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Thoracic Imaging |
1 From the Departments of Pulmonology (I.T.L., F.R., S.P., A.B.T.) and Radiology (I.M., J.R., M.R.J.), University Center Hospital Calmette; Boulevard Jules Leclerc, 59037 Lille Cedex, France; and Medical Research Group, Equipe d’Accueil No. 2682, Lille, France (I.M., J.R., M.R.J.). Received May 11, 2001; revision requested June 8; revision received August 1; accepted September 17. Address correspondence to M.R.J. (e-mail: mremy-jardin@chru-lille.fr).
PURPOSE: To evaluate the effect of pulmonary disease on diagnostic utility of spiral computed tomographic (CT) angiography in clinical practice.
MATERIALS AND METHODS: Three hundred thirty-four patients, including 215 patients with pulmonary disease (group 1) and 119 patients with no history of respiratory disorder (group 2), were referred for thin-collimation CT angiography of the pulmonary circulation as the first-line diagnostic test. Patients with negative angiograms who had not received anticoagulation therapy and who could be clinically followed up at 3 months, 6 months, and 1 year were considered in the final study groups (n = 185); 135 patients had lung disease (group 3), and 50 patients had no history of a respiratory disorder (group 4).
RESULTS: Between groups 3 and 4, no significant differences were found in the referral location, age, and risk factors. Confident evaluation of pulmonary arteries down to the subsegmental level was performed in 31 (23%) patients in group 3 and in 15 (30%) in group 4 (P = .5). Three episodes of acute pulmonary embolism (PE), all fatal, were diagnosed in group 3 patients; two cases occurred 14 days and one case occurred 6 months after the negative spiral CT scan. The negative predictive value of spiral CT angiography was 98% (175 of 178) in the study group in which follow-up was performed, with no significant difference between the values in groups 3 (98% [132 of 135]) and 4 (100% [50 of 50]).
CONCLUSION: Underlying respiratory disease does not affect the negative predictive value of thin-collimation CT angiography, which appears to be a reliable tool in the work-up in this subgroup of patients with acute PE.
© RSNA, 2002
Index terms: Computed tomography (CT), angiography, 60.12116 • Embolism, pulmonary, 60.72 • Emphysema, pulmonary, 60.751 • Pneumoconiosis, 60.772
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