Accuracy of CT angiography versus pulmonary angiography in the diagnosis of acute pulmonary embolism: evaluation of the literature with summary ROC curve analysis.
OBJECTIVE
The authors performed this study to estimate, by using published data, the sensitivity and specificity of computed tomographic (CT) angiography in the evaluation of suspected acute pulmonary embolism (PE).


METHODS
Summary receiver operating characteristic (ROC) curve analysis was used to determine the sensitivity and specificity of CT angiography in the diagnosis of acute PE. Pulmonary angiography was used as the diagnostic standard of reference. The authors reviewed the results of 11 independent studies published in the English-language literature between January 1992 and June 1999.


RESULTS
The sensitivity of CT angiography in the diagnosis or exclusion of PE in the central pulmonary arteries (to the level of the segmental pulmonary arteries) ranged from 0.74 to 0.81 on the basis of specificities of 0.89-0.91. The sensitivity of CT angiography in the diagnosis or exclusion of PE in all pulmonary arteries (to the level of the subsegmental pulmonary arteries) was 0.68 on the basis of a specificity of 0.91.


CONCLUSIONS
On the basis of the studies in the current literature, most of which used 5.0-mm collimation and single-detector CT, CT angiography may be less accurate in the diagnosis of PE than previously reported. With improvements in data acquisition, particularly the use of thinner section collimation and multidetector CT, and in the increased use of workstations for data analysis, the accuracy and utility of CT angiography will require continued investigation.
Harvey
R T
RT
Department of Radiology, The Hospital of the University of Pennsylvania, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
Gefter
W B
WB
Hrung
J M
JM
Langlotz
C P
CP
D000792:Angiography / Q000379:methods*; D003937:Diagnosis, Differential; D006801:Humans; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*