CT pulmonary angiography (CTPA) is the gold standard for diagnosing acute pulmonary embolism (PE), an emergency condition that manifests as a filling defect in the pulmonary artery (PA). The thrombus burden and the level of propagation within the PA tree are among the key indicators of right heart strain and predictors of adverse outcomes. The subjective nature of the assessment and the experience of the radiologist may affect the findings of CTPA.

This retrospective study included 61 CTPAs with confirmed PE from June to December 2023 at the Emergency Center of the University Clinical Center of Serbia. The scans were reviewed by an experienced radiologist subspecialized in angiography and a resident. The PE propagation was quantified at all levels (trunk, main, lobar, and segmental branches), and the thrombus burden was expressed using the modified Qanadli score. Additionally, the presence of parenchymal consolidations, ground-glass opacities, and pleural effusions, as potential supplementary outcome predictors, was recorded. Agreement analysis was conducted using kappa statistics.