To describe the trends in computed tomography pulmonary angiography (CTPA) utilization and pulmonary embolism (PE) positivity rate among patients at a tertiary hospital in China between January 2018 and December 2021 and explore the incidence of isolated PE.
Methods
A total of 4378 patients who underwent CTPA examinations between January 2018 and December 2021 were included in the study, retrospectively. The demographic characteristics and PE positivity rate of the included population were compared each year. The incidence of deep venous thrombosis (DVT)-related and isolated PEs and the relationship between the two were explored.
Results
The mean age of the included patients was 63.0 ± 14.9 years. A total of 1905 (43.5%) patients were male. CTPA showed positive PE results in 901 (20.6%) patients. There was no statistical difference in terms of sex (p = 0.078) and age (p = 0.225) or PE positivity rate (p = 0.393) among the included individuals in each year. DVT-related PE occurred more often, manifested as central (p = 0.003) and multiple (p = 0.007) PE, when compared to isolated PE.
Conclusion
In a retrospective study conducted at a tertiary hospital in China, the CTPA positivity rate for PE was 20.6%. There was no statistical difference in the annual PE positivity rate. The clinical features of patients with DVT-related PE were more severe than of those with isolated PE.
GoldhaberSZBounameauxH. Pulmonary embolism and deep vein thrombosis. Lancet2012; 379(9828): 1835–1846.
2.
OsinbowaleOAliLChiYW. Venous thromboembolism: a clinical review. Postgrad Med J2010; 122(2): 54–65.
3.
KonstantinidesSVGuyMMarcH, et al.ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J2019; 54(3): 543–603.
4.
LeeYHChaSIShinKM, et al.Clinical characteristics and outcomes of patients with isolated pulmonary embolism. Blood Coagul Fibrinolysis2021; 32(6): 387–393.
5.
BhattMBraunCPatelP, et al.Diagnosis of deep vein thrombosis of the lower extremity: a systematic review and meta-analysis of test accuracy. Blood Adv2020; 4(7): 1250–1264.
6.
AndersonDRKahnSRRodgerMA, et al.Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA2007; 298(23): 2743–2753.
7.
DebloisSChartrand-LefebvreCToporowiczK, et al.Interventions to reduce the overuse of imaging for pulmonary embolism: a systematic review. J Hosp Med2018; 13(1): 52–61.
8.
CarrierMRighiniMWellsPS, et al.Subsegmental pulmonary embolism diagnosed by computed tomography: incidence and clinical implications. A systematic review and meta-analysis of the management outcome studies. J Thromb Haemostasis2010; 8(8): 1716–1722.
9.
RajaASGreenbergJOQaseemA, et al.Evaluation of patients with suspected acute pulmonary embolism: best practice advice from the clinical guidelines committee of the American college of physicians. Ann Intern Med2015; 163(9): 701–711.
10.
KonstantinidesSVTorbickiAAgnelliG, et al.2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J2014; 35(43): 3033–3069.
11.
KandagatlaPGorantaSAntoineH, et al.PADUA score as a predictor for pulmonary embolism: a potential strategy for reducing unnecessary imaging. J Thromb Thrombolysis2019; 47(4): 566–571.
12.
RoyPMFriouEGermeauB, et al.Derivation and validation of a 4-level clinical pretest probability score for suspected pulmonary embolism to safely decrease imaging testing. JAMA Cardiol2021; 6(6): 669–677.
13.
CostantinoMMRandallGGosselinM, et al.CT angiography in the evaluation of acute pulmonary embolus. AJR Am J Roentgenol2008; 191(2): 471–474.
14.
CostaAFBasseriHSheikhA, et al.The yield of CT pulmonary angiograms to exclude acute pulmonary embolism. Emerg Radiol2014; 21(2): 133–141.
15.
SaneMALaukkanenJAGranérMA, et al.Pulmonary embolism location is associated with the co-existence of the deep venous thrombosis. Blood Coagul Fibrinolysis2019; 30(5): 188–192.
16.
PalaretiGSchellongS. Isolated distal deep vein thrombosis: what we know and what we are doing. J Thromb Haemostasis2012; 10(1): 11–19.
17.
KimSM. Clinical presentation of isolated calf deep vein thrombosis in inpatients and prevalence of associated pulmonary embolism. J Vasc Surg Venous Lymphat Disord2022; 10(5): 1037–1043.
18.
KlineJAGarrettJSSarmientoEJ, et al.Over-testing for suspected pulmonary embolism in American emergency departments: the continuing epidemic. Circ Cardiovasc Qual Outcomes2020; 13(1): e005753.
