title: Modified PIOPED criteria used in clinical practice.
abstract: To assess the use of modified PIOPED scintigraphic criteria for lung scan (V/Q) interpretation to detect pulmonary embolism (PE), we prospectively applied these criteria in suspected PE patients referred for V/Q from 9/1/92 to 2/7/94. PIOPED criteria were modified by placing a moderate segmental perfusion mismatch in the intermediate instead of low probability of PE category and using the "stripe sign."
  
  
  METHODS
  Patients were studied by six-view V/Q imaging using 74 MBq (2 mCi) 99mTc-MAA followed by 148-370 MBq (4-10 mCi) 99mTc-DTPA aerosol, contrast pulmonary selective angiography and Doppler sonography with leg compression as needed. Patients underwent follow-up (mean 13.9 mo) to detect subsequent thromboembolic events. In this study group, 1000 patients were studied by V/Q followed by angiography in 133 patients.
  
  
  RESULTS
  The distribution of V/Q-assigned PE probabilities was: high probability 5.7%, intermediate 17.4%, low 41.4% and normal 35.5%. Group A patients (133) underwent angiography, which resulted in the determination of a 27.1% PE prevalence. Group B patients (867) did not have angiograms; the clinical prevalence of PE was 7.5%. In the total study population, the positive predictive value of a high probability V/Q study for PE (10.1% prevalence) was 98.2%, intermediate probability V/Q study for PE was 24.1% and a low probability study for PE was only 0.5%.
  
  
  CONCLUSIONS
  Modified PIOPED V/Q interpretation criteria afford better angioproven PE discrimination between intermediate (31.8% PE prevalence) and low (5.5% PE prevalence) probability V/Q results than reported for PIOPED intermediate (32.6% PE prevalence) and low (16.3% PE prevalence) probability V/Q interpretation criteria.
authors.affiliation: Department of Radiology, St. Joseph Mercy Hospital, Ann Arbor, Michigan 48106, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Freitas
authors.forename: M G
authors.initials: MG
authors.lastname: Sarosi
authors.forename: C C
authors.initials: CC
authors.lastname: Nagle
authors.forename: M E
authors.initials: ME
authors.lastname: Yeomans
authors.forename: A E
authors.initials: AE
authors.lastname: Freitas
authors.forename: J E
authors.initials: JE
authors.lastname: Juni
mesh_terms: D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D011859:Radiography; D011877:Radionuclide Imaging; D014463:Ultrasonography; D014692:Ventilation-Perfusion Ratio