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Volume 12
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10.3390/jcdd12090333
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Review

Advancements in Acute Pulmonary Embolism Diagnosis and Treatment: A Narrative Review of Emerging Imaging Techniques and Intravascular Interventions

by
Michaela Cellina
1,*,
Matilde Pavan
2,
Niccolò Finardi
2,
Francesco Cicchetti
2,
Maurizio Cè
3,
Pierpaolo Biondetti
3,
Carolina Lanza
3,
Serena Carriero
3 and
Gianpaolo Carrafiello
2,3
1
Radiology Department, ASST Fatebenefratelli Sacco, Ospedale Fatebenefratelli, Piazza Principessa Clotilde 3, 20121 Milan, Italy
2
Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
3
Radiology Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy
*
Author to whom correspondence should be addressed.
J. Cardiovasc. Dev. Dis. 2025, 12(9), 333; https://doi.org/10.3390/jcdd12090333
Submission received: 30 May 2025 / Revised: 25 August 2025 / Accepted: 26 August 2025 / Published: 29 August 2025
(This article belongs to the Special Issue Advances in Cardiovascular Imaging: An Exciting Future to Revolutionize the Diagnosis and Management of Cardiovascular Disease)
Versions Notes

Abstract

Acute pulmonary embolism (APE) represents a significant cause of morbidity and mortality worldwide, requiring rapid and precise diagnosis and effective therapy strategies. Computed Tomography Pulmonary Angiography (CTPA) is currently the gold standard technique for diagnosing PE; however, it presents some disadvantages, including limited sensitivity in detecting sub-segmental emboli and contrast-related risks. Recent advancements in imaging technologies, including Dual-Energy Computed Tomography (DECT) and Photon Counting (PC), offer improved sensitivity and specificity for APE and perfusion abnormalities detection. Digital Dynamic Radiography (DDR) perfusion imaging represents a novel imaging that allows pulmonary perfusion assessment without contrast medium administration, able to detect anomalies at the patient’s bedside, representing a promising advancement, particularly for critically ill or contrast-allergic patients. In parallel, interventional radiology has become integral to APE management, particularly for high-risk and intermediate–high-risk patients, with evolving intravascular treatment techniques such as catheter-directed thrombolysis, mechanical thrombectomy, and thrombus aspiration. This narrative review provides an overview of the latest developments in APE diagnostic imaging and interventional radiology, contextualizing them within current guideline recommendations for endovascular treatment.
Keywords: pulmonary embolism; photon counting CT; DECT; mechanical thrombectomy; catheter-directed thrombolysis pulmonary embolism; photon counting CT; DECT; mechanical thrombectomy; catheter-directed thrombolysis

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MDPI and ACS Style

Cellina, M.; Pavan, M.; Finardi, N.; Cicchetti, F.; Cè, M.; Biondetti, P.; Lanza, C.; Carriero, S.; Carrafiello, G. Advancements in Acute Pulmonary Embolism Diagnosis and Treatment: A Narrative Review of Emerging Imaging Techniques and Intravascular Interventions. J. Cardiovasc. Dev. Dis. 2025, 12, 333. https://doi.org/10.3390/jcdd12090333

AMA Style

Cellina M, Pavan M, Finardi N, Cicchetti F, Cè M, Biondetti P, Lanza C, Carriero S, Carrafiello G. Advancements in Acute Pulmonary Embolism Diagnosis and Treatment: A Narrative Review of Emerging Imaging Techniques and Intravascular Interventions. Journal of Cardiovascular Development and Disease. 2025; 12(9):333. https://doi.org/10.3390/jcdd12090333

Chicago/Turabian Style

Cellina, Michaela, Matilde Pavan, Niccolò Finardi, Francesco Cicchetti, Maurizio Cè, Pierpaolo Biondetti, Carolina Lanza, Serena Carriero, and Gianpaolo Carrafiello. 2025. "Advancements in Acute Pulmonary Embolism Diagnosis and Treatment: A Narrative Review of Emerging Imaging Techniques and Intravascular Interventions" Journal of Cardiovascular Development and Disease 12, no. 9: 333. https://doi.org/10.3390/jcdd12090333

APA Style

Cellina, M., Pavan, M., Finardi, N., Cicchetti, F., Cè, M., Biondetti, P., Lanza, C., Carriero, S., & Carrafiello, G. (2025). Advancements in Acute Pulmonary Embolism Diagnosis and Treatment: A Narrative Review of Emerging Imaging Techniques and Intravascular Interventions. Journal of Cardiovascular Development and Disease, 12(9), 333. https://doi.org/10.3390/jcdd12090333

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