What is the role of CTA in the detection of pulmonary embolism (PE)?

Updated: Sep 18, 2020
  • Author: Daniel R Ouellette, MD, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Computed tomography angiography (CTA) is the initial imaging modality of choice for stable patients with suspected pulmonary embolism. [66, 67, 68] The American College of Radiology (ACR) considers chest CTA to be the current standard of care for the detection of pulmonary embolism. [69] A study by Ward et al determined that a selective strategy in which CTA is used after compression ultrasonography is cost-effective for patients with a high pretest probability of pulmonary embolism. [70] This strategy may reduce the need for CTA and help eliminate adverse effects associated with CTA.

Toward a goal of reducing unnecessary CTA and associated radiation exposure, Drescher et al studied the effect of implementing a computerized decision support system for pulmonary embolism evaluation in the ED. Before implementation, the rate of positive pulmonary embolism diagnosis for CTAs performed was 8.3%; after, the positivity rate rose to 12.7%. The positive yield would have been higher (16.7%) had emergency physicians adhered in all cases to the outcome of the decision support system; in 27% of cases they did not. [71]

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