Spiral computed tomography for acute pulmonary embolism.

Area of Science:

• Radiology
• Medical Imaging
• Cardiovascular Imaging

Background:

• The optimal diagnostic imaging modality for acute pulmonary embolism (PE) is debated.
• Current options include nuclear medicine scanning, catheter pulmonary angiography, and spiral CT.
• Spiral CT is increasingly used but has limitations in detecting small peripheral emboli.

Purpose of the Study:

• To review the current role and future potential of CT in diagnosing acute pulmonary embolism.
• To assess the evolution of CT technology for PE detection.
• To compare CT performance against other imaging modalities.

Main Methods:

• Review of current literature on CT imaging for pulmonary embolism.
• Discussion of single-slice vs. multidetector-row spiral CT (MDCT) capabilities.
• Evaluation of diagnostic accuracy for central and peripheral emboli.

Main Results:

• Single-slice spiral CT has limitations in detecting peripheral PE, with reported miss rates up to 30%.
• Multidetector-row spiral CT (MDCT) significantly improves visualization of peripheral pulmonary arteries and detection of small emboli.
• MDCT appears to outperform other modalities for both central and peripheral PE detection.

Conclusions:

• MDCT technology is overcoming previous accuracy concerns with spiral CT for PE.
• Evidence supports withholding anticoagulation based on negative MDCT findings.
• MDCT is poised to become the standard of reference for diagnosing acute pulmonary embolism.