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Background <p>Computed Tomography Pulmonary Angiography (CTPA) is the gold standard for diagnosing acute Pulmonary Embolism (PE). However, overlapping symptoms and reliance on non-specific biomarkers often lead to over-testing. This study provides a comprehensive analysis of CTPA utilization, evaluating diagnostic yield, biomarker performance, and the landscape of alternative thoracic diagnoses with a special focus on radioprotection.</p> Methods <p>A retrospective, single-centre study of 659 patients evaluated in the Emergency Department (ED) between January 2023 and November 2025. Data were extensively stratified by patient age, presenting symptoms, D-dimer thresholds, and radiological outcomes.</p> Results <p>The global diagnostic yield was 20.9% (138/659). Advanced age correlated linearly with PE prevalence (25.2% in patients &gt; 70&#xa0;years) but inversely with D-dimer specificity, resulting in a 42% false-positive biomarker rate in the geriatric cohort. Dyspnea was the most common presenting symptom (62%) but demonstrated limited diagnostic specificity for PE. Crucially, in the 521 PE-negative scans, CTPA provided clinically relevant alternative diagnoses in 72.0% of cases (375/521), primarily infectious consolidations and heart failure.</p> Conclusion <p>While clinical triage remains within optimal international benchmarks, the standard diagnostic algorithm is heavily confounded by patient age and inflammatory "PE mimics." Integrating age-adjusted D-dimer thresholds and structured pre-test probability scoring is imperative to optimize resource allocation and mitigate unnecessary radiation exposure while preserving diagnostic safety (Righini in JAMA 311:1117–1124, 2014;Konstantinides in Eur Heart J 41:543–603, 2020;).</p> Graphical Abstract <p></p>

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Beyond the clot: diagnostic yield, biomarker performance, and the landscape of alternative diagnoses in emergency CT pulmonary angiography

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月30日

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  • Francesco Lionetti,
  • Federica Castelli,
  • Giovanni Scavone,
  • Giacomo Tamburino,
  • Salvatore Seminatore,
  • Daniele Carmelo Caltabiano,
  • Luca Mammino,
  • Antonio Basile,
  • Maria Vittoria Raciti,
  • Gianluca Galvano

摘要

Background

Computed Tomography Pulmonary Angiography (CTPA) is the gold standard for diagnosing acute Pulmonary Embolism (PE). However, overlapping symptoms and reliance on non-specific biomarkers often lead to over-testing. This study provides a comprehensive analysis of CTPA utilization, evaluating diagnostic yield, biomarker performance, and the landscape of alternative thoracic diagnoses with a special focus on radioprotection.

Methods

A retrospective, single-centre study of 659 patients evaluated in the Emergency Department (ED) between January 2023 and November 2025. Data were extensively stratified by patient age, presenting symptoms, D-dimer thresholds, and radiological outcomes.

Results

The global diagnostic yield was 20.9% (138/659). Advanced age correlated linearly with PE prevalence (25.2% in patients > 70 years) but inversely with D-dimer specificity, resulting in a 42% false-positive biomarker rate in the geriatric cohort. Dyspnea was the most common presenting symptom (62%) but demonstrated limited diagnostic specificity for PE. Crucially, in the 521 PE-negative scans, CTPA provided clinically relevant alternative diagnoses in 72.0% of cases (375/521), primarily infectious consolidations and heart failure.

Conclusion

While clinical triage remains within optimal international benchmarks, the standard diagnostic algorithm is heavily confounded by patient age and inflammatory "PE mimics." Integrating age-adjusted D-dimer thresholds and structured pre-test probability scoring is imperative to optimize resource allocation and mitigate unnecessary radiation exposure while preserving diagnostic safety (Righini in JAMA 311:1117–1124, 2014;Konstantinides in Eur Heart J 41:543–603, 2020;).

Graphical Abstract