Strategies Incorporating Spiral CT for the Diagnosis of Acute Pulmonary Embolism* A Cost-effectiveness Analysis D. Ian Paterson, MD; and Kevin Schwartzman, MD, MPH Objective: To assess the cost-effectiveness of spiral CT for the diagnosis of acute pulmonary embolism. The first part of this study retrospectively compared the discriminatory power of spiral CT versus clinical findings in 112 consecutive patients referred with chest pain or dyspnoea. Mild nausea is common when the contrast dye is injected. Contrast-enhanced spiral computed tomography (spiral CT) is a promising new technique for the diagnosis of pulmonary embolism. Most patients who are mildly claustrophobic can tolerate this study after There is still considerable debate about the optimal diagnostic imaging modality for acute pulmonary embolism. Direct visualisation of the embolus [l], with no more invasion than an intravenous injection of contrast medium, carries obvious and immediate appeal. NEJM Journal Watch reviews over 250 scientific and medical journals to present important clinical … In comparison to pulmonary angiography it is less invasive, less expensive, and its use may be more acceptable to physicians ( 7 ). CRD COMMENTARY - Selection of comparators CT pulmonary angiography ― also called CT pulmonary embolism study ― creates 3D images that can detect abnormalities such as pulmonary embolism within the arteries in your lungs. Anthony P. Borzotta, MD, Portland, Ore: The authors have attempted to define the role of spiral computed tomography of the chest in the diagnosis of pulmonary embolism in critically ill surgical patients, 77% of whom were victims of trauma. However, in many instances, a chest radiograph is usually performed as a first-line examination. This paper reviews the technical aspects, typical findings and diagnostic pitfalls of this recent technique. Despite these limitations, several studies have now documented that, in patients with suspected pulmonary embolism, it is safe to withhold anticoagulation therapy if a spiral computed tomography exam of the pulmonary arteries is negative and no lower extremity venous thrombosis is present. CONCLUSION: In cases of pulmonary embolism, sensitivity of spiral CT is greater than that of scintigraphy. The current standard of care for members with suspected pulmonary embolism is a spiral CT scan, also called a CTA, CT PA (computed tomography pulmonary angiography), MDCT (multidector CT) or helical CT scan. 26 With conventional CT, the patient lies on a scanner table that is intermittently advanced. Sensitivities, specificities, and kappa values with spiral CT and scintigraphy were 87%, 95%, and 0.85 and 65%, 94%, and 0.61, respectively. Criteria to be used for Chest CTA or a CT is requested for Pulmonary Emboli which cannot be approved based on Interqual or Milliman criteria. Acute pulmonary emboli were detected with conventional CT,23, 24 but the potential of spiral CT for diagnosing pulmonary emboli became apparent with the introduction of spiral CT, 25 a major advance in CT scanner technology. Background: Spiral computed tomography (CT) has emerged as a potentially conclusive diagnostic test to exclude pulmonary embolism (PE) in patients with … The Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II study was designed to assess the validity of contrast-enhanced spiral CT in the diagnosis of acute PE. Many departments around the world are performing more and more spiral CT investigations for suspected pulmonary embolism. Pulmonary embolism: optimization of small pulmonary artery visualization at multi-detector row CT. Radiology. Spiral CT of the pulmonary arteries is a recent modality, that allows reliable visualization of emboli in pulmonary arteries up to fourth-order branches. 227(2):455-60. . However, the accuracy of pulmonary angiography has never been evaluated against an independent gold standard. The use of spiral CT angiography is likely to lead to improved patient outcomes in terms of mortality and also improvements in the cost-effectiveness of the diagnosis of suspected pulmonary embolism. There is still considerable debate about the optimal diagnostic imaging modality for acute pulmonary embolism. Multislice spiral CT is becoming an increasingly important tool for diagnosing pulmonary embolism. Design: Computer-based cost-effectiveness analysis. A considerable advantage of CT over both V/Q scintigraphy and pulmonary angiography is the ability to depict other conditions that clinically mimic pulmonary embolism, such as acute pneumonia, lung abscess (Figs. The use of spiral computed