Diagnostic Yield of CT Pulmonary Angiogram in the Diagnosis of Pulmonary Embolism and Its Predictive Factors

Chooi Leng Low; Ren Yi Kow; Azian Abd Aziz; Mubarak Mohd Yusof; Bee Chiu Lim; Norie Azilah Kamarudin; Ahmad Razali Md Ralib Md Raghib

doi:10.7759/cureus.40484

Diagnostic Yield of CT Pulmonary Angiogram in the Diagnosis of Pulmonary Embolism and Its Predictive Factors

Cureus. 2023 Jun 15;15(6):e40484. doi: 10.7759/cureus.40484. eCollection 2023 Jun.

Authors

Chooi Leng Low¹, Ren Yi Kow², Azian Abd Aziz¹, Mubarak Mohd Yusof³, Bee Chiu Lim⁴, Norie Azilah Kamarudin³, Ahmad Razali Md Ralib Md Raghib¹

Affiliations

¹ Department of Radiology, International Islamic University Malaysia, Kuantan, MYS.
² Department of Orthopaedics, Traumatology and Rehabilitation, International Islamic University Malaysia, Kuantan, MYS.
³ Department of Radiology, Hospital Tengku Ampuan Afzan, Kuantan, MYS.
⁴ Clinical Research Centre, Hospital Tengku Ampuan Afzan, Kuantan, MYS.

Abstract

Introduction Computed tomography pulmonary angiography (CTPA) is the reference investigation of choice to diagnose pulmonary embolism (PE). Nevertheless, the use of CTPA should be weighed against its risks, such as radiation and contrast-induced nephropathy. We aim to assess the yield of CTPA in diagnosing PE at a tertiary centre in Malaysia. We also identify predictive factors associated with the yield of CTPA in this cohort. Methods This was a cross-sectional study involving all patients who had had CTPA done at Hospital Tengku Ampuan Afzan, Kuantan, Malaysia, from January 1, 2021, to November 30, 2021. All patients' records were retrieved and reviewed. CTPA images were retrieved from the Radiology Information System (RIS) and Picture Archiving and Communication System (PACS). They were double-reviewed by the authors, with the initial reports redacted from reporting radiologists to prevent reporting bias. The predictive factors were determined using simple logistic regression and multiple logistic regression. Results A total of 351 CTPAs were reviewed, of which 93 were found to be positive for PE, giving rise to an overall CTPA yield of 26.5%. Upon simple logistic regression, factors such as gender, discipline, history of trauma, presence of COVID-19 infection, and pneumonia were found to be associated with positive CTPA. Upon multiple logistic regression, male patients were found to have a higher chance of positive CTPA results. On the other hand, patients with COVID-19 infection and pneumonia have a lower chance of positive results in CTPA. Conclusion The yield of CTPA in diagnosing PE at our institution was acceptable at 26.5%. Upon multiple logistic regression, patients with COVID-19 infection and pneumonia were more likely to have a negative CTPA result, highlighting the need for clinicians to be more prudent in requesting CTPAs in these patients.

Keywords: computed tomography (ct ); covid 19; multidetector computed tomography (ct) pulmonary angiography (ctpa); pneumonia; predictive risk factors; pulmonary disease; pulmonary embolism (pe); risk scoring system.