Pulmonary Embolism Overlooked on Chest CT Under the Application of the American College of Radiology Appropriateness Criteria

Junghwa Choi; Bae Young Lee; Dae Hee Han; Jung Im Jung
December 2016
Journal of the Korean Society of Radiology;Dec2016, Vol. 75 Issue 6, p455
Academic Journal
Purpose: We retrospectively estimated the frequency and clinical significance of pulmonary embolism (PE) that would have been missed on chest CT scans if the American College of Radiology (ACR) appropriateness criteria were applied and contrast enhanced CT scans were not performed. Materials and Methods: From 2007 to 2014, a total of 696 patients with acute PE were reviewed. The ACR appropriateness criteria relevant to performing a chest CT scan were reorganized into 37 clinical topics (reasons for performing CT). Furthermore, based on the strength of recommendation for CT contrast usage, topics were divided into Group A (appropriate), Group B (not appropriate), Group C (may be appropriate), and Group D (no CT). The patients were assigned into groups and compared for the clinical characteristics and prognostic CT findings. Results: Four hundred ninety-one patients were assigned into Group A (70.5%), 104 patients were assigned into Group B (14.9%), 101 patients were assigned into Group C (14.5%), and none of the patients were assigned into Group D. Patients in Group C (69.3 ± 14.6 years) were significantly older (p < 0.001) than those in the other groups. The most common reason for performing CT in Group B was screening of pulmonary metastasis (72%). Conclusion: Under circumstances of many pulmonary emboli without clinical suspicion, PE could be overlooked under the application of contrast usage criteria, especially in patients in old age and with underlying malignancy. Such a recommendation can be useful to determine the usage of CT contrast in patients with a complex medical background.


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