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Diagnosis of Acute Pulmonary Embolism in Outpatients: Comparison of Thin-Collimation Multi–Detector Row Spiral CT and Planar Ventilation-Perfusion Scintigraphy¹

¹ From the Departments of Radiology (E.C., P.G., L.G., F.H.), Emergency Medicine (F.V., F.Z., P.M., M.S.R.), Nuclear Medicine (A.K.), Internal Medicine (P.H.), and Clinical Biology Haemostasis Unit (E.L.), Cliniques Universitaires St-Luc, Université Catholique de Louvain, Av Hippocrate 10, 1200 Brussels, Belgium. Received July 16, 2002; revision requested September 3; final revision received March 6, 2003, accepted April 3. Address correspondence to E.C. (e-mail: coche@rdgn.ucl.ac.be).

PURPOSE: To compare multi–detector row computed tomography (CT) and ventilation-perfusion (V-P) scintigraphy in the diagnosis of acute pulmonary embolism (PE) in outpatients who were cared for in the emergency department.

MATERIALS AND METHODS: Ninety-four nonconsecutive patients, in whom acute PE was suspected, underwent thin-collimation multi–detector row CT (collimation, 4 x 1 mm; pitch, 1.25; scanning time, 0.5 second) and V-P scintigraphy. Concordance between CT and scintigraphic images was used in the diagnosis of PE. Pulmonary angiography was performed within 24 hours if interpretations of V-P and spiral CT images were inconclusive or discordant. Sensitivity and specificity values were calculated for V-P scintigrams and CT scans of the lungs. The rates of conclusive results for scintigraphy and CT were compared.

RESULTS: The sensitivity of thin-collimation multi–detector row CT and V-P scintigraphy for the detection of PE was 96% (27 of 28; CI: 82%, 99%) and 98% (65 of 66; CI: 92%, 99%), respectively. The specificity of CT and V-P scintigraphy was 86% (24 of 28; CI: 67%, 96%) and 88% (58 of 66; CI: 77%, 94%), respectively. Seven V-P scintigrams were of intermediate probability, and one spiral CT study was indeterminate. Examinations with spiral CT yielded conclusive results more often than examinations with planar V-P scintigraphy (P < .05). Five V-P scintigrams and spiral CT scans were discordant. Twelve pulmonary angiographic examinations were performed. Angiographic findings were concordant in 10 (91%) of 11 patients with conclusive CT scans in whom pulmonary angiography was attempted. CT was used to establish an alternative diagnosis in 19 (29%) of 66 patients in whom PE was excluded.

CONCLUSION: Thin-collimation multi–detector row CT is more accurate than V-P scintigraphy in the diagnosis of acute PE in outpatients. Furthermore, CT provides alternative diagnoses for patients without PE on high-quality transverse or near-isotropic reformatted images.

© RSNA, 2003

Index terms: Computed tomography (CT), multi–detector row, 60.12115 • Embolism, pulmonary, 60.72 • Lung, radionuclide studies, 60.1216

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