Subsequent pulmonary embolism: Risk after a negative helical CT pulmonary angiogram - Prospective comparison with scintigraphy

Lawrence R. Goodman, Randolph J. Lipchik, Ronald S. Kuzo, Yu Liu, Timothy L. McAuliffe, Daniel J. O'Brien

Research output: Contribution to journalArticle

239 Scopus citations

Abstract

PURPOSE: To determine whether a helical computed tomographic (CT) scan that is negative for pulmonary embolism (PE) is a sufficiently reliable criterion to safely withhold anticoagulation therapy. MATERIALS AND METHODS: Patients with negative helical CT scans were prospectively compared with patients with negative or low-probability scintigrams. In a 460-bed university hospital and clinic, 1,015 adult patients underwent either scintigraphy or helical CT for possible PE for 25 months. Five hundred forty- eight patients who had negative images and were not receiving anticoagulation therapy were prospectively followed up for 3 months for clinical, new imaging, death certificate, or autopsy evidence of subsequent PE. Ninety- seven patients were lost to follow-up. RESULTS: Subsequent PE was found in two (1.0%) of 198 patients with negative CT scans, none of 188 patients with negative ventilation-perfusion (V-P) scans, and five (3.1%) of 162 patients with low-probability V-P scans (not statistically significant). Patient in the helical CT group were hospitalized more often, had more severe disease, had more substantial PE risk factors, and had a higher death rate. No deaths were attributed to PE in either group. CONCLUSION: The frequency of clinical diagnoses of PE after a negative CT scan was low and similar to that after a negative or low-probability V-P scan. Helical CT is a reliable imaging tool for excluding clinically important PE.

Original languageEnglish (US)
Pages (from-to)535-542
Number of pages8
JournalRadiology
Volume215
Issue number2
DOIs
StatePublished - 2000

Keywords

  • Computed tomography (CT), comparative studies
  • Computed tomography (CT), helical
  • Embolism, pulmonary
  • Lung, perfusion
  • Lung, ventilation
  • Pulmonary arteries, CT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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