Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 2006 Jun 01;354(22):2317-27
Date
06/02/2006Pubmed ID
16738268DOI
10.1056/NEJMoa052367Scopus ID
2-s2.0-33744503127 (requires institutional sign-in at Scopus site) 1509 CitationsAbstract
BACKGROUND: The accuracy of multidetector computed tomographic angiography (CTA) for the diagnosis of acute pulmonary embolism has not been determined conclusively.
METHODS: The Prospective Investigation of Pulmonary Embolism Diagnosis II trial was a prospective, multicenter investigation of the accuracy of multidetector CTA alone and combined with venous-phase imaging (CTA-CTV) for the diagnosis of acute pulmonary embolism. We used a composite reference test to confirm or rule out the diagnosis of pulmonary embolism.
RESULTS: Among 824 patients with a reference diagnosis and a completed CT study, CTA was inconclusive in 51 because of poor image quality. Excluding such inconclusive studies, the sensitivity of CTA was 83 percent and the specificity was 96 percent. Positive predictive values were 96 percent with a concordantly high or low probability on clinical assessment, 92 percent with an intermediate probability on clinical assessment, and nondiagnostic if clinical probability was discordant. CTA-CTV was inconclusive in 87 of 824 patients because the image quality of either CTA or CTV was poor. The sensitivity of CTA-CTV for pulmonary embolism was 90 percent, and specificity was 95 percent. CTA-CTV was also nondiagnostic with a discordant clinical probability.
CONCLUSIONS: In patients with suspected pulmonary embolism, multidetector CTA-CTV has a higher diagnostic sensitivity than does CTA alone, with similar specificity. The predictive value of either CTA or CTA-CTV is high with a concordant clinical assessment, but additional testing is necessary when the clinical probability is inconsistent with the imaging results.
Author List
Stein PD, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, Leeper KV Jr, Popovich J Jr, Quinn DA, Sos TA, Sostman HD, Tapson VF, Wakefield TW, Weg JG, Woodard PK, PIOPED II InvestigatorsAuthor
Lawrence Goodman MD Emeritus Professor in the Radiology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Acute DiseaseContrast Media
Female
Humans
Leg
Male
Middle Aged
Phlebography
Predictive Value of Tests
Prospective Studies
Pulmonary Artery
Pulmonary Embolism
Sensitivity and Specificity
Tomography, X-Ray Computed
Ultrasonography
Venous Thrombosis
