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Role of CT in chronic pulmonary embolism: comparison with pulmonary angiography

A A Tardivon1, D Musset, S Maitre

  • 1Department of Radiology, Hôpital Antoine Béclère, Clamart, France.

Journal of Computer Assisted Tomography
|May 1, 1993
PubMed

Insights

Computed tomography (CT) offers advantages over pulmonary angiography for detecting proximal clots and analyzing distal pulmonary arteries in chronic pulmonary embolism (CPE). While less sensitive for stenosis, CT better characterizes pulmonary infarctions.

Area of Science:

  • Radiology
  • Pulmonary Medicine
  • Medical Imaging

Background:

  • Chronic pulmonary embolism (CPE) poses diagnostic challenges.
  • Pulmonary angiography has been the gold standard but has limitations.
  • Computed tomography (CT) is increasingly used for pulmonary vascular assessment.

Purpose of the Study:

  • To evaluate the diagnostic value of CT compared to pulmonary angiography in patients with CPE.
  • To assess the strengths and weaknesses of CT in visualizing thrombotic material and pulmonary vascular changes in CPE.

Main Methods:

  • Retrospective review of CT scans and pulmonary angiograms from 21 consecutive patients with suspected CPE.
  • Comparative analysis of CT and angiography findings regarding clot detection, vascular distortions, stenosis, and pulmonary infarctions.

Main Results:

  • CT demonstrated superiority in identifying proximal clots, detecting three thrombi missed by angiography and ruling out three false positives.
  • CT enabled analysis of pulmonary arteries beyond the 'amputations' seen in angiography.
  • CT was less sensitive than angiography for vascular distortions (38% vs. 50%) and stenosis (35% vs. 71.8%).
  • CT provided better detection and characterization of pulmonary infarctions.
  • High-resolution CT improved delineation of parenchymal ground-glass opacities, observed in 18 patients.

Conclusions:

  • CT serves as a valuable adjunct to pulmonary angiography in the comprehensive assessment of chronic pulmonary embolism.
  • CT's ability to detect proximal clots and analyze distal vessels, along with superior infarction characterization, enhances diagnostic accuracy in CPE.

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