Comprehensive review of pulmonary embolism imaging: past, present and future innovations in computed tomography (CT) and other diagnostic techniques

Abstract

Pulmonary embolism (PE) remains a critical condition that demands rapid and accurate diagnosis, for which computed tomographic pulmonary angiography (CTPA) is widely recognized as the diagnostic gold standard. However, recent advancements in imaging technologies-such as dual-energy computed tomography (DECT), photon-counting CT (PCD-CT), and artificial intelligence (AI)-offer promising enhancements to traditional diagnostic methods. This study reviews past, current and emerging technologies, focusing on their potential to optimize diagnostic accuracy, reduce contrast volumes and radiation doses, and streamline clinical workflows. DECT, with its dual-energy imaging capabilities, enhances image clarity even with lower contrast media volumes, thus reducing patient risk. Meanwhile, PCD-CT has shown potential for dose reduction and superior image resolution, particularly in challenging cases. AI-based tools further augment diagnostic speed and precision by assisting radiologists in image analysis, consequently decreasing workloads and expediting clinical decision-making. Collectively, these innovations hold promise for improved clinical management of PE, enabling not only more accurate diagnoses but also safer, more efficient patient care. Further research is necessary to fully integrate these advancements into routine clinical practice, potentially redefining diagnostic workflows for PE and enhancing patient outcomes.

Keywords: Artificial intelligence (AI); Computed tomographic pulmonary angiography (CTPA); Computer-aid detection (CAD); Dual-energy computed tomography (DECT); Photon-counting detector CT (PCD-CT); Pulmonary embolism (EP).

Fig. 1

Coronal CTA scan that reveals massive arterial occlusion with failure to enhance the entire lumen due to a substantial filling defect of the right lobar arteries

Fig. 2

Axial CTA scan shows massive arterial occlusion with failure to enhance the entire lumen due to a substantial filling defect of both left and right lobar arteries

Fig. 3

Axial CTA scan reveals submassive PE of a right subsegmental lobar artery