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European Radiology

, Volume 15, Issue 5, pp 919–929 | Cite as

CT imaging in acute pulmonary embolism: diagnostic strategies

  • Joachim E. WildbergerEmail author
  • Andreas H. Mahnken
  • Marco Das
  • Axel Küttner
  • Michael Lell
  • Rolf W. Günther
Chest

Abstract

Computed tomography pulmonary angiography (CTA) has increasingly become accepted as a widely available, safe, cost-effective, and accurate method for a quick and comprehensive diagnosis of acute pulmonary embolism (PE). Pulmonary catheter angiography is still considered the gold standard and final imaging method in many diagnostic algorithms. However, spiral CTA has become established as the first imaging test in clinical routine due to its high negative predictive value for clinically relevant PE. Despite the direct visualization of clot material, depiction of cardiac and pulmonary function in combination with the quantification of pulmonary obstruction helps to grade the severity of PE for further risk stratification and to monitor the effect of thrombolytic therapy. Because PE and deep venous thrombosis are two different aspects of the same disease, additional indirect CT venography may be a valuable addition to the initial diagnostic algorithm—if this was positive for PE—and demonstration of the extent and localization of deep venous thrombosis has an impact on clinical management. Additional and alternate diagnoses add to the usefulness of this method. Using advanced multislice spiral CT technology, some practitioners have advocated CTA as the sole imaging tool for routine clinical assessment in suspected acute PE. This will simplify standards of practice in the near future.

Keywords

Diagnostic algorithms Diagnostic CT Pulmonary embolism Thoracic chest CT 

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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Joachim E. Wildberger
    • 1
    Email author
  • Andreas H. Mahnken
    • 1
  • Marco Das
    • 1
  • Axel Küttner
    • 2
  • Michael Lell
    • 3
  • Rolf W. Günther
    • 1
  1. 1.Department of Diagnostic Radiology, University HospitalUniversity of Technology (RWTH)AachenGermany
  2. 2.Department of Diagnostic RadiologyEberhard Karls UniversityTübingenGermany
  3. 3.Department of Diagnostic RadiologyFriedrich Alexander UniversityErlangenGermany

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