• Gudula J A M Boon, Pushpa M Jairam, Gerie M C Groot, Cornelis J van Rooden, Yvonne M Ende-Verhaar, BeenenLudo F MLFMDepartment of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands., KroftLucia J MLJMDepartment of Radiology, Leiden University Medical Center, Leiden, the Netherlands., Harm Jan Bogaard, Menno V Huisman, Petr Symersky, Anton Vonk Noordegraaf, Lilian J Meijboom, and Frederikus A Klok.
• Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: g.j.a.m.boon@LUMC.nl.
• Eur. J. Intern. Med. 2021 Nov 1; 93: 647064-70.

BackgroundExpert reading often reveals radiological signs of chronic thromboembolic pulmonary hypertension (CTEPH) or chronic PE on computed tomography pulmonary angiography (CTPA) performed at the time of acute pulmonary embolism (PE) presentation preceding CTEPH. Little is known about the accuracy and reproducibility of CTPA reading by radiologists in training in this setting.ObjectivesTo evaluate 1) whether signs of CTEPH or chronic PE are routinely reported on CTPA for suspected PE; and 2) whether CTEPH-non-expert readers achieve comparable predictive accuracy to CTEPH-expert radiologists after dedicated instruction.MethodsOriginal reports of CTPAs demonstrating acute PE in 50 patients whom ultimately developed CTEPH, and those of 50 PE who did not, were screened for documented signs of CTEPH. All scans were re-assessed by three CTEPH-expert readers and two CTEPH-non-expert readers (blinded and independently) for predefined signs and overall presence of CTEPH.ResultsSigns of chronic PE were mentioned in the original reports of 14/50 cases (28%), while CTEPH-expert radiologists had recognized 44/50 (88%). Using a standardized definition (≥3 predefined radiological signs), moderate-to-good agreement was reached between CTEPH-non-expert readers and the experts' consensus (k-statistics 0.46; 0.61) at slightly lower sensitivities. The CTEPH-non-expert readers had moderate agreement on the presence of CTEPH (κ-statistic 0.38), but both correctly identified most cases (80% and 88%, respectively).ConclusionsConcomitant signs of CTEPH were poorly documented in daily practice, while most CTEPH patients were identified by CTEPH-non-expert readers after dedicated instruction. These findings underline the feasibility of achieving earlier CTEPH diagnosis by assessing CTPAs more attentively.Copyright © 2021. Published by Elsevier B.V.

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