Unsuspected pulmonary embolism: Prospective detection on routine helical CT scans

Mark V. Gosselin, Geoffrey D. Rubin, Ann N. Leung, Judy Huang, Norman W. Rizk

Research output: Contribution to journalArticle

140 Scopus citations

Abstract

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 unsuspectd 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 unsuspectd PE was highest among inpatients with cancer. A directed, workstation-based search can improve the PE detection rate over that with hard-copy review.

Original languageEnglish (US)
Pages (from-to)209-215
Number of pages7
JournalRADIOLOGY
Volume208
Issue number1
DOIs
StatePublished - Jul 1998

Keywords

  • Computers, diagnostic aid
  • Embolism, pulmonary, 60.72, 944.77
  • Pulmonary arteries, CT, 944.12915
  • Pulmonary arteries, thrombosis, 944.77

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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    Gosselin, M. V., Rubin, G. D., Leung, A. N., Huang, J., & Rizk, N. W. (1998). Unsuspected pulmonary embolism: Prospective detection on routine helical CT scans. RADIOLOGY, 208(1), 209-215. https://doi.org/10.1148/radiology.208.1.9646815