tomography (CT) for the diagnosis of pulmonary embolism has been compared to angiography, the current gold standard. Spiral computer tomography (CT) has become a widely accepted clinical tool in the diagnosis of acute pulmonary embolism. Thirty-six consecutive patients without underlying cardiopulmonary disease and high clinical suspicion of PE underwent prospectively thin-collimation SCTA and echocardiography at the time of the initial … Remy-Jardin M, Remy J, Deschildre F, et al. The multi-slice spiral CT image is significantly better than the unprocessed image after being processed by the enhancement algorithm. Methods: A total of 83 patients with suspected pulmonary embolism were examined using V/Q lung scintigraphy in SPECT technique as well as 4-slice spiral CT. It is a preferred choice of imaging in the diagnosis of PE due to its minimally invasive nature for the patient, whose only requirement for the scan is an intravenous line. Abstract & Commentary Synopsis: Of 11 published investigations of spiral volumetric computed tomography in the diagnosis of pulmonary embolism, none met all 11 standards applied by the authors for studies of diagnostic tests, and only five articles met five standards. CT pulmonary angiogram (CTPA) is a medical diagnostic test that employs computed tomography (CT) angiography to obtain an image of the pulmonary arteries.Its main use is to diagnose pulmonary embolism (PE). Summary. Bob: Pulmonary embolism (PE) accounts for 300,000 deaths per year.Because the signs and symptoms are inconsistent, the diagnosis is often missed. Now spiral computed tomographic (CT) angiography provides a readily available, noninvasive test for pulmonary embolism. How good is chest CT at identifying PE? If imaging is deemed necessary from an initial clinical evaluation such as d-dimer testing, options include nuclear medicine scanning, catheter pulmonary angiography, and spiral CT. For this reason, patients are usually kept NPO for 4 hours before the test. The detection method is based on segmentation of pulmonary vessels to limit the search space, and analysis of several three-dimensional features inside segmented vessel volume. Although pulmonary angiography is the "gold standard" for diagnosing pulmonary embolism (PE), this technique carries some risks and is not always. The study was supported by the National Institutes of Health and the National Heart, Lung, and Blood Institute. The purpose of this study was to investigate whether the severity of acute pulmonary embolism (PE) could be quantitatively assessed with spiral CT angiography (SCTA). Subclinical myocardial injury and right ventricular dysfunction, assessed by biomarkers, echocardiography or spiral computed tomography, also have been shown to be associated with an increased risk of an adverse outcome in patients with pulmonary embolism … Diagnosis of pulmonary embolism with spiral CT: comparison with pulmonary angiography and scintigraphy. Spiral Volumetric CT to Diagnose Pulmonary Embolism. Abstract. Hence, the aim of our study was a balanced comparison between V/Q lung scintigraphy and CT angiography using advanced imaging techniques for both modalities. The accuracy of this examination is exceedingly high, so it should become the first-line test for pulmonary embolism. Design of PIOPED II Spiral volumetric computed tomography (SVCT) has been recognized as a test with potential for use in the diagnosis of pulmonary embolism (PE) since 1992, at which time Remy-Jardin et al 1 employed it in the evaluation of 42 patients. Patel S, Kazerooni EA, Cascade PN. Initial results were promising, with sensitivity and specificity reported as 100% and 96%, respectively. In some cases, contrast material is given intravenously during the CT scan to outline the pulmonary arteries. Spiral CT and scintigraphic scans of four patients with embolism did not show embolism. Recent investigations reveal a high negative predictive value for spiral CT, further proving its value. Download Citation | Spiral CT for Pulmonary Embolism | Radiologic imaging for pulmonary embolism has been problematic. CLINICAL PRIORITIES Check the patient for allergy to iodinated dyes. Many parenchymal, vascular, and other ancillary findings may be observed on both imaging modalities with a highly detailed depiction of abnormalities on multislice CT. Results: Pulmonary embolism: A total of 1741 pulmonary arteries were found, of which 407 (23.37%) showed different degrees of embolism, mainly in the pulmonary artery and pulmonary artery. 2003 May. 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