Abstract
Abstract
Objectives
Evaluate the prevalence of true-positive and false-positive incidental pulmonary embolism (iPE) diagnoses and the impact of expert review on diagnostic accuracy.
Methods
This single-center retrospective study included consecutive contrast-enhanced thoracic CT examinations without dedicated PE protocols which reported iPE over an 18-month period (2022-24). Electronic health records were reviewed to identify requests to confirm PE based on previous non-dedicated studies. Studies identifying iPE were graded from 1 (most certain) to 5 by original report diagnostic certainty and compared between PE-positive and PE-negative subgroups using Fisher’s exact test. Identified imaging received retrospective expert review to calculate expert agreement with CTPA, where CTPA had been performed, using Cohen’s kappa.
Results
Of 25 214 CT examinations, 260 (1%) reported iPE (mean age 73 ± 12 years; 51% women). Of these, 25% (n = 65/260) underwent confirmatory CTPA. Patients receiving CTPA had lower initial iPE diagnostic certainty (median 3 versus 1, P
Conclusions
Expert review could be an effective tool to reduce CTPA requirement in cases of intermediate (grade 3) iPE diagnostic certainty.
Advances in knowledge
Low-certainty incidental pulmonary embolism diagnoses on initial non-dedicated CT are more likely to be false-positives according to CTPA findings or expert thoracic radiologist review. Expert review of initial CT may therefore reduce excessive imaging and avoid treating false-positive cases.