The added value of spiral computed tomographic angiography after lung scintigraphy for the diagnosis of pulmonary embolism.
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.
Radan
L
L
Department of Nuclear Medicine, Lady Davis Carmel Medical Center, Technion, Haifa, Israel.
Mor
M
M
Gips
S
S
Schlag-Eisenberg
D
D
Lurie
Y
Y
Dickstein
K
K
Bitterman
H
H
Ben-Haim
S
S
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