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. 1996 Jan;51(1):23–28. doi: 10.1136/thx.51.1.23

Role of spiral volumetric computed tomographic scanning in the assessment of patients with clinical suspicion of pulmonary embolism and an abnormal ventilation/perfusion lung scan.

A B van Rossum 1, F E Treurniet 1, G J Kieft 1, S J Smith 1, R Schepers-Bok 1
PMCID: PMC472794  PMID: 8658363

Abstract

BACKGROUND: A study was carried out to evaluate the potential place of spiral volumetric computed tomography (SVCT) in the diagnostic strategy for pulmonary embolism. METHODS: In a prospective study 249 patients with clinical suspicion of pulmonary embolism were evaluated with various imaging techniques. In all patients a ventilation/perfusion (V/Q) scan was performed. Seventy seven patients with an abnormal V/Q scan underwent SVCT. Pulmonary angiography was then performed in all 42 patients with a non-diagnostic V/Q scan and in three patients with a high probability V/Q scan without emboli on the SVCT scan. Patients with an abnormal perfusion scan also underwent ultrasonography of the legs for the detection of deep vein thrombosis. RESULTS: One hundred and seventy two patients (69%) had a normal V/Q scan. Forty two patients (17%) had a non-diagnostic V/Q scan, and in five of these patients pulmonary emboli were found both by SVCT and pulmonary angiography. In one patient, although SVCT showed no emboli, the angiogram was positive for pulmonary embolism. In one of the 42 patients the SVCT scan showed an embolus which was not confirmed by pulmonary angiography. The other 35 patients showed no sign of emboli. Thirty five patients (14%) had a high probability V/Q scan, and in 32 patients emboli were seen on SVCT images. Two patients had both a negative SVCT scan and a negative pulmonary angiogram. In one who had an inconclusive SVCT scan pulmonary angiography was positive. The sensitivity for pulmonary embolism was 95% and the specificity 97%; the positive and negative predicted values of SVCT were 97% and 97%, respectively. CONCLUSIONS: SVCT is a relatively noninvasive test for pulmonary embolism which is both sensitive and specific and which may serve as an alternative to ventilation scintigraphy and possibly to pulmonary angiography in the diagnostic strategy for pulmonary embolism.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Biello D. R., Mattar A. G., McKnight R. C., Siegel B. A. Ventilation-perfusion studies in suspected pulmonary embolism. AJR Am J Roentgenol. 1979 Dec;133(6):1033–1037. doi: 10.2214/ajr.133.6.1033. [DOI] [PubMed] [Google Scholar]
  2. Cronan J. J. Venous thromboembolic disease: the role of US. Radiology. 1993 Mar;186(3):619–630. doi: 10.1148/radiology.186.3.8430164. [DOI] [PubMed] [Google Scholar]
  3. Dalen J. E., Alpert J. S. Natural history of pulmonary embolism. Prog Cardiovasc Dis. 1975 Jan-Feb;17(4):259–270. doi: 10.1016/s0033-0620(75)80017-x. [DOI] [PubMed] [Google Scholar]
  4. Hull R. D., Hirsh J., Carter C. J., Jay R. M., Dodd P. E., Ockelford P. A., Coates G., Gill G. J., Turpie A. G., Doyle D. J. Pulmonary angiography, ventilation lung scanning, and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan. Ann Intern Med. 1983 Jun;98(6):891–899. doi: 10.7326/0003-4819-98-6-891. [DOI] [PubMed] [Google Scholar]
  5. Hull R. D., Hirsh J., Carter C. J., Raskob G. E., Gill G. J., Jay R. M., Leclerc J. R., David M., Coates G. Diagnostic value of ventilation-perfusion lung scanning in patients with suspected pulmonary embolism. Chest. 1985 Dec;88(6):819–828. doi: 10.1378/chest.88.6.819. [DOI] [PubMed] [Google Scholar]
  6. Hull R. D., Raskob G. E., Carter C. J., Coates G., Gill G. J., Sackett D. L., Hirsh J., Thompson M. Pulmonary embolism in outpatients with pleuritic chest pain. Arch Intern Med. 1988 Apr;148(4):838–844. [PubMed] [Google Scholar]
  7. Hull R. D., Raskob G. E., Coates G., Panju A. A. Clinical validity of a normal perfusion lung scan in patients with suspected pulmonary embolism. Chest. 1990 Jan;97(1):23–26. doi: 10.1378/chest.97.1.23. [DOI] [PubMed] [Google Scholar]
  8. Hull R. D., Raskob G. E. Low-probability lung scan findings: a need for change. Ann Intern Med. 1991 Jan 15;114(2):142–143. doi: 10.7326/0003-4819-114-2-142. [DOI] [PubMed] [Google Scholar]
  9. Kipper M. S., Moser K. M., Kortman K. E., Ashburn W. L. Longterm follow-up of patients with suspected pulmonary embolism and a normal lung scan. Perfusion scans in embolic suspects. Chest. 1982 Oct;82(4):411–415. doi: 10.1378/chest.82.4.411. [DOI] [PubMed] [Google Scholar]
  10. Moser K. M. Venous thromboembolism. Am Rev Respir Dis. 1990 Jan;141(1):235–249. doi: 10.1164/ajrccm/141.1.235. [DOI] [PubMed] [Google Scholar]
  11. Quinn R. J., Nour R., Butler S. P., Glenn D. W., Travers P. L., Wellings G., Kwan Y. L. Pulmonary embolism in patients with intermediate probability lung scans: diagnosis with Doppler venous US and D-dimer measurement. Radiology. 1994 Feb;190(2):509–511. doi: 10.1148/radiology.190.2.8284407. [DOI] [PubMed] [Google Scholar]
  12. Remy-Jardin M., Remy J., Wattinne L., Giraud F. Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the single-breath-hold technique--comparison with pulmonary angiography. Radiology. 1992 Nov;185(2):381–387. doi: 10.1148/radiology.185.2.1410342. [DOI] [PubMed] [Google Scholar]
  13. Robin E. D. Overdiagnosis and overtreatment of pulmonary embolism: the emperor may have no clothes. Ann Intern Med. 1977 Dec;87(6):775–781. doi: 10.7326/0003-4819-87-6-775. [DOI] [PubMed] [Google Scholar]
  14. Teigen C. L., Maus T. P., Sheedy P. F., 2nd, Johnson C. M., Stanson A. W., Welch T. J. Pulmonary embolism: diagnosis with electron-beam CT. Radiology. 1993 Sep;188(3):839–845. doi: 10.1148/radiology.188.3.8351359. [DOI] [PubMed] [Google Scholar]
  15. Teigen C. L., Maus T. P., Sheedy P. F., 2nd, Stanson A. W., Johnson C. M., Breen J. F., McKusick M. A. Pulmonary embolism: diagnosis with contrast-enhanced electron-beam CT and comparison with pulmonary angiography. Radiology. 1995 Feb;194(2):313–319. doi: 10.1148/radiology.194.2.7824704. [DOI] [PubMed] [Google Scholar]

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