Skip to main content
Log in

Incremental diagnostic quality gain of CTA over V/Q scan in the assessment of pulmonary embolism by means of a Wells score Bayesian model: results from the ACDC collaboration

  • Original Article
  • Published:
Emergency Radiology Aims and scope Submit manuscript

Abstract

Objective

Our objective was to evaluate the diagnostic value of computed tomography angiography (CTA) and ventilation perfusion (V/Q) scan in the assessment of pulmonary embolism (PE) by means of a Bayesian statistical model.

Methods

Wells criteria defined pretest probability. Sensitivity and specificity of CTA and V/Q scan for PE were derived from pooled meta-analysis data. Likelihood ratios calculated for CTA and V/Q were inserted in the nomogram. Absolute (ADG) and relative diagnostic gains (RDG) were analyzed comparing post- and pretest probability. Comparative gain difference was calculated for CTA ADG over V/Q scan integrating ANOVA p value set at 0.05.

Results

The sensitivity for CT was 86.0% (95% CI: 80.2%, 92.1%) and specificity of 93.7% (95% CI: 91.1%, 96.3%). The V/Q scan yielded a sensitivity of 96% (95% CI: 95%, 97%) and a specificity of 97% (95% CI: 96%, 98%). Bayes nomogram results for CTA were low risk and yielded a posttest probability of 71.1%, an ADG of 56.1%, and an RDG of 374%, moderate-risk posttest probability was 85.1%, an ADG of 56.1%, and an RDG of 193.4%, and high-risk posttest probability was 95.2%, an ADG of 36.2%, and an RDG of 61.35%. The comparative gain difference for low-risk population was 46.1%; in moderate-risk 41.6%; and in high-risk a 22.1% superiority. ANOVA analysis for LR+ and LR− showed no significant difference (p = 0.8745, p = 0.9841 respectively).

Conclusions

This Bayesian model demonstrated a superiority of CTA when compared to V/Q scan for the diagnosis of pulmonary embolism. Low-risk patients are recognized to have a superior overall comparative gain favoring CTA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Wiener RS, Schwartz LM, Woloshin S (2011) Time trends in pulmonary embolism in the United States. Arch Intern Med Arch Int Med 171(9)

  2. Venous thromboembolism in adult hospitalizations—United States, 2007–2009. MMWR: Morbidity & Mortality Weekly Report [serial on the Internet]. (2012, June 8), [cited August 20, 2016]; 61(22): 401–404. Available from: CINAHL Plus

  3. Fanikos J, Rao A, Seger A, Piazza G, Goldhaber SZ (2012) Hospital costs of acute pulmonary embolism. J Am Coll Cardiol 59(13)

  4. Reilly BM, Evans AT (2006) Translating clinical research into clinical practice: impact of using prediction rules to make decisions. Ann Intern Med 144:201–209

    Article  PubMed  Google Scholar 

  5. Wells’ criteria for pulmonary embolism—MDCalc [Internet]. MDCalc. [cited 2016Aug21]. Available from: http://www.mdcalc.com/wells-criteria-for-pulmonary-embolism-pe/

  6. Wells PS (2001) Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Annals of Internal Medicine Ann Intern Med 135(2):98

    Article  CAS  PubMed  Google Scholar 

  7. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, d-dimer testing, and computed tomography. JAMA 2006 Nov 295(2):172

  8. Cochon L, Peña M, Baez AA (2013) Abstract. Comparative assessment of diagnostic accuracy of computed tomography and ultrasonography in the diagnosis of acute appendicitis after the application of the Alvarado scoring system. Ann Emerg Med 62(4):S35

    Article  Google Scholar 

  9. Cochon L, Peña M, Baez AA (2013) Abstract. Evidence of incremental diagnostic quality gain in the assessment of pulmonary embolism with computed tomography angiography versus ventilation perfusion scan using Wells score and Bayesian statistical modeling. Ann Emerg Med 62(4):S38

    Article  Google Scholar 

  10. Baez AA, Cochon L (2015) Acute care diagnostics collaboration: assessment of a Bayesian clinical decision model integrating the prehospital sepsis score and point-of-care lactate. Am J Emerg Med

  11. Baez AA, Cochon L Improved rule-out diagnostic gain with a combined aortic dissection detection risk score and D-dimer Bayesian decision support scheme. Ann Emerg Med 64(4):S48

  12. Cochon L, Ovalle A, Baez AA Bayesian model for comparative assessment of lactate and procalcitonin using CURB 65 risk score as predictor for ICU admission. Ann Emerg Med 64(4):S21–S22

  13. Hayashino Y, Goto M, Noguchi Y, Fukui T (2005) Ventilation-perfusion scanning and helical CT in suspected pulmonary embolism: meta-analysis of diagnostic performance 1. Radiology 234(3):740–748

    Article  PubMed  Google Scholar 

  14. Kan Y, Yuan L, Meeks JK, Li C, Liu W, Yang J (2014) The accuracy of V/Q SPECT in the diagnosis of pulmonary embolism: a meta-analysis. Acta Radiol 56(5):565–572

    Article  PubMed  Google Scholar 

  15. One-way ANOVA calculator [Internet]. One-way ANOVA calculator. [cited 2016Aug21]. Available from: http://turner.faculty.swau.edu/mathematics/math241/materials/anova/

  16. Johnson TR, Nikolaou K, Wintersperger BJ, Knez A, Boekstegers P, Reiser MF, Becker CR (2007) ECG-gated 64-MDCT angiography in the differential diagnosis of acute chest pain. Am J Roentgenol 188(1):76–82

    Article  Google Scholar 

  17. Compare healthcare costs in your area at NewChoiceHealth.com! (n.d.) Retrieved January 29, 2017, from https://www.newchoicehealth.com/procedures/ct-angiography-chest

  18. Lung ventilation/perfusion scan cost in Pensacola, Florida—MDsave. (n.d.) Retrieved January 29, 2017, from https://www.mdsave.com/procedures/lung-scan2/d785f8cf/florida/pensacola-fl

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Laila Cochon.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cochon, L., McIntyre, K., Nicolás, J.M. et al. Incremental diagnostic quality gain of CTA over V/Q scan in the assessment of pulmonary embolism by means of a Wells score Bayesian model: results from the ACDC collaboration. Emerg Radiol 24, 355–359 (2017). https://doi.org/10.1007/s10140-017-1486-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10140-017-1486-6

Keywords

Navigation