View source for Computed tomographic pulmonary angiography

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In [[diagnostic imaging]], '''computed tomographic pulmonary angiography''', also called '''CT pulmonary angiography''' ('''CTPA'''), is a form of [[x-ray computed tomography]] for examining the pulmonary vessels.<ref name="pmid18165667">{{cite journal |author=Anderson DR, Kahn SR, Rodger MA, ''et al'' |title=Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial |journal=JAMA : the journal of the American Medical Association |volume=298 |issue=23 |pages=2743–53 |year=2007 |month=December |pmid=18165667 |doi=10.1001/jama.298.23.2743 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=18165667 |issn=}}</ref> 

Introduction of computed tomographic pulmonary angiography may have led to overdiagnosis of [[pulmonary embolism]].<ref name="pmid21555660">{{cite journal| author=Wiener RS, Schwartz LM, Woloshin S| title=Time trends in pulmonary embolism in the United States: evidence of overdiagnosis. | journal=Arch Intern Med | year= 2011 | volume= 171 | issue= 9 | pages= 831-7 | pmid=21555660 | doi=10.1001/archinternmed.2011.178 | pmc=PMC3140219 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21555660  }} </ref>

==Methods==

Standards for reporting of the findings of CTPA have been studied.<ref name="pmid19692272">{{cite journal| author=Abujudeh HH, Kaewlai R, Farsad K, Orr E, Gilman M, Shepard JA| title=Computed tomography pulmonary angiography: an assessment of the radiology report. | journal=Acad Radiol | year= 2009 | volume= 16 | issue= 11 | pages= 1309-15 | pmid=19692272 | doi=10.1016/j.acra.2009.06.012 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19692272  }} </ref>

The reproducibility of interpretations of the CTPA by radiologists has been studied.<ref name="pmid16021452">{{cite journal| author=Brunot S, Corneloup O, Latrabe V, Montaudon M, Laurent F| title=Reproducibility of multi-detector spiral computed tomography in detection of sub-segmental acute pulmonary embolism. | journal=Eur Radiol | year= 2005 | volume= 15 | issue= 10 | pages= 2057-63 | pmid=16021452 | doi=10.1007/s00330-005-2844-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16021452  }} </ref><ref name="pmid23245652">{{cite journal| author=Lucassen WA, Beenen LF, Büller HR, Erkens PM, Schaefer-Prokop CM, van den Berk IA et al.| title=Concerns in using multi-detector computed tomography for diagnosing pulmonary embolism in daily practice. A cross-sectional analysis using expert opinion as reference standard. | journal=Thromb Res | year= 2013 | volume= 131 | issue= 2 | pages= 145-9 | pmid=23245652 | doi=10.1016/j.thromres.2012.11.027 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23245652  }} </ref>

==Pulmonary embolism==
;Role in diagnosis
Assessing the ''accuracy'' of CT pulmonary angiography is hindered by the rapid changes in the number of rows of detectors available in multidetector CT (MDCT) machines.<ref name="pmid16479644">{{cite journal |author=Schaefer-Prokop C, Prokop M |title=MDCT for the diagnosis of acute pulmonary embolism |journal=European radiology |volume=15 Suppl 4 |issue= |pages=D37-41 |year=2005 |pmid=16479644 |doi=}}</ref> The PIOPED II study used a mixture of 4 slice and 16 slice scanners and reported a [[sensitivity (tests)|sensitivity]] of 83% and a [[specificity (tests)|specificity]] of 96%. This study noted that additional testing is necessary when the clinical probability is inconsistent with the imaging results.<ref name="pmid16738268">{{cite journal |author=Stein PD, Fowler SE, Goodman LR, ''et al'' |title=Multidetector computed tomography for acute pulmonary embolism |journal=N. Engl. J. Med. |volume=354 |issue=22 |pages=2317-27 |year=2006 |pmid=16738268 |doi=10.1056/NEJMoa052367}}</ref>

;Role in Prognosis
Two [[systematic review]]s<ref name="pmid15855435">{{cite journal |author=Quiroz R, Kucher N, Zou KH, ''et al'' |title=Clinical validity of a negative computed tomography scan in patients with suspected pulmonary embolism: a systematic review |journal=JAMA : the journal of the American Medical Association |volume=293 |issue=16 |pages=2012–7 |year=2005 |month=April |pmid=15855435 |doi=10.1001/jama.293.16.2012 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=15855435 |issn=}}</ref><ref name="pmid15583229">{{cite journal |author=Moores LK, Jackson WL, Shorr AF, Jackson JL |title=Meta-analysis: outcomes in patients with suspected pulmonary embolism managed with computed tomographic pulmonary angiography |journal=Annals of internal medicine |volume=141 |issue=11 |pages=866–74 |year=2004 |month=December |pmid=15583229 |doi= |url= |issn=}}</ref> and two more recent [[randomized controlled trial]]s<ref name="pmid18424324">{{cite journal |author=Righini M, Le Gal G, Aujesky D, ''et al'' |title=Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial |journal=Lancet |volume=371 |issue=9621 |pages=1343–52 |year=2008 |month=April |pmid=18424324 |doi=10.1016/S0140-6736(08)60594-2 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(08)60594-2 |issn=}}</ref><ref name="pmid18165667">{{cite journal |author=Anderson DR, Kahn SR, Rodger MA, Kovacs MJ, Morris T, Hirsch A, Lang E, Stiell I, Kovacs G, Dreyer J, Dennie C, Cartier Y, Barnes D, Burton E, Pleasance S, Skedgel C, O'Rouke K, Wells PS |title=Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial |journal=JAMA |volume=298 |issue=23 |pages=2743-53 |year=2007 |pmid=18165667 |doi=10.1001/jama.298.23.2743 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=18165667 |issn=}}</ref> have studied ''prognosis'' after a negative CTPA.

;Overuse
The test may be overused.<ref name="pmid23167851">{{cite journal| author=Crichlow A, Cuker A, Mills AM| title=Overuse of computed tomography pulmonary angiography in the evaluation of patients with suspected pulmonary embolism in the emergency department. | journal=Acad Emerg Med | year= 2012 | volume= 19 | issue= 11 | pages= 1219-26 | pmid=23167851 | doi=10.1111/acem.12012 | pmc=PMC3506180 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23167851  }} </ref>

==References==
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