic disease: Diagnostic accuracy for deep venous evaluation. AJR Am J Roentgenol. 2000;174:61–65
  72. Ghaye B, Dondelinger RF. Non-traumatic thoracic emergencies: CT venography in an integrated diagnostic strategy of acute pulmonary embolism and venous thrombosis. Eur Radiol. 2002;12:1906–1921
  73. Cham MD, Yankelevitz DF, Henschke CI. Thromboembolic disease detection at indirect CT venography versus CT pulmonary angiography. Radiology. 2005;234:591–594
  74. Coche EE, Hamoir XL, Hammer FD, et al. Using dual-detector helical CT angiography to detect deep venous thrombosis in patients with suspicion of pulmonary embolism: Diagnostic value and additional findings. AJR Am J Roentgenol. 2001;176:1035–1039
  75. Richman PB, Wood J, Kasper DM, et al. Contribution of indirect computed tomography venography to computed tomography angiography of the chest for the diagnosis of thromboembolic disease in two United States emergency departments. J Thromb Haemost. 2003;1:652–657
  76. Walsh G, Redmond S. Does addition of CT pelvic venography to CT pulmonary angiography protocols contribute to the diagnosis of thromboembolic disease?. Clin Radiol. 2002;57:462–465
  77. Jonetz-Mentzel L, Eger C, Basche S. CT Venography and CT Angiography of the Pulmonary Arteries in Acute Pulmonary Embolism. Zentralbl Chir. 2002;127:755–759
  78. Ghaye B, Nchimi A, Noukoua CT, et al. Does multi-detector row CT pulmonary angiography reduce the incremental value of indirect CT venography compared with single-detector row CT pulmonary angiography?. Radiology. 2006;240:256–262
  79. Goodman LR, Stein PD, Beemath A, et al. CT venography for deep venous thrombosis: Continuous images versus reformatted discontinuous images using PIOPED II data. AJR Am J Roentgenol. 2007;189:409–412
  80. Garg K, Kemp JL, Wojcik D, et al. Thromboembolic disease: comparison of combined CT pulmonary angiography and venography with bilateral leg sonography in 70 patients. AJR Am J Roentgenol. 2000;175:997–1001
  81. Cham MD, Yankelevitz DF, Shaham D, et al. Deep venous thrombosis: Detection by using indirect CT venography. The Pulmonary Angiography-Indirect CT Venography Cooperative Group. Radiology. 2000;216:744–751
  82. Duwe KM, Shiau M, Budorick NE, et al. Evaluation of the lower extremity veins in patients with suspected pulmonary embolism: a retrospective comparison of helical CT venography and sonography. 2000 ARRS Executive Council Award I (American Roentgen Ray Society). AJR Am J Roentgenol. 2000;175:1525–1531
  83. Ghaye B, Szapiro D, Willems V, et al. Combined CT venography of the lower limbs and spiral CT angiography of pulmonary arteries in acute pulmonary embolism: preliminary results of a prospective study. JBR-BTR: Organe de la Societe Royale Belge de Radiologie. 2000;83:271–278
  84. Katz DS, Loud PA, Klippenstein DL, et al. Extra-thoracic findings on the venous phase of combined computed tomographic venography and pulmonary angiography. Clin Radiol. 2000;55:177–181
  85. Peterson DA, Kazerooni EA, Wakefield TW, et al. Computed tomographic venography is specific but not sensitive for diagnosis of acute lower-extremity deep venous thrombosis in patients with suspected pulmonary embolus. J Vasc Surg. 2001;34:798–804
  86. Loud PA, Katz DS, Bruce DA, et al. Deep venous thrombosis with suspected pulmonary embolism: Detection with combined CT venography and pulmonary angiography. Radiology. 2001;219:498–502
  87. Begemann PG, Bonacker M, Kemper J, et al. Evaluation of the deep venous system in patients with suspected pulmonary embolism with multi-detector CT: A prospective study in comparison to Doppler sonography. J Comput Assist Tomogr. 2003;27:399–409
  88. Remy-Jardin M, Tillie-Leblond I, Szapiro D, et al. CT angiography of pulmonary embolism in patients with underlying respiratory disease: Impact of multislice CT on image quality and negative predictive value. Eur Radiol. 2002;12:1971–1978
  89. Krestan CR, Klein N, Fleischmann D, et al. Value of negative spiral CT angiography in patients with suspected acute PE: Analysis of PE occurrence and outcome. Eur Radiol. 2004;14:93–98
  90. Bourriot K, Couffinhal T, Bernard V, et al. Clinical outcome after a negative spiral CT pulmonary angiographic finding in an inpatient population from cardiology and pneumology wards. Chest. 2003;123:359–365
  91. Kavanagh EC, O'Hare A, Hargaden G, et al. Risk of pulmonary embolism after negative MDCT pulmonary angiography findings. AJR Am J Roentgenol. 2004;182:499–504
  92. Musset D, Parent F, Meyer G, et al. Diagnostic strategy for patients with suspected pulmonary embolism: A prospective multicentre outcome study. Lancet. 2002;360:1914–1920
