PE-RADS v2026

Table 5: Assessment Categories

Zoom Table 5
PE-RADS table 5 assessment categories

Primary management table. Use the zoom button, then use Zoom + inside the viewer for a closer read.

Reference Images

PE-RADS figure 1 stages of thromboembolism
Figure 1: StagesClick to enlarge
PE-RADS figure 2 ordinal scoring
Figure 2: Ordinal ScoringClick to enlarge
PE-RADS figure 3 image quality modifiers
Figure 3: Image QualityClick to enlarge
PE-RADS figure 4 exception E examples
Figure 4: Exception EClick to enlarge
PE-RADS figure 5 right ventricular enlargement
Figure 5: RV/LV RatioClick to enlarge
PE-RADS figure 6 RV enlargement and right heart thrombus
Figure 6: RV+ / T+Click to enlarge
PE-RADS table 1 lexicon
Table 1: LexiconClick to enlarge
PE-RADS table 2 ordinal anatomic grading
Table 2: GradingClick to enlarge
PE-RADS table 3 exception E
Table 3: Exception EClick to enlarge
PE-RADS table 4 accessory findings
Table 4: Accessory FindingsClick to enlarge

Core Concept

Use PE-RADS for CT pulmonary angiography or MR angiography exams evaluating pulmonary embolism.

What the label communicates

  • Most proximal acute PE location.
  • Image quality limitations or nondiagnostic central assessment.
  • Nonacute or non-PE intravascular filling defects.
  • Right ventricular enlargement and definite right heart thrombus.

Reporting principle

  • Use the most proximal acute embolus for the ordinal score.
  • Do not use the score as a total clot burden estimate.
  • Final shorthand examples: PE-RADS 2, PE-RADS 0L, PE-RADS E, PE-RADS 4/RV+/T+.

Ordinal Score

Acute PE anatomic grade

  • 0: no acute pulmonary embolism.
  • 1: most proximal embolus is subsegmental.
  • 2: most proximal embolus is segmental.
  • 3: most proximal embolus is lobar or interlobar artery.
  • 4: most proximal embolus is central, involving main, right, or left pulmonary arteries.
  • N: nondiagnostic study; cannot exclude acute PE at main or lobar level.

Location wording

  • State the most proximal level and laterality when useful.
  • Describe burden separately when clinically important.

Quality / Exceptions

Image quality modifiers

  • Optimal diagnostic: adequate to exclude PE to subsegmental level.
  • Limited/suboptimal: central assessment is adequate, but segmental or subsegmental assessment is limited.
  • Non-diagnostic: cannot exclude PE at the main or lobar pulmonary arteries.

How to use 0L and N

  • Use 0L when no acute PE is identified but distal assessment is limited.
  • Use N when central evaluation is nondiagnostic.
  • Do not use limited or nondiagnostic labels when a definite acute PE is identified.

Exception E

  • Use E for a filling defect that is not acute PE.
  • Examples: chronic thromboembolism, in-situ thrombus, pulmonary artery sarcoma, tumor embolus, cement or other exogenous material embolus, and air embolus.
  • Name the suspected process in the report when possible.

RV+ / T+

RV+ modifier

  • RV+ means right ventricular enlargement.
  • Use when RV/LV ratio is greater than or equal to 1.0.
  • Measurement may be axial, four-chamber, or volumetric.
  • Prefer "RV enlargement" over "RV strain"; chronic pressure overload can also enlarge the RV.

T+ modifier

  • T+ means definite thrombus in the right atrium and/or right ventricle.
  • Use only when the thrombus is confidently identified.
  • Example: PE-RADS 4/RV+/T+ = central acute PE with RV enlargement and right heart thrombus.

Management Snapshot

Acute PE

  • Any acute PE: consider anticoagulation in the context of bleeding risk and clinical severity.
  • Isolated subsegmental PE: individualized anticoagulation versus surveillance; consider lower extremity venous imaging.
  • Segmental PE: anticoagulation and clinical VTE/symptom assessment.
  • Lobar or central PE: PE risk stratification and clinical severity assessment.

Escalation patterns

  • RV+ may warrant dedicated cardiovascular assessment, such as echocardiography and ECG.
  • Lobar/central PE with RV+ may warrant reperfusion therapy assessment and PE specialist or PERT consultation.
  • T+ warrants urgent specialist input; consider cardiac surgery or vascular intervention when thrombus is traversing a patent foramen ovale.
  • PE-RADS N: repeat or alternative CT/MR angiography may be needed.

Report Language

Reusable phrases

  • No acute pulmonary embolism. PE-RADS 0.
  • No acute PE in the central or lobar arteries; segmental/subsegmental evaluation is limited by motion artifact. PE-RADS 0L.
  • Acute pulmonary embolus is present to the segmental pulmonary arteries. PE-RADS 2.
  • Central acute pulmonary embolism with RV/LV ratio 1.1. PE-RADS 4/RV+.
  • Central acute pulmonary embolism with RV enlargement and definite right atrial/right ventricular thrombus. PE-RADS 4/RV+/T+.
  • Nonacute pulmonary arterial filling defect compatible with chronic thromboembolic disease. PE-RADS E.

Source

  • Koweek et al. Radiology. 2026;320(1):e252721.
  • PE-RADS is a reporting framework; management should incorporate patient-specific risk, hemodynamics, biomarkers, comorbidities, and local PE response pathways.

Source Article

Primary Reference

Secondary Links

Home Incidental Findings Chest General Resources