Subsequent pulmonary embolism: risk after a negative helical CT pulmonary angiogram--prospective comparison with scintigraphy. Radiology 2000 May;215(2):535-42
Date
05/05/2000Pubmed ID
10796937DOI
10.1148/radiology.215.2.r00ma23535Scopus ID
2-s2.0-0033999934 (requires institutional sign-in at Scopus site) 248 CitationsAbstract
PURPOSE: To determine whether a helical computed tomographic (CT) scan that is negative for pulmonary embolism (PE) is a sufficiently reliable criterion to safely withhold anticoagulation therapy.
MATERIALS AND METHODS: Patients with negative helical CT scans were prospectively compared with patients with negative or low-probability scintigrams. In a 460-bed university hospital and clinic, 1,015 adult patients underwent either scintigraphy or helical CT for possible PE for 25 months. Five hundred forty-eight patients who had negative images and were not receiving anticoagulation therapy were prospectively followed up for 3 months for clinical, new imaging, death certificate, or autopsy evidence of subsequent PE. Ninety-seven patients were lost to follow-up.
RESULTS: Subsequent PE was found in two (1.0%) of 198 patients with negative CT scans, none of 188 patients with negative ventilation-perfusion (V-P) scans, and five (3.1%) of 162 patients with low-probability V-P scans (not statistically significant). Patients in the helical CT group were hospitalized more often, had more severe disease, had more substantial PE risk factors, and had a higher death rate. No deaths were attributed to PE in either group.
CONCLUSION: The frequency of clinical diagnoses of PE after a negative CT scan was low and similar to that after a negative or low-probability V-P scan. Helical CT is a reliable imaging tool for excluding clinically important PE.
Author List
Goodman LR, Lipchik RJ, Kuzo RS, Liu Y, McAuliffe TL, O'Brien DJAuthors
Randolph J. Lipchik MD Professor in the Medicine department at Medical College of WisconsinTimothy L. McAuliffe PhD Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAnalysis of Variance
Angiography
Anticoagulants
Chi-Square Distribution
Contraindications
Female
Follow-Up Studies
Hospitalization
Humans
Image Processing, Computer-Assisted
Logistic Models
Lung
Male
Multivariate Analysis
Predictive Value of Tests
Probability
Prospective Studies
Pulmonary Embolism
Radionuclide Imaging
Radiopharmaceuticals
Reproducibility of Results
Risk Factors
Safety
Survival Rate
Tomography, X-Ray Computed
Ventilation-Perfusion Ratio
