Clinical validity of helical CT being interpreted as negative for pulmonary embolism: implications for patient treatment.
OBJECTIVE
The purpose of our study was to assess the clinical usefulness of helical CT findings that are interpreted as negative for pulmonary embolism.


METHODS
One hundred twenty-six patients underwent 132 helical CT examinations and 352 patients underwent ventilation-perfusion scanning for suspected acute pulmonary embolism over a 17-month period at a single institution. Findings from clinical follow-up at a minimum of 6 months were assessed, with a special focus on the presence of recurrent thromboembolism and mortality in 78 consecutive patients in whom helical CT findings were interpreted as negative for pulmonary embolism and anticoagulant therapy was not administered (group I). During the same 17-month period, 46 patients underwent ventilation-perfusion scanning that was interpreted as normal (group II), and 132 patients underwent ventilation-perfusion scanning that was interpreted as showing a very low to low probability for pulmonary embolism (group III). Patients in groups II and III did not undergo helical CT or pulmonary angiography and did not receive anticoagulant therapy. However, clinical follow-up was solicited. Patients from groups II and III were used as control subjects.


RESULTS
Nine patients in group I died, one of whom was found to have a microscopic pulmonary embolism at autopsy. In group II, four patients died, none of whom were shown to have a missed or recurrent pulmonary embolism. Of the 18 patients in group III who died, three had a recurrent or missed pulmonary embolism (mean interval, 9 days), and two were found to have deep vein thrombosis on sonography of the leg (mean interval, 12 weeks). Negative predictive values for helical CT, normal lung scanning, and low-probability ventilation-perfusion scanning were 99%, 100%, and 96%, respectively (p = .299). CT provided either additional findings or an alternate diagnosis in 42 (53.8%) of the 78 patients in whom helical CT findings had been interpreted as negative for pulmonary embolism.


CONCLUSIONS
A helical CT scan can be effectively used to rule out clinically significant pulmonary emboli and may prevent further investigation or unnecessary treatment of most patients.
Garg
K
K
Department of Radiology, Veterans Affairs Medical Center and University of Colorado, Denver 80220, USA.
Sieler
H
H
Welsh
C H
CH
Johnston
R J
RJ
Russ
P D
PD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000188:drug therapy; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D014463:Ultrasonography
D000925:Anticoagulants