The diagnostic accuracy and impact of computer-aided diagnosis of pulmonary emboli using CT pulmonary angiography

The diagnosis of pulmonary embolism (PE) remains a challenge to treating physicians as PE can occur unpredictably and fast and the symptoms are often unspecific in some patients. This ultimately means that adequate and accurate diagnosis of PE is crucial and necessary. CT pulmonary angiography (CTPA) is the imaging of choice for patients with suspected PE. However, small PE could potentially be missed resulting in morbidity and mortality if left untreated. The primary objective of this literature review is to summarise and analyse the diagnostic accuracy and impact of computer-aided diagnosis (CAD) software within the current literature to diagnose a PE on a CTPA examination. The current findings suggest that CAD technology as a “first reader” has a comparable sensitivity but substantially decreased specificity compared to radiologist read studies. CAD technology as a “second reader” or “concurrent reader” has a higher sensitivity and comparable specificity. The increase in sensitivity is small at this stage and reading time has been reported as increasing with CAD technology as a second reader. CAD as “concurrent reader” is unlikely to achieve FDA approval due to the theoretical possibility of missing a lesion.