The British journal of radiology · 2026
Incidental pulmonary embolism and the value of CT pulmonary angiography follow-up versus expert review.
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Kidson Callum R T, Sohn Hyon-Mok, Page Joseph, Rodrigues Jonathan C L
Аннотация
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 < .01) and 52% (n = 34/65) were PE-positive on CTPA. Patients with false-positive diagnoses had reduced diagnostic certainty on non-dedicated studies compared to those with a true-positive diagnosis (median 3 versus 2, P < .001). Agreement between the expert review of the iPE scan and the ground-truth CTPA diagnosis had κ of 0.96.
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.
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 < .01) and 52% (n = 34/65) were PE-positive on CTPA. Patients with false-positive diagnoses had reduced diagnostic certainty on non-dedicated studies compared to those with a true-positive diagnosis (median 3 versus 2, P < .001). Agreement between the expert review of the iPE scan and the ground-truth CTPA diagnosis had κ of 0.96.
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.