Role of CT pulmonary angiography in diagnosis of clinically suspected acute pulmonary thromboembolism, its comparison with clinical (Wells) criteria and biochemical (D-dimer) status

Dr Prashant Khade

Volume : IX, Issue : I, January - 2019

Role of CT pulmonary angiography in diagnosis of clinically suspected acute pulmonary thromboembolism, its comparison with clinical (Wells) criteria and biochemical (D-dimer) status

Dr Prashant Khade

Abstract :

Since its introduction in 1992, computed tomography angiography (CTA) of the pulmonary arteries has become the main diagnostic test for the evaluation of pulmonary embolism (PE). With the advent of multi detector scanning, CTA has gained substantially in image acquisition speed and spatial resolution, which changed its diagnostic yield in many respects. Pulmonary embolism is the third most common acute cardiovascular disease after myocardial infarction and stroke and results in thousands of deaths each year because it often goes undetected. Pulmonary angiography, the diagnostic standard of reference for confirming or refuting a diagnosis of pulmonary embolism, remains underused. For each lung the main, lobar, segmental and subsegmental arteries are examined for pulmonary embolism. Acute pulmonary embolism cause intraluminal filling defects that should have a sharp interface with the intravascular contrast material. The vessels are seen as either normal, containing acute pulmonary embolism, or indeterminate. Aims of this study were to diagnose pulmonary thromboembolism on CT pulmonary angiography and compare the CT pulmonary angiography study results with Wells grade, D–dimer status. Total of 80 subjects were included irrespective of their age and sex. Comparison of results were done using ‘Fisher’s exact test’. In conclusion, Most of the emboli were seen at segmental (53.75%) and lobar (30.0%) levels. There is significant association between CTPA diagnosis and Wells grade (P value <0.05), no significant association between CTPA diagnosis and D–dimer status (P value >0.05). D–dimer had low specificity.