Prospective evaluation of unsuspected pulmonary embolism on coronary computed tomographic…

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Interobserver agreement between on-call radiology residents and radiology specialists in the diagnosis of pulmonary embolism using computed tomography pulmonary angiography.

J Comput Assist Tomogr. 2009 Nov-Dec;33(6):952-5

Authors: Verweij JW, Hofstee HM, Golding RP, van Waesberghe JH, Smulders YM

OBJECTIVE: The objective of this study was to assess the interobserver agreement between on-call radiology residents and radiology specialists in the evaluation of pulmonary embolism (PE) using computed tomographic pulmonary angiography (CTPA). MATERIALS AND METHODS: Single center, prospective cohort study of 119 consecutive inpatients and outpatients with clinically suspected PE in whom CTPA was performed during out-of-office hours and weekends. The on-call radiology resident interpreted the CTPA for the presence of PE. An experienced radiology specialist, without knowledge of earlier reading, reviewed the CTPA the following morning. In discordant cases, a consensus reading was conducted. The radiology specialists’ assessment and the consensus reading in case of discordance were considered as the gold standard. RESULTS: Five CTPA studies were excluded from the analysis. In the remaining cases, radiology residents and radiology specialists agreed on the interpretations of CTPAs (no PE vs PE present) in 106 (93%) of the 114 cases, with a kappa value of 0.84 (95% confidence interval, 0.74-0.95). The consensus reading equally disagreed with both radiology resident and radiology specialist in 8 (7%) of the 114 discordant cases. Seven out of 8 discordant cases had suboptimal scan quality. CONCLUSIONS: The assessment of CTPA in patients with suspected PE by radiology residents seems reliable during out-of-office hours.

PMID: 19940666 [PubMed - indexed for MEDLINE]

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The prevalence of symptomatic and coincidental pulmonary embolism on computed tomography.

J Comput Assist Tomogr. 2008 Sep-Oct;32(5):783-7

Authors: Hui GC, Legasto A, Wittram C

PURPOSE: To investigate the proportion of pulmonary embolism (PE) on computed tomographic pulmonary angiography (CTPA) and the proportion of coincidental PE on regular contrast-enhanced CT in oncological and nononcological patients. METHODS: This study received internal review board approval and was Health Insurance Portability and Accountability Act compliant. All consecutive adult patients who had contrast-enhanced chest CT or dedicated CTPA during January 2005 were studied. Procedural codes were used to identify cases, and all CT images were reviewed. Clinical data collected included oncology status, chemotherapy regimen, site of tumor, and location of PE. chi2 Tests were used for statistical analysis. RESULTS: Two hundred twenty-nine patients had CTPA, and 27 (11.8%) of them were positive for PE. Of 1168 patients who had contrast-enhanced CT for other indications, coincidental PE was found in 21 patients (1.8%). The proportions of coincidental PE were 3.3% of patients with progressive cancer, 2.5% of patients with stable cancer, 0.7% of patients with no evidence of cancer posttreatment, and 1.0% of nononcological patients. Coincidental PE was found more frequently in patients with progressive cancer compared with nononcological patients (P = 0.035). Patients who were on chemotherapy also had a higher risk of coincidental PE (P=0.019). CONCLUSIONS: The prevalence of symptomatic PE on dedicated CTPA was 11.8%, and the rate of coincidental PE on contrast-enhanced CT was 1.8%. Coincidental PE was significantly higher inpatients with progressive cancer or those receiving chemotherapy.

PMID: 18830112 [PubMed - indexed for MEDLINE]

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