title: Interest of chest X-ray in tailoring the diagnostic strategy in patients with suspected pulmonary embolism.
abstract: Current diagnostic strategies for pulmonary embolism rely on the sequential use of noninvasive diagnostic tests including ventilation-perfusion (V/Q) scan and computed tomography pulmonary angiography (CTPA). V/Q scan remains criticized because of a high proportion of nondiagnostic test results, especially when the chest X-ray (CXR) is abnormal. The present study assesses whether CXR results have an impact on the conclusiveness of a noninvasive diagnostic strategy of pulmonary embolism based on the combination of pretest probability, compression ultrasonography, V/Q scan, and CTPA. Patients suspected of having pulmonary embolism were managed according to a validated diagnostic strategy. All patients underwent a CXR within 24 h of the suspicion of pulmonary embolism. CXR results were correlated to strategy conclusiveness, as assessed by the rate of required CTPA as per the diagnostic algorithm. Two hundred and twenty-three patients were retrospectively analyzed. CXRs were considered as normal in 108 (48%) patients and abnormal in 115 (52%) patients. According to the diagnostic algorithm, a CTPA was required to reach a diagnostic conclusion in 11 (10%) patients of the normal CXR group, and in 14 (12%) patients of the abnormal CXR group (P > 0.05). In this study, the presence of CXR abnormalities did not have an impact on the conclusiveness of a diagnostic strategy of pulmonary embolism based on V/Q scan. CXR abnormalities should likely not be regarded as a contraindication to the use of V/Q scan in patients with suspected pulmonary embolism.
authors.affiliation: aUniversité Européenne de Bretagne bUniversité de Brest, EA3878 (GETBO) IFR 148 cCHRU de la Cavale Blanche, Service de Médecine Nucléaire dCHRU de la Cavale Blanche, Service de Radiologie eCHRU de la Cavale Blanche, Département de Médecine Interne et de Pneumologie fINSERM CIC 05-02 IFR148, Brest, France gUniversité de Brest, INSERM CIC 05-02 IFR148, Brest, France hOttawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Robin
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Le Roux
authors.forename: Valentin
authors.initials: V
authors.lastname: Tissot
authors.forename: Aurélien
authors.initials: A
authors.lastname: Delluc
authors.forename: Alexandra
authors.initials: A
authors.lastname: Le Duc-Pennec
authors.forename: Ronan
authors.initials: R
authors.lastname: Abgral
authors.forename: Xavier
authors.initials: X
authors.lastname: Palard
authors.forename: Francis
authors.initials: F
authors.lastname: Couturaud
authors.forename: Grégoire
authors.initials: G
authors.lastname: Le Gal
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Salaun
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D011655:Pulmonary Embolism / Q000175:diagnosis*; D011859:Radiography; D014692:Ventilation-Perfusion Ratio; D014965:X-Rays