Incremental diagnostic quality gain of CTA over V/Q scan in the assessment of pulmonary embolism by means of a Wells score Bayesian model: results from the ACDC collaboration

Laila Cochon, Kaitlin McIntyre, José M. Nicolás, Amado Alejandro Baez

Research output: Contribution to journalArticle

Abstract

Objective: Our objective was to evaluate the diagnostic value of computed tomography angiography (CTA) and ventilation perfusion (V/Q) scan in the assessment of pulmonary embolism (PE) by means of a Bayesian statistical model. Methods: Wells criteria defined pretest probability. Sensitivity and specificity of CTA and V/Q scan for PE were derived from pooled meta-analysis data. Likelihood ratios calculated for CTA and V/Q were inserted in the nomogram. Absolute (ADG) and relative diagnostic gains (RDG) were analyzed comparing post- and pretest probability. Comparative gain difference was calculated for CTA ADG over V/Q scan integrating ANOVA p value set at 0.05. Results: The sensitivity for CT was 86.0% (95% CI: 80.2%, 92.1%) and specificity of 93.7% (95% CI: 91.1%, 96.3%). The V/Q scan yielded a sensitivity of 96% (95% CI: 95%, 97%) and a specificity of 97% (95% CI: 96%, 98%). Bayes nomogram results for CTA were low risk and yielded a posttest probability of 71.1%, an ADG of 56.1%, and an RDG of 374%, moderate-risk posttest probability was 85.1%, an ADG of 56.1%, and an RDG of 193.4%, and high-risk posttest probability was 95.2%, an ADG of 36.2%, and an RDG of 61.35%. The comparative gain difference for low-risk population was 46.1%; in moderate-risk 41.6%; and in high-risk a 22.1% superiority. ANOVA analysis for LR+ and LR− showed no significant difference (p = 0.8745, p = 0.9841 respectively). Conclusions: This Bayesian model demonstrated a superiority of CTA when compared to V/Q scan for the diagnosis of pulmonary embolism. Low-risk patients are recognized to have a superior overall comparative gain favoring CTA.

Original languageEnglish (US)
Pages (from-to)355-359
Number of pages5
JournalEmergency Radiology
Volume24
Issue number4
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

Fingerprint

Pulmonary Embolism
Nomograms
Analysis of Variance
Statistical Models
Computed Tomography Angiography
Ventilation
Meta-Analysis
Perfusion
Sensitivity and Specificity
Population

Keywords

  • Bayesian model
  • CT angiography
  • Pulmonary embolism
  • V/Q scan

ASJC Scopus subject areas

  • Emergency Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Incremental diagnostic quality gain of CTA over V/Q scan in the assessment of pulmonary embolism by means of a Wells score Bayesian model : results from the ACDC collaboration. / Cochon, Laila; McIntyre, Kaitlin; Nicolás, José M.; Baez, Amado Alejandro.

In: Emergency Radiology, Vol. 24, No. 4, 01.08.2017, p. 355-359.

Research output: Contribution to journalArticle

@article{f48395d1b32e4a1c9fd617d310c5d00f,
title = "Incremental diagnostic quality gain of CTA over V/Q scan in the assessment of pulmonary embolism by means of a Wells score Bayesian model: results from the ACDC collaboration",
abstract = "Objective: Our objective was to evaluate the diagnostic value of computed tomography angiography (CTA) and ventilation perfusion (V/Q) scan in the assessment of pulmonary embolism (PE) by means of a Bayesian statistical model. Methods: Wells criteria defined pretest probability. Sensitivity and specificity of CTA and V/Q scan for PE were derived from pooled meta-analysis data. Likelihood ratios calculated for CTA and V/Q were inserted in the nomogram. Absolute (ADG) and relative diagnostic gains (RDG) were analyzed comparing post- and pretest probability. Comparative gain difference was calculated for CTA ADG over V/Q scan integrating ANOVA p value set at 0.05. Results: The sensitivity for CT was 86.0{\%} (95{\%} CI: 80.2{\%}, 92.1{\%}) and specificity of 93.7{\%} (95{\%} CI: 91.1{\%}, 96.3{\%}). The V/Q scan yielded a sensitivity of 96{\%} (95{\%} CI: 95{\%}, 97{\%}) and a specificity of 97{\%} (95{\%} CI: 96{\%}, 98{\%}). Bayes nomogram results for CTA were low risk and yielded a posttest probability of 71.1{\%}, an ADG of 56.1{\%}, and an RDG of 374{\%}, moderate-risk posttest probability was 85.1{\%}, an ADG of 56.1{\%}, and an RDG of 193.4{\%}, and high-risk posttest probability was 95.2{\%}, an ADG of 36.2{\%}, and an RDG of 61.35{\%}. The comparative gain difference for low-risk population was 46.1{\%}; in moderate-risk 41.6{\%}; and in high-risk a 22.1{\%} superiority. ANOVA analysis for LR+ and LR− showed no significant difference (p = 0.8745, p = 0.9841 respectively). Conclusions: This Bayesian model demonstrated a superiority of CTA when compared to V/Q scan for the diagnosis of pulmonary embolism. Low-risk patients are recognized to have a superior overall comparative gain favoring CTA.",
keywords = "Bayesian model, CT angiography, Pulmonary embolism, V/Q scan",
author = "Laila Cochon and Kaitlin McIntyre and Nicol{\'a}s, {Jos{\'e} M.} and Baez, {Amado Alejandro}",
year = "2017",
month = "8",
day = "1",
doi = "10.1007/s10140-017-1486-6",
language = "English (US)",
volume = "24",
pages = "355--359",
journal = "Emergency Radiology",
issn = "1070-3004",
publisher = "Springer New York",
number = "4",

