EKG-gated digital subtraction angiography in the detection of pulmonary emboli.

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Abstract
Detection of pulmonary emboli was investigated using electrocardiographically gated (ECG-gated) i.v. digital subtraction angiography (DSA) in 6 anesthetized and paralyzed dogs. Six autologous blood clots were introduced into the internal jugular vein of each dog, and both conventional pulmonary angiography and ECG-gated DSA performed in frontal and oblique projections. When 2 observers scored any definite or equivocal embolus as positive, sensitivity was 82.1% for one and 92.9% for the other; the respective positive predictive values (PPV) were 88.5 and 65%. When only definite emboli were considered positive, sensitivity was 75% for one observer and 71.4% for the other; PPV was 100% for both. DSA evidently can demonstrate individual emboli with good sensitivity and excellent precision. If several emboli are present, ECG-gated DSA should prove highly accurate; however, care must be taken because overinterpretation is more likely with DSA than with conventional pulmonary angiography.