Clinical outcomes of patients after a negative spiral CT pulmonary arteriogram in the evaluation of acute pulmonary embolism.
OBJECTIVE
To examine 6-month clinical outcomes of patients after acquisition of a spiral computed tomography (CT) pulmonary arteriogram interpreted as negative for acute pulmonary embolism (PE).


METHODS
A retrospective review was performed on a consecutive series of 143 patients who underwent spiral CT pulmonary arteriography for possible acute PE during a 19-month period. All studies were performed on a HiSpeed Scanner with use of 3-mm collimation with a pitch between 1.3 and 2.0, depending on patient size. All imaging was performed during dynamic contrast material injection at rates between 3.0 and 4.0 mL/sec, timed to peak pulmonary arterial enhancement. For the studies interpreted as negative for PE through the segmental (fourth order) pulmonary arteries, follow-up data were collected by telephone interviews with patients or surviving relatives, and by medical record reviews.


RESULTS
Among 143 patients, 22 studies (15%) were positive for PE, eight (6%) were suboptimal to exclude PE to the segmental artery level, and 113 (79%) were interpreted as negative for acute PE. Among the 113 negative studies, 13 patients were lost to follow-up, leaving a study population of 100 patients. Eighty-one patients were alive a minimum of 6 months after acquisition of a negative spiral CT pulmonary arteriogram (mean, 9 months; range, 6-24 months) and were without interim diagnosis of PE. Nineteen patients died within the follow-up period after a negative spiral CT pulmonary arteriogram (mean, 3 months; range, 0-8 months); however, in none of these cases was acute pulmonary embolus reported as the cause of death. No documented PE was identified by subsequent imaging studies or autopsy within the study population.


CONCLUSIONS
A series of 100 patients with a negative spiral CT pulmonary arteriogram did not experience significant morbidity and mortality as a result of pulmonary embolic disease within a 6-month follow-up period.
Department of Radiology, University of Utah SOM, Salt Lake City 84132, USA.
N N
NN
Lomis
H C
HC
Yoon
A G
AG
Moran
F J
FJ
Miller
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D002423:Cause of Death; D003287:Contrast Media / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007407:Interviews as Topic; D008168:Lung / Q000098:blood supply*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D011856:Radiographic Image Enhancement / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018616:Ultrasonography, Doppler, Duplex; D020246:Venous Thrombosis / Q000000981:diagnostic imaging; D014692:Ventilation-Perfusion Ratio
D003287:Contrast Media