Reassessment of pulmonary angiography for the diagnosis of pulmonary embolism: relation of interpreter agreement to the order of the involved pulmonary arterial branch.

PURPOSE To reassess the validity of conventional pulmonary angiography in the diagnosis of pulmonary embolism (PE) in main, lobar, segmental, and subsegmental pulmonary arteries. MATERIALS AND METHODS Data are from examinations of 375 patients with angiographically diagnosed PE who participated in the Prospective Investigation of Pulmonary Embolism Diagnosis. The average co-positivity of readings of the pulmonary angiograms was evaluated in relation to the order of the largest pulmonary artery that showed PE. RESULTS Among 217 patients whose angiograms showed PE in main or lobar pulmonary arteries, as well as in smaller orders of arteries, there was an average co-positivity of 98% (95% Cl = 96%, 98%). Among 136 patients whose pulmonary angiograms showed PE in segmental or subsegmental pulmonary arteries but not in larger orders of arteries, the average co-positivity was 90% (95% Cl = 85%, 95%). Among 22 patients with PE limited to the subsegmental arteries, the average co-positivity was 66% (95% Cl = 46%, 86%). CONCLUSION Conventional pulmonary angiography is not precise for the diagnosis of PE limited to subsegmental arteries. To evaluate subsegmental arteries, techniques that improve the visualization of PE in small arteries should be used.

[1]  J. Wilson,et al.  An improved pulmonary angiographic technique using a balloon-tipped catheter. , 1976, The American review of respiratory disease.

[2]  T L Chenevert,et al.  Diagnosis of pulmonary embolism with magnetic resonance angiography. , 1997, The New England journal of medicine.

[3]  P. Stein,et al.  Wedge arteriography for the identification of pulmonary emboli in small vessels. , 1971, American heart journal.

[4]  A. Alavi,et al.  Complications and Validity of Pulmonary Angiography in Acute Pulmonary Embolism , 1992, Circulation.

[5]  L. Dexter,et al.  Pulmonary cineangiography in acute pulmonary embolism. , 1972, American heart journal.

[6]  P. Investigators,et al.  Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). , 1990 .

[7]  L. Goodman,et al.  Diagnosis of acute pulmonary embolism: time for a new approach. , 1996, Radiology.

[8]  J. D. Garnic,et al.  Reliability of selective pulmonary arteriography in the diagnosis of pulmonary embolism. , 1987, AJR. American journal of roentgenology.

[9]  E. Angtuaco,et al.  Angiography of pulmonary emboli: digital studies and balloon-occlusion cineangiography. , 1984, AJR. American journal of roentgenology.

[10]  J. W. Henry,et al.  Prevalence of Acute Pulmonary Embolism in Central and Subsegmental Pulmonary Arteries and Relation to Probability Interpretation of Ventilation/Perfusion Lung Scans , 1997 .

[11]  J. Bookstein Segmental arteriography by pulmonary embolism. , 1969, Radiology.

[12]  P. Stein Opinion Response to Acute Pulmonary Embolism: The Role of Computed Tomographic Imaging , 1997 .

[13]  J. Leyendecker,et al.  Effect of anatomic distribution of pulmonary emboli on interobserver agreement in the interpretation of pulmonary angiography. , 1998, AJR. American journal of roentgenology.