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Thoracic Imaging |
1 From the Departments of Radiology (L.R.G., R.S.K., Y.L., D.J.O.) and Medicine, Division of Pulmonary Medicine and Critical Care Medicine (L.R.G., R.J.L.), and the Division of Biostatistics (T.L.M.), Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226-3596. Received July 23, 1999; revision requested September 29; revision received November 3; accepted November 15. Supported in part by a research grant from GE Medical Systems, Milwaukee. Address correspondence to L.R.G. (e-mail: lgoodman@mcw.edu).
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.
Index terms: Computed tomography (CT), comparative studies, 60.12112, 60.12115, 60.12116, 944.12912, 944.12915, 944.12916 • Computed tomography (CT), helical, 60.12115, 944.12915 • Embolism, pulmonary, 60.7212, 60.723, 60.724, 944.751, 944.77 • Lung, perfusion, 60.12171 • Lung, ventilation, 60.12176 • Pulmonary arteries, CT, 944.12912, 944.12915, 944.12916
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Radiology 2000 215: 325-326.
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