Gladwin Chun Wai Hui MD, Presenter: Nothing to Disclose

Conrad Wittram MBChB, Abstract Co-Author: Nothing to Disclose

To compare the imaging utilization for PE diagnosis and its impact on the treatment pattern over a ten year period.

A retrospective review was conducted on consecutive patients with symptoms suspicious of PE during the months of January 1995 & 2005. Hospital procedural codes were used to identify cases. Patients were excluded if there was a known diagnosis of PE. Patient clinical information and radiological reports were reviewed. Chi square and Fisher’s Exact tests were used for analysis. Data collected included imaging modality, PE test results, ancillary findings, heparin therapy and IVC filter placements.

In January 1995, 76 patients underwent imaging for PE. In January 2005, the number of patients who had PE imaging increased to 229. In 1995, first line tests consist of V/Q (89.5%) and transvenous pulmonary angiogram (10.5%). All patients in 2005 had CTPA (plus follow up CT Venogram) as first test. In 1995, test results were 12% “Positive”, 17% “Negative” and 71% “Indeterminate”. In 2005, test results were 12% “Positive”, 83% “Negative” and 5% “Indeterminate” (p < 0.001). The use of CTPA in 2005 detected more ancillary findings, including emphysema, consolidation, atelectasis, pleural effusion, pericardial effusion and lymphadenopathy (p < 0.05). For heparin therapy, percentage of patients received heparin prior to imaging and remained on heparin was 6.6% in 1995 and 0.9% in 2005. Percentage of patients received heparin prior to imaging but had treatment terminated afterwards was 3.9% in 1995 and 1.3% in 2005. Percentage of patients who did not receive heparin until after imaging diagnosis was 13.2% in 1995 and 14.4% in 2005. Percentage of patients who never received heparin was 76.3% in 1995 and 83.4% in 2005 (overall p = 0.018). Percentage of patients who had IVC filter was 5.3% in 1995 and 0.9% in 2005 (p = 0.04).

In comparison to V/Q scan and angiography, CTPA identifies more alternative diagnoses, reduces the indeterminate rate and inappropriate use of heparin therapy.

Use of CTPA for PE diagnosis leads to more appropriate use of heparin therapy.

Hui, G, Wittram, C, The Impact of CTPA in Pulmonary Embolism Diagnosis and Management.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4427729.html