Imaging techniques for the diagnosis of pulmonary embolism

Donia Aghajanzadeh¹, Natig Gassanov¹, Matthias Schmidt², Nasser Semmo³, Fikret Er^1
1Department of Internal Medicine III, ²Department of Nuclear Medicine, University of Cologne, Cologne, Germany; ³Department of Medicine II, University Hospital Freiburg, Freiburg, Germany

Abstract: Pulmonary embolism (PE) is a cardiovascular emergency with high morbidity and mortality. The diagnostic workup of patients with suspected acute PE remains difficult due to a wide spectrum of clinical presentations. There is still no diagnostic test that is accurate, safe, readily available, and cost-effective. Pulmonary angiography has a high diagnostic accuracy, but it is an invasive and resource-demanding procedure. Noninvasive imaging tests including computerized tomographic pulmonary angiography and ventilation/perfusion scanning are well validated for the diagnosis of PE, but have limited sensitivity and specificity. For optimal efficiency, the choice of the initial imaging modality should be guided by the clinical probability assessment and D-dimer testing. This review covers the performance of different diagnostic tests and presents a diagnostic algorithm for PE diagnosis.

Keywords: pulmonary embolism, diagnosis, algorithm, imaging, cardiovascular, mortality