  93. Lomis NN, Yoon HC, Moran AG, et al. Clinical outcomes of patients after a negative spiral CT pulmonary arteriogram in the evaluation of acute pulmonary embolism. J Vasc Interv Radiol. 1999;10:707–712
  94. Goodman LR, Lipchik RJ, Kuzo RS, et al. Subsequent pulmonary embolism: risk after a negative helical CT pulmonary angiogram–prospective comparison with scintigraphy. [see comments] Radiology. 2000;215:535–542
  95. Gottsater A, Berg A, Centergard J, et al. Clinically suspected pulmonary embolism: Is it safe to withhold anticoagulation after a negative spiral CT?. Eur Radiol. 2001;11:65–72
  96. Ost D, Rozenshtein A, Saffran L, et al. The negative predictive value of spiral computed tomography for the diagnosis of pulmonary embolism in patients with nondiagnostic ventilation-perfusion scans. Am J Med. 2001;110:16–21
  97. Swensen SJ, Sheedy PF, Ryu JH, et al. Outcomes after withholding anticoagulation from patients with suspected acute pulmonary embolism and negative computed tomographic findings: A cohort study. Mayo Clin Proc. 2002;77:130–138
  98. Tillie-Leblond I, Mastora I, Radenne F, et al. Risk of pulmonary embolism after a negative spiral CT angiogram in patients with pulmonary disease: 1-year clinical follow-up study. Radiology. 2002;223:461–467
  99. van Strijen MJ, de Monye W, Schiereck J, et al. Single-detector helical computed tomography as the primary diagnostic test in suspected pulmonary embolism: A multicenter clinical management study of 510 patients. Ann Intern Med. 2003;138:307–314
  100. Donato AA, Scheirer JJ, Atwell MS, et al. Clinical outcomes in patients with suspected acute pulmonary embolism and negative helical computed tomographic results in whom anticoagulation was withheld. Arch Intern Med. 2003;163:2033–2038
  101. Novelline RA, Baltarowich OH, Athanasoulis CA, et al. The clinical course of patients with suspected pulmonary embolism and a negative pulmonary arteriogram. Radiology. 1978;126:561–567
  102. Henry JW, Relyea B, Stein PD. Continuing risk of thromboemboli among patients with normal pulmonary angiograms. Chest. 1995;107:1375–1378
  103. Quiroz R, Kucher N, Zou KH, et al. Clinical validity of a negative computed tomography scan in patients with suspected pulmonary embolism: a systematic review. JAMA. 2005;293:2012–2017
  104. Resten A, Mausoleo F, Valero M, et al. Comparison of doses for pulmonary embolism detection with helical CT and pulmonary angiography. Eur Radiol. 2003;13:1515–1521
  105. Rademaker J, Griesshaber V, Hidajat N, et al. Combined CT pulmonary angiography and venography for diagnosis of pulmonary embolism and deep vein thrombosis: Radiation dose. J Thorac Imaging. 2001;16:297–299
  106. Managing patient dose in computed tomography (A report of the International Commission on Radiological Protection). Ann ICRP. 2000;30:7–45
  107. Kuiper JW, Geleijns J, Matheijssen NA, et al. Radiation exposure of multi-row detector spiral computed tomography of the pulmonary arteries: Comparison with digital subtraction pulmonary angiography. Eur Radiol. 2003;13:1496–1500
  108. Hurwitz LM, Reiman RE, Yoshizumi TT, et al. Radiation dose from contemporary cardiothoracic multidetector CT protocols with an anthropomorphic female phantom: Implications for cancer induction. Radiology. 2007;245:742–750
  109. Moro L, Bolsi A, Baldi M, et al. Single-slice and multi-slice computerized tomography: dosimetric comparison with diagnostic reference dose levels. Radiol Med (Torino). 2001;102:262–265
  110. Remy-Jardin M, Pistolesi M, Goodman LR, et al. Management of suspected acute pulmonary embolism in the era of CT angiography: A statement from the Fleischner Society. Radiology. 2007;245:315–329
  111. Kalva SP, Jagannathan JP, Hahn PF, et al. Venous thromboembolism: Indirect CT venography during CT pulmonary angiography—should the pelvis be imaged?. Radiology. 2008;246:605–611
  112. Amis ES, Butler PF, Applegate KE, et al. American College of Radiology white paper on radiation dose in medicine. J Am Coll Radiol. 2007;4:272–284
  113. Parker MS, Hui FK, Camacho MA, et al. Female breast radiation exposure during CT pulmonary angiography. AJR Am J Roentgenol. 2005;185:1228–1233
  114. Cook JV, Kyriou J. Radiation from CT and perfusion scanning in pregnancy. BMJ. 2005;331:350
  115. Radiation dose to patients from radiopharmaceuticals. (addendum 2 to ICRP publication 53) Ann ICRP. 1998;28:1–126
  116. Einstein AJ, Henzlova MJ, Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA. 2007;298:317–323