}

TY - JOUR

T1 - Incremental diagnostic quality gain of CTA over V/Q scan in the assessment of pulmonary embolism by means of a Wells score Bayesian model

T2 - results from the ACDC collaboration

AU - Cochon, Laila

AU - McIntyre, Kaitlin

AU - Nicolás, José M.

AU - Baez, Amado Alejandro

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Objective: Our objective was to evaluate the diagnostic value of computed tomography angiography (CTA) and ventilation perfusion (V/Q) scan in the assessment of pulmonary embolism (PE) by means of a Bayesian statistical model. Methods: Wells criteria defined pretest probability. Sensitivity and specificity of CTA and V/Q scan for PE were derived from pooled meta-analysis data. Likelihood ratios calculated for CTA and V/Q were inserted in the nomogram. Absolute (ADG) and relative diagnostic gains (RDG) were analyzed comparing post- and pretest probability. Comparative gain difference was calculated for CTA ADG over V/Q scan integrating ANOVA p value set at 0.05. Results: The sensitivity for CT was 86.0% (95% CI: 80.2%, 92.1%) and specificity of 93.7% (95% CI: 91.1%, 96.3%). The V/Q scan yielded a sensitivity of 96% (95% CI: 95%, 97%) and a specificity of 97% (95% CI: 96%, 98%). Bayes nomogram results for CTA were low risk and yielded a posttest probability of 71.1%, an ADG of 56.1%, and an RDG of 374%, moderate-risk posttest probability was 85.1%, an ADG of 56.1%, and an RDG of 193.4%, and high-risk posttest probability was 95.2%, an ADG of 36.2%, and an RDG of 61.35%. The comparative gain difference for low-risk population was 46.1%; in moderate-risk 41.6%; and in high-risk a 22.1% superiority. ANOVA analysis for LR+ and LR− showed no significant difference (p = 0.8745, p = 0.9841 respectively). Conclusions: This Bayesian model demonstrated a superiority of CTA when compared to V/Q scan for the diagnosis of pulmonary embolism. Low-risk patients are recognized to have a superior overall comparative gain favoring CTA.

AB - Objective: Our objective was to evaluate the diagnostic value of computed tomography angiography (CTA) and ventilation perfusion (V/Q) scan in the assessment of pulmonary embolism (PE) by means of a Bayesian statistical model. Methods: Wells criteria defined pretest probability. Sensitivity and specificity of CTA and V/Q scan for PE were derived from pooled meta-analysis data. Likelihood ratios calculated for CTA and V/Q were inserted in the nomogram. Absolute (ADG) and relative diagnostic gains (RDG) were analyzed comparing post- and pretest probability. Comparative gain difference was calculated for CTA ADG over V/Q scan integrating ANOVA p value set at 0.05. Results: The sensitivity for CT was 86.0% (95% CI: 80.2%, 92.1%) and specificity of 93.7% (95% CI: 91.1%, 96.3%). The V/Q scan yielded a sensitivity of 96% (95% CI: 95%, 97%) and a specificity of 97% (95% CI: 96%, 98%). Bayes nomogram results for CTA were low risk and yielded a posttest probability of 71.1%, an ADG of 56.1%, and an RDG of 374%, moderate-risk posttest probability was 85.1%, an ADG of 56.1%, and an RDG of 193.4%, and high-risk posttest probability was 95.2%, an ADG of 36.2%, and an RDG of 61.35%. The comparative gain difference for low-risk population was 46.1%; in moderate-risk 41.6%; and in high-risk a 22.1% superiority. ANOVA analysis for LR+ and LR− showed no significant difference (p = 0.8745, p = 0.9841 respectively). Conclusions: This Bayesian model demonstrated a superiority of CTA when compared to V/Q scan for the diagnosis of pulmonary embolism. Low-risk patients are recognized to have a superior overall comparative gain favoring CTA.

KW - Bayesian model

KW - CT angiography

KW - Pulmonary embolism

KW - V/Q scan

UR - http://www.scopus.com/inward/record.url?scp=85013839871&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85013839871&partnerID=8YFLogxK

U2 - 10.1007/s10140-017-1486-6

DO - 10.1007/s10140-017-1486-6

M3 - Article

C2 - 28236025

AN - SCOPUS:85013839871

VL - 24

SP - 355

EP - 359

JO - Emergency Radiology

JF - Emergency Radiology

SN - 1070-3004

IS - 4

ER -