Pulmonary Embolism Detection: Prospective Evaluation of Dual-Section Helical CT versus Selective Pulmonary Arteriography in 157 Patients1
Salah D. Qanadli, MD, MSc,
Mostafa El Hajjam, MD,
Benoît Mesurolle, MD,
Olivier Barré, MD,
Fréderic Bruckert, MD,
Thierry Joseph, MD,
François Mignon, MD,
Antoine Vieillard-Baron, MD,
Olivier Dubourg, MD and
Pascal Lacombe, MD
1 From the Departments of Radiology (S.D.Q., M.E.H., B.M., O.B., F.B., F.M., P.L.) and Cardiology (T.J, O.D.) and the Intensive Care Unit (A.V.B.), Ambroise Paré Hospital-René Descartes Paris V University, 9 avenue Charles de Gaulle, 92104 Boulogne, France. Received May 6, 1999; revision requested July 16; final revision received February 23, 2000; accepted March 2. Address correspondence to S.D.Q. (e-mail: salah.qanadli@apr.ap-hop-paris.fr)
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Figure 1a. True-positive CT and arteriographic findings in a 45-year-old man with isolated subsegmental emboli. (a) Four overlapped transverse helical CT scans show occlusion of the posterior subsegmental branch (white arrow) of the apical segmental artery of the upper left lobe, with infarction in the parenchyma distally (black arrow). (b) Posteroanterior selective left pulmonary arteriogram demonstrates isolated vascular cutoff in the corresponding branch (arrow), without a filling defect, which was overlooked by one investigator at the initial interpretation.
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Figure 1b. True-positive CT and arteriographic findings in a 45-year-old man with isolated subsegmental emboli. (a) Four overlapped transverse helical CT scans show occlusion of the posterior subsegmental branch (white arrow) of the apical segmental artery of the upper left lobe, with infarction in the parenchyma distally (black arrow). (b) Posteroanterior selective left pulmonary arteriogram demonstrates isolated vascular cutoff in the corresponding branch (arrow), without a filling defect, which was overlooked by one investigator at the initial interpretation.
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Figure 2a. True-positive CT and arteriographic findings in a 54-year-old woman with multiple subsegmental emboli. (a) Selective left anterior oblique arteriogram in the right-lower-lobe artery shows subsegmental clots (arrowheads) that are well demonstrated in (b) helical CT scan (arrows). (c) Selective right anterior oblique arteriogram in the left lower lobe artery demonstrates a peripheral embolus at the eighth order (arrowhead) that was overlooked at CT.
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Figure 2b. True-positive CT and arteriographic findings in a 54-year-old woman with multiple subsegmental emboli. (a) Selective left anterior oblique arteriogram in the right-lower-lobe artery shows subsegmental clots (arrowheads) that are well demonstrated in (b) helical CT scan (arrows). (c) Selective right anterior oblique arteriogram in the left lower lobe artery demonstrates a peripheral embolus at the eighth order (arrowhead) that was overlooked at CT.
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Figure 2c. True-positive CT and arteriographic findings in a 54-year-old woman with multiple subsegmental emboli. (a) Selective left anterior oblique arteriogram in the right-lower-lobe artery shows subsegmental clots (arrowheads) that are well demonstrated in (b) helical CT scan (arrows). (c) Selective right anterior oblique arteriogram in the left lower lobe artery demonstrates a peripheral embolus at the eighth order (arrowhead) that was overlooked at CT.
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Figure 3a. False-negative CT and arteriographic findings in a 52-year-old man with left-sided chest pain. (a) Selective right anterior oblique arteriogram in the left lower lobe artery shows an isolated thrombus (arrow) in the medial subsegmental branch of the anterobasal artery. (b) Helical CT findings were technically suboptimal and were considered negative at the initial interpretation. A clot could not be identified in retrospect.
