PULMONARY-EMBOLISM - COMPARISON OF CUT-FILM AND DIGITAL PULMONARY ANGIOGRAPHY

PURPOSE: To compare ''cut-film'' (film hard-copy) angiography (CFA) wi th digital pulmonary angiography in the detection of pulmonary embolis m (PE). MATERIALS AND METHODS: Thirty-six adult-patients (39 lungs) un derwent selective digital pulmonary angiography for suspected PE. Imag ing was repeated in one selected projection by using cut film. The sta ndard was consensus interpretation of both CFA and digital angiographi c images and clinical course. Three Vascular : radiologists subsequent ly reviewed the digital and cut-film images in a blinded fashion and r anked the likelihood of the presence of PE on a five-point scale. The two. modalities were compared by means of receiver operating character istic (ROC) analysis. image quality tie, sharpness, opacification of s ubsegmental vessels, and exposure) was judged on a three-point scale. The highest-order pulmonary artery branch seen on each study was recor ded. RESULTS: ROC curve analyses for all three operators showed simila r diagnostic performance for digital pulmonary angiography and CFA, wi th one operator showing better performance with digital subtraction an giography than with CFA (P = .04). Compared with the final diagnosis, single-plane digital pulmonary angiography had higher sensitivity for the detection:of PE than had CFA. The specificity was 100% for both mo dalities. The mean score in patients with findings positive for PE was higher in the digital pulmonary angiography group than in the CFA gro up (P < .005). There was no difference in the mean score in patients w ho did not have a PE. There also was no difference in the smallest det ectable subsegmental branch (P = .87) or in the average estimate of im age quality. CONCLUSION: Selective digital pulmonary angiography and C FA offer similar diagnostic performance and image quality. Digital pul monary angiography is a reasonable alternative to CFA in the diagnosis of PE.