Multidetector computed tomographic pulmonary angiography in patients with a high clinical probability of pulmonary embolism. (14th December 2015)

• Record Type: Journal Article
• Authors: Moores, L.; Kline, J.; Portillo, A. K.; Resano, S.; Vicente, A.; Arrieta, P.; Corres, J.; Tapson, V.; Yusen, R. D.; Jiménez, D.
• Is Part Of: Journal of thrombosis and haemostasis. Volume 14:Number 1(2016:Jan.)
• Page Start: 114
• Page End: 120
• Publication Date: 2015-12-14
• Subjects: diagnosis -- diagnostic imaging -- multidetector computed tomography -- probability -- pulmonary embolism; Thrombosis -- Periodicals; Hemostasis -- Periodicals; Blood coagulation disorders -- Periodicals; 616.1
• DOI: 10.1111/jth.13188
• Languages: English
• ISSNs: 1538-7933

Abstract

Abstract : Essentials When high probability of pulmonary embolism (PE), sensitivity of computed tomography (CT) is unclear. We investigated the sensitivity of multidetector CT among 134 patients with a high probability of PE. A normal CT alone may not safely exclude PE in patients with a high clinical pretest probability. In patients with no clear alternative diagnosis after CTPA, further testing should be strongly considered. Summary: Background: Whether patients with a negative multidetector computed tomographic pulmonary angiography (CTPA) result and a high clinical pretest probability of pulmonary embolism (PE) should be further investigated is controversial. Methods: This was a prospective investigation of the sensitivity of multidetector CTPA among patients with a priori clinical assessment of a high probability of PE according to the Wells criteria. Among patients with a negative CTPA result, the diagnosis of PE required at least one of the following conditions: ventilation/perfusion lung scan showing a high probability of PE in a patient with no history of PE, abnormal findings on venous ultrasonography in a patient without previous deep vein thrombosis at that site, or the occurrence of venous thromboembolism (VTE) in a 3‐month follow‐up period after anticoagulation was withheld because of a negative multidetector CTPA result. Results: We identified 498 patients with a priori clinical assessment of a high probability of PE and a completed CTPA study. CTPA excluded PE in 134 patients; in these patients, the pooled incidence of VTE was 5.2% (seven of 134 patients; 95% confidence interval [CI] 1.5–9.0). Five patients had VTEs that were confirmed by an additional imaging test despite a negative CTPA result (five of 48 patients; 10.4%; 95% CI 1.8–19.1), and two patients had objectively confirmed VTEs that occurred during clinical follow‐up of at least 3 months (two of 86 patients; 2.3%; 95% CI 0–5.5). None of the patients had a fatal PE during follow‐up. Conclusions: A normal multidetector CTPA result alone may not safely exclude PE in patients with a high clinical pretest probability.