  117. Remy-Jardin M, Remy J. Spiral CT angiography of the pulmonary circulation. Radiology. 1999;212:615–636
  118. Chan WS, Ray JG, Murray S, et al. Suspected pulmonary embolism in pregnancy: Clinical presentation, results of lung scanning, and subsequent maternal and pediatric outcomes. Arch Intern Med. 2002;162:1170–1175
  119. Boiselle PM, Reddy SS, Villas PA, et al. Pulmonary embolus in pregnant patients: Survey of ventilation-perfusion imaging policies and practices. Radiology. 1998;207:201–206
  120. Winer-Muram HT, Boone JM, Brown HL, et al. Pulmonary embolism in pregnant patients: Fetal radiation dose with helical CT. Radiology. 2002;224:487–492
  121. Weiss CR, Scatarige JC, Diette GB, et al. CT pulmonary angiography is the first-line imaging test for acute pulmonary embolism: A survey of US clinicians. Acad Radiol. 2006;13:434–446
  122. Stein PD, Henry JW, Relyea B. Untreated patients with pulmonary embolism (Outcome, clinical, and laboratory assessment). Chest. 1995;107:931–935
  123. Stein PD, Henry JW. Prevalence of acute pulmonary embolism in central and subsegmental pulmonary arteries and relation to probability interpretation of ventilation/perfusion lung scans. Chest. 1997;111:1246–1248
  124. Eyer BA, Goodman LR, Washington L. Clinicians' response to radiologists' reports of isolated subsegmental pulmonary embolism or inconclusive interpretation of pulmonary embolism using MDCT. AJR Am J Roentgenol. 2005;184:623–628
  125. Goodman LR. Small pulmonary emboli: What do we know?. Radiology. 2005;234:654–658
  126. Egermayer P. Follow-up for death or recurrence is not a reliable way of assessing the accuracy of diagnostic tests for thromboembolic disease. Chest. 1997;111:1410–1413
  127. Ryu JH, Olson EJ, Pellikka PA. Clinical recognition of pulmonary embolism: Problem of unrecognized and asymptomatic cases. Mayo Clin Proc. 1998;73:873–879
  128. Swensen SJ, sheedy PF, Ryu JH, et al. Outcomes after withholding anticoagulation from patients with suspected pulmonary embolism and negative computed tomographic findings: A cohort study. Mayo Clin Proc. 2002;77:130–138
  129. Moores LK, Jackson WL, Shorr AF, Jackson JL. Meta-analysis: Outcomes in patients with suspected pulmonary embolism managed with computed tomographic pulmonary angiography. Ann Intern Med. 2004;141:866–874
  130. Hull RD, Raskob GE, Ginsberg JS, et al. A noninvasive strategy for the treatment of patients with suspected pulmonary embolism. Arch Intern Med. 1994;154:289–297
  131. Wells PS, Ginsberg JS, Anderson DR, et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med. 1998;129:997–1005
  132. Stein PD, Hull RD, Raskob GE. Withholding treatment in patients with acute pulmonary embolism who have a high risk of bleeding and negative serial noninvasive leg tests. Am J Med. 2000;109:301–306
  133. Hambleton J. Anticoagulation in high-risk patients: When is this approach not worth the risk?. Am J Med. 2000;109:335–337
  134. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax. 2003;58:470–483
  135. Levine MN, Raskob G, Landefeld S. Hemorrhagic complications of anticoagulant treatment. Chest. 1998;114:511S–523S
  136. Kreit JW. The impact of right ventricular dysfunction on the prognosis and therapy of normotensive patients with pulmonary embolism. Chest. 2004;125:1539–1545
  137. Leacche M, Unic D, Goldhaber SZ, et al. Modern surgical treatment of massive pulmonary embolism: Results in 47 consecutive patients after rapid diagnosis and aggressive surgical approach. J Thorac Cardiovasc Surg. 2005;129:1018–1023
  138. Schoepf UJ. Pulmonary artery CTA. Tech Vasc Interv Radiol. 2006;9:180–191
  139. Stein PD, Woodard PK, Weg JG, et al. Diagnostic pathways in acute pulmonary embolism: Recommendations of the PIOPED II investigators. Am J Med. 2006;119:1048–1055
  140. Stein PD, Woodard PK, Weg JG, et al. Diagnostic pathways in acute pulmonary embolism: Recommendations of the PIOPED II Investigators. Radiology. 2007;242:15–21
  141. Goodman LR, Stein PD, Matta F, et al. CT venography and compression sonography are diagnostically equivalent: Data from PIOPED II. AJR Am J Roentgenol. 2007;189:1071–1076
  142. Stein PD, Beemath A, Matta F, et al. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med. 2007;120:871–879
  143. Stein PD, Beemath A, Quinn DA, et al. Usefulness of multidetector spiral computed tomography according to age and gender for diagnosis of acute pulmonary embolism. Am J Cardiol. 2007;99:1303–1305

PII: S0001-2998(08)00095-0

doi: 10.1053/j.semnuclmed.2008.07.002

Seminars in Nuclear Medicine
Volume 38, Issue 6 , Pages 418-431 , November 2008

Article Tools

* Image Usage & Resolution