Accuracy of CT angiography versus pulmonary angiography in the diagnosis of acute pulmonary embolism: Evaluation of the literature with summary ROC curve analysis

Rationale and Objectives. The authors performed this study to estimate, by using published data, the sensitivity and specificity of computed tomograph ic (CT) angiography in the evaluation of suspected acute pulmonary embolism (PE). Materials and Methods. Summary receiver operating characteristic (ROC) curv e analysis was used to determine the sensitivity and specificity of CT angi ography in the diagnosis of acute PE. Pulmonary angiography was used as the diagnostic standard of reference. The authors reviewed the results of 11 i ndependent studies published in the English-language literature between Jan uary 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 pulmon ary arteries) ranged from 0.74 to 0.81 on the basis of specificities of 0.8 9-0.91. The sensitivity of CT angiography in the diagnosis or exclusion of PE in all pulmonary arteries (to the level of the subsegmental pulmonary ar teries) was 0.68 on the basis of a specificity of 0.91. Conclusion. 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 improv ements in data acquisition, particularly the use of thinner section collima tion and multidetector CT, and in the increased use of workstations for dat a analysis, the accuracy and utility of CT angiography will require continu ed investigation.