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Chest multidetector computed tomography (MDCT) in patients with suspected acute pulmonary embolism: diagnostic yield and proportion of other clinically relevant findings

Tomografia computerizzata multidetettore (TCMD) del torace in pazienti con sospetta embolia polmonare acuta: resa diagnostica e proporzione di altri reperti di rilevanza clinica

  • Chest Radiology / Radiologia Toracica
  • Published:
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Abstract

Purpose

The authors evaluated the diagnostic yield of chest multidetector computed tomography (MDCT) in acute pulmonary embolism (PE) and the proportion of other clinically relevant findings in a large cohort of consecutive inpatients and patients referred from the emergency department (outpatients).

Materials and methods

A total of 327 radiological reports of chest MDCT scans performed for suspected acute PE in 327 patients (158 men, 169 women; mean age 69 years, standard deviation 17.33 years; 233 inpatients, 94 outpatients) were retrospectively evaluated and classified into four categories: 1, positive for PE; 2, negative for PE but positive for other findings requiring specific and immediate intervention; 3, completely negative or positive for findings with a potential for significant morbidity requiring specific action on follow-up; 4, indeterminate. The distribution of findings by categories among the entire population and inpatients and outpatients separately was calculated (chi-square test, α=0.05).

Results

In the entire population, the diagnostic yield (i.e. proportion of cases classified as category 1) was 20.2% (66/327). Proportions of cases classified as categories 2, 3 and 4 were 27.5% (90/327), 44.3% (145/327) and 7.9% (26/327), respectively. No statistically significant difference was found between inpatients and outpatients (p=0.193).

Conclusions

In patients with suspected acute PE, chest MDCT provides evidence of conditions requiring immediate and specific intervention (i.e. categories 1 and 2) in nearly 50% of cases, without differences between inpatients and outpatients.

Riassunto

Obiettivo

Scopo del nostro lavoro è stato valutare la resa diagnostica della tomografia computerizzata multidetettore (TCMD) del torace nell’embolia polmonare acuta (EP) e la proporzione di altri reperti clinicamente rilevanti in un’ampia coorte di pazienti consecutivi, sia ricoverati che provenienti dal Pronto Soccorso (PS).

Materiali e metodi

Sono stati retrospettivamente considerati 327 referti radiologici di TCMD del torace eseguite per sospetta EP acuta in 327 pazienti (158 M, 169 F; età media, 69 anni, deviazione standard [DS] 17,33 anni; 233 ricoverati, 94 provenienti dal PS). Gli esami sono stati classificati in quattro categorie: 1. positivi per EP; 2. negativi per EP, ma positivi per altri reperti richiedenti intervento specifico ed immediato; 3. negativi del tutto o positivi per reperti con potenziale significato di morbilità richiedenti specifico intervento al follow-up; 4. indeterminati. È stata calcolata la distribuzione dei reperti in categorie nell’intera popolazione e, separatamente, nei pazienti ricoverati e nei pazienti provenienti dal PS (test Chi-quadrato, α=0,05).

Risultati

Nell’intera popolazione, la resa diagnostica (vale a dire proporzione di casi classificati in categoria 1) è stata del 20,2% (66/327). Le proporzioni di casi classificati in categoria 2, 3 e 4 sono state del 27,5% (90/327), 44,3% (145/327) e 7,9% (26/327), rispettivamente. Non sono state rilevate differenze statisticamente significative tra i pazienti ricoverati e quelli provenienti dal PS (p=0,193).

Conclusioni

Nei pazienti con sospetta EP acuta, la TCMD del torace evidenzia condizioni richiedenti un intervento specifico ed immediato (vale a dire, categorie 1 e 2) in quasi il 50% dei casi, senza differenze tra i pazienti ricoverati e quelli provenienti dal PS.

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Authors and Affiliations

  1. Institute of Diagnostic Radiology, University of Udine, Via Colugna 50, 33100, Udine, Italy

    L. Cereser, D. Bagatto, R. Girometti, G. Como, C. Zuiani & M. Bazzocchi

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  1. L. Cereser
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  2. D. Bagatto
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  3. R. Girometti
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  4. G. Como
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  5. C. Zuiani
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  6. M. Bazzocchi
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Correspondence to L. Cereser.

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Cereser, L., Bagatto, D., Girometti, R. et al. Chest multidetector computed tomography (MDCT) in patients with suspected acute pulmonary embolism: diagnostic yield and proportion of other clinically relevant findings. Radiol med 116, 219–229 (2011). https://doi.org/10.1007/s11547-010-0612-2

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  • DOI: https://doi.org/10.1007/s11547-010-0612-2

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