Clinical usefulness of computed tomography study without contrast injection in the evaluation of acute pulmonary embolism

Objective: To evaluate the percentage of cases in which emboli can be detected in unenhanced scans and to identify the cases in which they appear hyperattenuating or hypoattenuating in comparison to the circulating blood. Method: An angio-computed tomography (CT) scan was performed before and after contrast injection in 140 consecutive patients after clinical suspicion of pulmonary embolism. A radiologist analyzed the examination results thus obtained. The enhanced scan was analyzed first, and after detecting the thrombus, the unenhanced scan was evaluated. Results: Fifty-one examinations were positive for a pulmonary embolism; in 21 cases, it was possible to identify the embolus even in the unenhanced scans. In 10 cases, the clots were hyperattenuating in comparison to the circulating blood; in 5 cases, they were hypoattenuating; and in 6 cases, they were mixed hyper-hypoattenuating. Conclusion: In a relatively high percentage of cases, particularly those of central thromboembolism, it is possible to identify and characterize the clots even in unenhanced scans.