Reassessment of pulmonary angiography for the diagnosis of pulmonary embolism: relation of interpreter agreement to the order of the involved pulmonary arterial branch.
Stein PD, Henry JW, Gottschalk A
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.
Publication Types:
Multicenter study
PMID: 10207468, UI: 99223875
