Stefan Puig MD, MSc, Abstract Co-Author: Nothing to Disclose

Rebekka Voegeli, Abstract Co-Author: Nothing to Disclose

Carmen Andrea Pfortmueller, Abstract Co-Author: Nothing to Disclose

Jennifer L.C. Cullmann, Abstract Co-Author: Nothing to Disclose

Johannes T. Heverhagen MD, PhD, Presenter: Speaker, Bracco Group

Gregor Lindner MD, Abstract Co-Author: Nothing to Disclose

Pulmonary embolism (PE) is a relative common, potentially fatal disease which remains a challenge in the daily clinical practice. Computed tomography pulmonary angiography (CTAP) has become the gold-standard non-invasive test in patients with suspected PE. Several studies have shown that due to the introduction of Multi-detectors-Computed-Tomography (MDCT) the sensitivity of CTAP increased significantly compared to single-detector-CT without changing the PE mortality rate. In July 2012, the MDCT-scanner in our ED was changed from a 16-row to a 128-row single source MDCT scanner. The aim of this retrospective study was to evaluate if the number of diagnoses of possibly clinically irrelevant solitary subsegmental PE (SPE) has increased after changing from a 16-row to a 128-row-MDCT-scanner. 

We included all CT-scans requested by the ED between January 1st, 2005 and December 31st, 2013. All scans before July 16th, 2012 were performed with 16-row-MDCT-scanner (Siemens Somatom Sensation 16), and thereafter, with a 128-row-MDCT- scanner (Siemens Somatom Edge). All examinations were performed with standard protocols for pulmonary embolism, triple-rule-out or poly-trauma.

3,533 examinations were included in this retrospective analysis, 2,661 with the 16-row (mean age: 49.2 years; male: 56.4%) and 872 with the 128-row scanner (mean age: 60.7 years; male: 60.2%). There were no significant differences in the number of PE or SPE diagnoses before and after change of the scanner. PE was diagnosed in 388/2,661 cases (14,6%) with the 16-row-scanner and in 118/872 cases (13,5%) with the 128-row-scanner (p=.44), SPE was diagnosed in 69/2,261 (2,6%) and in 24/872 cases (2.8%), respectively (p=.80).

Changing from a 16-row- to a 128-rowMDCT-scanner will not increase the number of possibly clinically irrelevant SPE and, therefore no further increase in unnecessary thrombolytic therapies based on radiological diagnoses has to be expected.

Although the detection rate of possibly clinically irrelevant SPE increased significantly after the introduction of MDCT compared to single-detector-CT, it seems that there is no further increase in the detection rate changing from an 16-row- to a 128-row scanner.

Puig, S, Voegeli, R, Pfortmueller, C, Cullmann, J, Heverhagen, J, Lindner, G, Does Better MDCT Technology Lead to an Increase of Clinically Irrelevant Diagnoses of Solitary Subsegmental Pulmonary Embolism in the Emergency Department?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14009562.html