The value of four-detector row spiral computed tomography for the diagnosis of pulmonary embolism.
Although spiral computed tomography (CT) is being used increasingly as the first-line imaging procedure in the diagnostic workup of patients with clinically suspected pulmonary embolism (PE), the diagnostic value of negative findings, at least when using the four-detector row scanners, is still controversial. A total of 702 consecutive patients with clinical symptoms suggestive of PE underwent four-slice CT. Patients with negative findings received the determination of D-dimer. Those with positive D-dimer underwent further diagnostic workup to confirm or rule out the diagnosis of PE. Those with negative D-dimer were followed-up to 6 months to detect the development of symptomatic venous thromboembolism (VTE). The CT test was interpreted as negative in 536 patients (76.3%). These patients had the D-dimer determination, which was positive in 279 and negative in the remaining 257 patients. Of the former, PE subsequently was documented in 55 patients (19.7%). Of the latter, symptomatic VTE in the follow-up period developed in three patients (1.17%; 95% confidence interval, 0.24 to 3.38%). In conclusion, when using the four-detector row, the negative predictive value of CT findings in patients with clinically suspected PE and positive D-dimer is low. In contrast, it is safe to withhold anticoagulation from patients with negative findings and negative D-dimer.
Vigo
Mario
M
Department of Radiology, Hospital of Bassano del Grappa, Italy.
Pesavento
Raffaele
R
Bova
Carlo
C
Porro
Fernando
F
Ghirarduzzi
Angelo
A
Bazzan
Mario
M
Polverosi
Roberta
R
Frulla
Michela
M
Noto
Alfonso
A
Castelli
Roberto
R
Giovanardi
Franco
F
Angelini
Federico
F
Pagnan
Antonio
A
Prandoni
Paolo
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000379:methods
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D