19.
HigashiyaKFordJYoonHC. Variation in positivity rates of computed tomography pulmonary angiograms for the evaluation of acute pulmonary embolism among emergency department physicians. Perm J2022; 26(1): 58–63.
20.
ChenZDebloisSToporowiczK, et al.Yield of CT pulmonary angiography in the diagnosis of acute pulmonary embolism: short report. BMC Res Notes2019; 12(1): 41.
21.
KligermanSJMitchellJWSechristJW, et al.Radiologist performance in the detection of pulmonary embolism: features that favor correct interpretation and risk factors for errors. J Thorac Imag2018; 33(6): 350–357.
22.
YouensDDoustJHaNT, et al.Computed tomography angiography for detection of pulmonary embolism in western Australia shows increasing use with decreasing diagnostic yield. J Clin Med2023; 12(3): 980.
23.
SharmaSLucasCD. Increasing use of CTPA for the investigation of suspected pulmonary embolism. Postgrad Med J2017; 129(2): 193–197.
24.
KauppiJMAiraksinenKEJSahaJ, et al.Adherence to risk-assessment protocols to guide computed tomography pulmonary angiography in patients with suspected pulmonary embolism. Eur Heart J Qual Care Clin Outcomes2022; 8(4): 461–468.
25.
StojanovskaJCarlosRCKocherKE, et al.CT pulmonary angiography: using decision rules in the emergency department. J Am Coll Radiol2015; 12(10): 1023–1029.
26.
MasottiLPanigadaGLandiniG, et al.Simplified PESI score and sex difference in prognosis of acute pulmonary embolism: a brief report from a real life study. J Thromb Thrombolysis2016; 41(4): 606–612.
27.
FinkMAMayerVLSchneiderT, et al.CT angiography Clot burden score from data mining of structured reports for pulmonary embolism. Radiology2022; 302(1): 175–184.
28.
van LangeveldeKSrámekAVinckenPWJ, et al.Finding the origin of pulmonary emboli with a total-body magnetic resonance direct thrombus imaging technique. Haematologica2013; 98(2): 309–315.
29.
ChopardRAlbertsenIEPiazzaG. Diagnosis and treatment of lower extremity venous thromboembolism: a review. JAMA2020; 324(17): 1765–1776.
30.
GeersingGJZuithoffNPAKearonC, et al.Exclusion of deep vein thrombosis using the Wells rule in clinically important subgroups: individual patient data meta-analysis. Br Med J2014; 348: g1340.
31.
Ten CateVProchaskaJHSchulzA, et al.Clinical profile and outcome of isolated pulmonary embolism: a systematic review and meta-analysis. EClinicalMedicine2023; 59: 101973.
32.
Ten CateVEggebrechtLSchulzA, et al.Isolated pulmonary embolism is associated with a high risk of arterial thrombotic disease: results from the VTEval study. Chest2020; 158(1): 341–349.
33.
BecattiniCCohenATAgnelliG, et al.Risk stratification of patients with acute symptomatic pulmonary embolism based on presence or absence of lower extremity DVT: systematic review and meta-analysis. Chest2016; 149(1): 192–200.
34.
EkiciMEkiciAİleriŞ. Chronic CT features in PE patients with co-existing DVT. Am J Emerg Med2021; 46: 126–131.
35.
BulgerCMJacobsCPatelNH. Epidemiology of acute deep vein thrombosis. Tech Vasc Intervent Radiol2004; 7(2): 50–54.
36.
JinZYLiCMZhengK, et al.Nomogram for predicting pulmonary embolism in gynecologic inpatients with isolated distal deep venous thrombosis. Int J Gynaecol Obstet2024; 164(1): 324–333.
37.
HughesMJSteinPDMattaF. Silent pulmonary embolism in patients with distal deep venous thrombosis: systematic review. Thromb Res2014; 134(6): 1182–1185.
38.
PalaretiGCosmiBAntonucciE, et al.Duration of anticoagulation after isolated pulmonary embolism. Eur Respir J2016; 47(5): 1429–1435.
39.
McGonagleDBridgewoodCMeaneyJFM. A tricompartmental model of lung oxygenation disruption to explain pulmonary and systemic pathology in severe COVID-19. Lancet Respir Med2021; 9(6): 665–672.
40.
RajKMajeedHChandnaS, et al.Increased risk of pulmonary embolism and deep vein thrombosis with COVID-19 pneumonia in comparison to influenza pneumonia: insights from the National Inpatient Sample database. J Thorac Dis2024; 16(9): 6161–6170.
