title: Combination of clinical and V/Q scan assessment for the diagnosis of pulmonary embolism: a 2-year outcome prospective study.
abstract: With the aim of evaluating the efficiency of our diagnostic approach in patients with suspected acute pulmonary embolism (PE), we prospectively studied 143 patients investigated by means of a ventilation/perfusion (V/Q) lung scan. A pre-test clinical probability of PE (Pclin) was assigned to all patients by the clinicians and scans were interpreted blinded to clinical assessment. A 2-year follow-up of our patients was systematically performed and possible in 134 cases. Distribution of clinical probabilities was high Pclin in 22.5%, intermediate Pclin in 24% and low Pclin in 53.5%, whereas the distribution of scan categories was high Pscan in 14%, intermediate Pscan in 18%, low Pscan in 57% and normal Pscan in 11%. The final prevalence of PE was 24.5%. High Pscan and normal Pscan were always conclusive (19 and 15 cases respectively). Low Pscan associated with low Pclin could exclude PE in 43/45 cases (96%). None of the patients in whom the diagnosis of PE was discarded had a major event related to PE during the 2-year follow-up. Overall, the combined assessment of clinical and scintigraphic probabilities allowed confirmation or exclusion of PE in 80% of subjects (107/134) and proved to be a valuable tool for selecting patients who needed pulmonary angiography, which was required in 20% of our patients (27/134).
authors.affiliation: Department of Nuclear Medicine, University Hospital, Lausanne, Switzerland.
authors.forename: G
authors.initials: G
authors.lastname: Barghouth
authors.forename: B
authors.initials: B
authors.lastname: Yersin
authors.forename: A
authors.initials: A
authors.lastname: Boubaker
authors.forename: F
authors.initials: F
authors.lastname: Doenz
authors.forename: P
authors.initials: P
authors.lastname: Schnyder
authors.forename: A B
authors.initials: AB
authors.lastname: Delaloye
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000503:physiopathology; D014692:Ventilation-Perfusion Ratio