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Figure 3b. False-negative CT and arteriographic findings in a 52-year-old man with left-sided chest pain. (a) Selective right anterior oblique arteriogram in the left lower lobe artery shows an isolated thrombus (arrow) in the medial subsegmental branch of the anterobasal artery. (b) Helical CT findings were technically suboptimal and were considered negative at the initial interpretation. A clot could not be identified in retrospect.
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Figure 4a. False-positive (at initial interpretation) helical CT and arteriographic findings in a 58-year-old man with chest pain. (a) Right selective pulmonary arteriogram shows no evidence of PE. (b) Helical CT scan demonstrates an intravascular area of low attenuation in the right posterior segmental artery (arrow). The plasma D-dimer level was greater than 1,000 mg/L, and the patient had deep venous thrombosis of the lower extremities. The definitive diagnosis was PEs that were probably missed at pulmonary arteriography.
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Figure 4b. False-positive (at initial interpretation) helical CT and arteriographic findings in a 58-year-old man with chest pain. (a) Right selective pulmonary arteriogram shows no evidence of PE. (b) Helical CT scan demonstrates an intravascular area of low attenuation in the right posterior segmental artery (arrow). The plasma D-dimer level was greater than 1,000 mg/L, and the patient had deep venous thrombosis of the lower extremities. The definitive diagnosis was PEs that were probably missed at pulmonary arteriography.
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Figure 5a. False-positive (at initial interpretation) CT and arteriographic findings in a 44-year-old man with right-sided chest pain and dyspnea. The CT scan and selective pulmonary arteriogram were suboptimal because of atelectasis and pleural effusion. (a, b) Helical CT scans reveal an endoluminal filling defect in the right laterobasal segmental artery (arrow). (c) Selective pulmonary arteriogram was interpreted as free of emboli at the initial interpretation. The definitive diagnosis was PE, and clot (arrowhead) was identified in retrospect at selective pulmonary arteriography.
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Figure 5b. False-positive (at initial interpretation) CT and arteriographic findings in a 44-year-old man with right-sided chest pain and dyspnea. The CT scan and selective pulmonary arteriogram were suboptimal because of atelectasis and pleural effusion. (a, b) Helical CT scans reveal an endoluminal filling defect in the right laterobasal segmental artery (arrow). (c) Selective pulmonary arteriogram was interpreted as free of emboli at the initial interpretation. The definitive diagnosis was PE, and clot (arrowhead) was identified in retrospect at selective pulmonary arteriography.
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Figure 5c. False-positive (at initial interpretation) CT and arteriographic findings in a 44-year-old man with right-sided chest pain and dyspnea. The CT scan and selective pulmonary arteriogram were suboptimal because of atelectasis and pleural effusion. (a, b) Helical CT scans reveal an endoluminal filling defect in the right laterobasal segmental artery (arrow). (c) Selective pulmonary arteriogram was interpreted as free of emboli at the initial interpretation. The definitive diagnosis was PE, and clot (arrowhead) was identified in retrospect at selective pulmonary arteriography.
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Figure 6a. Inconclusive helical CT and arteriographic findings in a 32-year-old man with chest pain and dyspnea. (a) Selective pulmonary arteriogram shows an embolus (arrow) in the right posterobasal segmental artery. (b) Helical CT findings were considered inconclusive by the two investigators. Analysis of the vascular lumen is difficult because of vessel orientation (related to atelectasis and pleural effusion) and insufficient enhancement of the pulmonary vessels. However, a clot is seen in the right posterobasal segmental artery (arrow).
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Figure 6b. Inconclusive helical CT and arteriographic findings in a 32-year-old man with chest pain and dyspnea. (a) Selective pulmonary arteriogram shows an embolus (arrow) in the right posterobasal segmental artery. (b) Helical CT findings were considered inconclusive by the two investigators. Analysis of the vascular lumen is difficult because of vessel orientation (related to atelectasis and pleural effusion) and insufficient enhancement of the pulmonary vessels. However, a clot is seen in the right posterobasal segmental artery (arrow).
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Copyright © 2000 by the Radiological Society of North America.
