title: The added value of spiral computed tomographic angiography after lung scintigraphy for the diagnosis of pulmonary embolism.
abstract: OBJECTIVE
  The objectives of this study were to evaluate the added clinical value of spiral computed tomographic angiography (CTA) after ventilation-perfusion lung scintigraphy (V/Q) for the management of patients with suspected pulmonary embolism (PE).
  
  
  METHODS
  Of 987 patients who had V/Q during 2001, 64 patients (6%) had CTA performed for further evaluation. V/Q and CTA findings were retrospectively analyzed by 2 clinicians who were blinded to the patients' outcome. Patient management was determined based on clinical and V/Q data and was reassessed after the addition of CTA data.
  
  
  RESULTS
  CTA was performed in 2 patients with normal V/Q, 16 patients with low probability, 28 patients with intermediate, 4 patients with high probability, and 14 patients with nonconclusive V/Q. Three patients (19%) with low probability, 9 (32%) with intermediate probability, 4 (29%) with nonconclusive, and 4 (100%) with high probability V/Q had PE diagnosed by CTA. CTA findings changed the management in 2 patients (13%) with low probability, 15 (54%) with intermediate probability, and 4 (29%) with nonconclusive V/Q.
  
  
  CONCLUSIONS
  In our institution, V/Q remains the main imaging modality for evaluation of patients with clinically suspected PE. CTA was performed after V/Q in 6% of patients. Patients with intermediate probability and those with nonconclusive V/Q, and to a much lesser extent, patients with low probability V/Q could benefit from the addition of CTA after V/Q. In patients with normal V/Q and those with high-probability V/Q, the addition of CTA does not seem to influence patient management.
authors.affiliation: Department of Nuclear Medicine, Lady Davis Carmel Medical Center, Technion, Haifa, Israel.
authors.forename: L
authors.initials: L
authors.lastname: Radan
authors.forename: M
authors.initials: M
authors.lastname: Mor
authors.forename: S
authors.initials: S
authors.lastname: Gips
authors.forename: D
authors.initials: D
authors.lastname: Schlag-Eisenberg
authors.forename: Y
authors.initials: Y
authors.lastname: Lurie
authors.forename: K
authors.initials: K
authors.lastname: Dickstein
authors.forename: H
authors.initials: H
authors.lastname: Bitterman
authors.forename: S
authors.initials: S
authors.lastname: Ben-Haim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007557:Israel / Q000453:epidemiology; D008168:Lung / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management / Q000379:methods*; D011379:Prognosis; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013382:Subtraction Technique; D036542:Tomography, Spiral Computed / Q000379:methods* / Q000706:statistics & numerical data