Premium
Multidetector computed tomographic pulmonary angiography in patients with a high clinical probability of pulmonary embolism
Author(s) -
Moores L.,
Kline J.,
Portillo A. K.,
Resano S.,
Vicente A.,
Arrieta P.,
Corres J.,
Tapson V.,
Yusen R. D.,
Jiménez D.
Publication year - 2016
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.13188
Subject(s) - medicine , pulmonary embolism , pulmonary angiography , pre and post test probability , radiology , confidence interval , angiography , deep vein , computed tomography angiography , thrombosis , venous thrombosis
EssentialsWhen 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 VTE s 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 VTE s 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.