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Semin intervent Radiol
DOI: 10.1055/s-0045-1806735
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What the Interventional Radiologist Needs to Know about Imaging Studies for the Detection, Risk Stratification, and Short- and Long-Term Follow-up of Pulmonary Embolism

Jacob Ref
1   Department of Internal Medicine, University of California – Irvine Medical Center, Orange, California
,
Tammer El-Aini
2   Division of Pulmonology, Banner – University Medical Center, Tucson, Arizona
,
Michael Insel
2   Division of Pulmonology, Banner – University Medical Center, Tucson, Arizona
,
Tushar Acharya
3   Division of Cardiology, Banner – University Medical Center, Tucson, Arizona
,
Jack Hannallah
4   Division of Interventional Radiology, Banner – University Medical Center, Tucson, Arizona
,
Daniel Goldberg
4   Division of Interventional Radiology, Banner – University Medical Center, Tucson, Arizona
,
Lucas Struycken
4   Division of Interventional Radiology, Banner – University Medical Center, Tucson, Arizona
,
Shamar Young
4   Division of Interventional Radiology, Banner – University Medical Center, Tucson, Arizona
,
Gregory Woodhead
4   Division of Interventional Radiology, Banner – University Medical Center, Tucson, Arizona
› Author Affiliations
Funding This project received no outside funding resources.
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Pulmonary embolism (PE) is a life-threatening condition that can present in the form of acute PE and chronic PE. Acute PE is one of the leading causes of cardiovascular death, accounting for 100,000 to 200,000 deaths per year in the United States alone,[1] [2] [3] and is expected to be the third leading cause of death among hospitalized patients at large.[4] In the United States, 600,000 patients are diagnosed with PE[5] every year and can be attributed to underlying genetic conditions (i.e., thrombophilia), acquired conditions (i.e., postsurgery/immobilization/malignancy), or acquired hypercoagulable states (i.e., obesity).

Chronic PE, better known as chronic thromboembolic pulmonary hypertension (CTEPH), is a variant of pulmonary hypertension that is potentially curable through two different procedures (thromboendarterectomy and balloon angioplasty).[6] A combination of noninvasive techniques can be used to assess both anatomic and functional information related to CTEPH: lung scintigraphy, computed tomography, and magnetic resonance angiography.[7]

The management of PE has evolved significantly in recent years, with imaging playing a central role throughout the patient journey. From initial diagnosis to long-term follow-up, various imaging modalities provide crucial information that guides clinical decision-making and patient care. The concept behind the pathophysiology and treatment for patients can be best understood if one considers the right heart and pulmonary arteries as one functional unit, emphasizing the importance of comprehensive imaging approaches.

This review will focus on the utilization of imaging studies during the detection, risk-stratification, and short-term, as well as long-term follow-up after acute PE. We will explore the strengths and limitations of different imaging modalities, including computed tomography pulmonary angiography (CTPA), echocardiography, ventilation/perfusion (V/Q) scanning, and cardiac magnetic resonance imaging (CMR). Additionally, we will discuss emerging technologies and techniques that promise to enhance our ability to diagnose, risk-stratify, and monitor patients with PE.

As interventional radiologists increasingly play a pivotal role in the management of PE, a thorough understanding of the imaging landscape is essential. This review aims to provide a comprehensive overview of current practices and future directions in PE imaging, equipping interventional radiologists with the knowledge to optimize patient care in this complex and evolving field.

Authors' Contributions

J.R.—manuscript drafting, figure creation, manuscript editing, compilation of all edits.


T.E-A.—senior physician-scientist, provided scientific guidance, assisted with manuscript drafting, and provided clinical context.


M.I.—senior physician-scientist, provided scientific guidance.


T.A.—senior physician-scientist, provided scientific guidance, assisted with manuscript drafting, and provided clinical context.


J.H.—senior physician-scientist, provided scientific guidance.


D.G.—senior physician-scientist, provided scientific guidance.


L.S.—senior physician-scientist, provided scientific guidance.


S.Y.—senior physician-scientist, provided scientific guidance.


G.W.—senior physician-scientist, provided scientific guidance, assisted with manuscript drafting, and provided clinical context.




Publication History

Article published online:
02 June 2025

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