Identification of pulmonary embolism: diagnostic accuracy of venous-phase dual-energy CT in comparison to pulmonary arte
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Identification of pulmonary embolism: diagnostic accuracy of venous-phase dual-energy CT in comparison to pulmonary arteries CT angiography Giovanni Foti 1 & Ronaldo Silva 2 & Niccolò Faccioli 3 & Alessandro Fighera 3 & Rossella Menghini 3 & Arianna Campagnola 3 & Giovanni Carbognin 1 Received: 3 June 2020 / Revised: 27 July 2020 / Accepted: 11 September 2020 # European Society of Radiology 2020
Abstract Objectives To evaluate the diagnostic accuracy of venous-phase dual-energy computed tomography (VP-DECT) in the identification of PE compared with standard CT pulmonary angiography (CTPA). Methods This prospective IRB-approved study included 61 consecutive oncology patients (35 females, 26 males, mean age 66.91 years) examined by CTPA and VP-DECT. DECT data were post-processed on a SyngoVia workstation to obtain monoenergetic images (MEI+). The diagnosis of PE was based on the presence of any vascular perfusion defects. DECT images were evaluated independently by two radiologists (8 and 16 years of experience). A consensus reading of CTPA images (two senior radiologists, 18 and 24 years of experience) represented the reference for diagnosis. The diagnostic accuracy values of VPDECT on a per-patient and per-lobe basis were assessed. Interobserver agreement was calculated using k-statistics. A value of p < 0.05 was considered statistically significant. Results Thirty of 61 patients (49.18%) were diagnosed with PE by CTPA, with 57/366 lobes being involved (15.57%). The sensitivity and specificity of the per-patient analysis of VP-DECT images were 90.0% (27/30) and 100% (31/31) respectively, for both readers. As concerns the per-lobe analysis, the sensitivity ranged from 100% for the right lower lobe to 50% for the left upper lobe for reader 1, and from 100% for the left upper lobe to 69.23% for the lingula for reader 2. The interobserver agreement ranged from 0.8671 (patients’ analysis) to 0.6419 (lobes’ analysis). Conclusion VP-DECT could be considered an accurate imaging tool for diagnosing PE in a selected, high-prevalence population, compared with CTPA. Key Points • With regard to the patients’ analysis, venous-phase DECT sensitivity and specificity in diagnosing pulmonary embolism were 90% and 100%, respectively, for both readers. • With regard to the lobes’ analysis, the sensitivity ranged from 100 to 50%, for reader 1, and from 100 to 69.23%, for reader 2, respectively. • The sensitivity and specificity of lung perfusion maps obtained from venous DECT were 73.33% and 67.74% as concerns the patients’ analysis and 71.92% and 75.72% as regards the lobes’ analysis, respectively. Keywords Lung . Multidetector computed tomography . Pulmonary embolism . Computed tomography angiography . Sensitivity and specificity
* Giovanni Foti [email protected]; [email protected] 1
Department of Radiology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni 1, 37024 Negrar, VR, Italy
2
Clinical Research Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
3
Department of Radiology, Verona U
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