Pulmonary embolism: prediction of the usefulness of initial ventilation-perfusion scanning with chest radiographic findings.
OBJECTIVE
To evaluate the usefulness of ventilation-perfusion scanning when chest radiographic findings are abnormal to decide which patients should initially undergo angiography because of suspected pulmonary embolism.


METHODS
The records of 951 patients who underwent examination between April 1, 1992, and August 24, 1993, were reviewed, and the results of ventilation-perfusion scanning and chest radiography were correlated.


RESULTS
Approximately 8% of patients with radiographic findings of no acute disease, pleural effusion, and linear atelectasis had high-probability ventilation-perfusion scans. Pulmonary edema and parenchymal consolidation categories had fewer high-probability studies (3% and 1%, respectively; P < .01). The chance of obtaining a nondiagnostic result was similar for the first three categories (12%) but was more likely for pleural effusion and parenchymal consolidation (36% and 82%, respectively; P < .01).


CONCLUSIONS
The results of ventilation-perfusion scanning are not useful with focal radiographic consolidation. It may be appropriate to proceed directly to pulmonary angiography in many of these patients.
Department of Radiology, Section of Nuclear Medicine, Massachusetts General Hospital, Boston 02114.
S N
SN
Goldberg
E L
EL
Palmer
J A
JA
Scott
R
R
Fisher
D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D010996:Pleural Effusion / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011336:Probability; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011859:Radiography; D011877:Radionuclide Imaging; D012189:Retrospective Studies