TY - JOUR
T1 - Subsequent pulmonary embolism
T2 - Risk after a negative helical CT pulmonary angiogram - Prospective comparison with scintigraphy
AU - Goodman, Lawrence R.
AU - Lipchik, Randolph J.
AU - Kuzo, Ronald S.
AU - Liu, Yu
AU - McAuliffe, Timothy L.
AU - O'Brien, Daniel J.
PY - 2000
Y1 - 2000
N2 - 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). Patient 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.
AB - 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). Patient 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.
KW - Computed tomography (CT), comparative studies
KW - Computed tomography (CT), helical
KW - Embolism, pulmonary
KW - Lung, perfusion
KW - Lung, ventilation
KW - Pulmonary arteries, CT
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U2 - 10.1148/radiology.215.2.r00ma23535
DO - 10.1148/radiology.215.2.r00ma23535
M3 - Article
C2 - 10796937
AN - SCOPUS:0033999934
SN - 0033-8419
VL - 215
SP - 535
EP - 542
JO - Radiology
JF - Radiology
IS - 2
ER -