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Routine CTV Not Needed for Suspected PE

February 7, 2008
Written by: , Filed in: Abdominal Imaging, Chest Radiology
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The objective of a recent study was to assess routine pelvic and lower extremity CT venography (CTV) in patients evaluated for suspected pulmonary embolism (PE).

The study has concluded that for patients suspected of having PE, indirect CTV in addition to CTA of the pulmonary arteries has the greatest yield in patients with a history of venous thromboembolism or with a history of malignancy.

Participants
829 patients who underwent CT angiography (CTA) in combination with CTV participated in this retrospective study.

Methodology
Based on review of the hospital computer database, a patient history of malignancy, previous venous thromboembolism (VTE), cardiovascular disease, or prior surgery within 1 month was recorded. Patients with any of these diseases were considered to be high-risk cases. All other patients were considered to be low-risk cases.

Symptoms of pleuritic chest pain, tachycardia, shortness of breath, tachypnea, and hemoptysis were also recorded.

All CTs were performed with a 16- or 64-MDCT scanner. All PE studies were followed by indirect CTV. The protocol for the CTV was imaging of the pelvis to the popliteal fossa 3 minutes after the CTA. Images were displayed with 10-mm thickness at 30-mm intervals.

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Results of the Study
VTE occurred in 152 patients (18.3%), PE in 124 (15.0%), and deep vein thrombosis (DVT) in 61 (7.3%). The prevalence of VTE was 114 of 446 within the high-risk group (25.6%) and 38 of 383 within the low-risk group (9.9%). The presence of PE was 92 of 446 within the high-risk group (20.6%) and 32 of 383 within the low-risk group (8.3%). DVT without PE was seen in 28 of 829 patients (3.4%).

The additional value of adding CTV to CTA for the diagnosis of VTE was 3.4% for all patients as a cohort, 0.72% for just the low-risk group (n=6), and 2.6% for just the high-risk group (n=22).

As a predictor of VTE or PE, a history of malignancy and a history of prior VTE were significant. As a predictor of DVT, a history of prior VTE was significant.

Conclusions
Performing indirect CTV in addition to CTA in all patients suspected of having PE has a low yield in low-risk patients. It has most incremental value in patients with a prior history of VTE and possibly in patients with a history of malignancy.

Reviewer’s Comments
The authors have nicely demonstrated the preexisting patient conditions that will most benefit from the addition of indirect CT venography to a CT PE protocol.

Author: Vineet R. Jain, MD

Reference:
Hunsaker AR, Zou KH, et al. Routine Pelvic and Lower Extremity CT Venography in Patients Undergoing Pulmonary CT Angiography.
AJR Am J Roentgenol; 2008; 190 (February): 322-326

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