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A noninvasive diagnostic strategy including spiral computed tomography in patients with suspected pulmonary embolism.
Am J Respir Crit Care Med 2000; 162(4 Pt 1):1413-8AJ

Abstract

We conducted a study to evaluate a noninvasive strategy including spiral computed tomography (CT) in patients with suspected pulmonary embolism (PE). We systematically performed spiral CT, ventilation/perfusion lung scanning, and D-dimer (DD) measurement (VIDAS test), and in some cases (with a normal CT with nondiagnostic lung scan and increased DD) performed venous ultrasonography (US) on 247 consecutive patients with clinically suspected PE in our hospital. Patients in whom PE was deemed absent were not given anticoagulants. All patients were followed for 3 mo. The prevalence of PE in the 228 patients who could be evaluated was 42% (96 of 228). PE was confirmed by spiral CT in 73% of the patients, by a high-probability lung scan in 4%, and by findings on US in 23%. PE was ruled out by a normal lung scan in 14% of the patients, by a normal DD concentration (< 500 ng/ml) in 31%, by an obvious differential diagnosis on spiral CT in 18%, by a similar prior lung scan in 11%, and by the combination of normal spiral CT findings, a nondiagnostic lung scan, a DD concentration > 500 ng/ml, and normal US in 26%. Pulmonary angiography was performed in only two patients, both of whom had a normal spiral CT scan and a high-probability lung scan, and was normal. The 3-mo risk of thromboembolism in patients not given anticoagulants, based on the results of the diagnostic protocol, was 1.7% (95% confidence interval: 1.5 to 2.3%). There were no deaths. The noninvasive strategy of combining spiral CT, lung scanning, DD measurement, and in some cases US, in patients with suspected PE yielded a definite diagnosis in 99% of patients, and appeared to be safe.

Authors+Show Affiliations

Departments of Pneumology, Radiology, Haemostasis, and Nuclear Medecine, Hôtel-Dieu, Paris, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11029354

Citation

Lorut, C, et al. "A Noninvasive Diagnostic Strategy Including Spiral Computed Tomography in Patients With Suspected Pulmonary Embolism." American Journal of Respiratory and Critical Care Medicine, vol. 162, no. 4 Pt 1, 2000, pp. 1413-8.
Lorut C, Ghossains M, Horellou MH, et al. A noninvasive diagnostic strategy including spiral computed tomography in patients with suspected pulmonary embolism. Am J Respir Crit Care Med. 2000;162(4 Pt 1):1413-8.
Lorut, C., Ghossains, M., Horellou, M. H., Achkar, A., Fretault, J., & Laaban, J. P. (2000). A noninvasive diagnostic strategy including spiral computed tomography in patients with suspected pulmonary embolism. American Journal of Respiratory and Critical Care Medicine, 162(4 Pt 1), pp. 1413-8.
Lorut C, et al. A Noninvasive Diagnostic Strategy Including Spiral Computed Tomography in Patients With Suspected Pulmonary Embolism. Am J Respir Crit Care Med. 2000;162(4 Pt 1):1413-8. PubMed PMID: 11029354.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A noninvasive diagnostic strategy including spiral computed tomography in patients with suspected pulmonary embolism. AU - Lorut,C, AU - Ghossains,M, AU - Horellou,M H, AU - Achkar,A, AU - Fretault,J, AU - Laaban,J P, PY - 2000/10/13/pubmed PY - 2001/2/28/medline PY - 2000/10/13/entrez SP - 1413 EP - 8 JF - American journal of respiratory and critical care medicine JO - Am. J. Respir. Crit. Care Med. VL - 162 IS - 4 Pt 1 N2 - We conducted a study to evaluate a noninvasive strategy including spiral computed tomography (CT) in patients with suspected pulmonary embolism (PE). We systematically performed spiral CT, ventilation/perfusion lung scanning, and D-dimer (DD) measurement (VIDAS test), and in some cases (with a normal CT with nondiagnostic lung scan and increased DD) performed venous ultrasonography (US) on 247 consecutive patients with clinically suspected PE in our hospital. Patients in whom PE was deemed absent were not given anticoagulants. All patients were followed for 3 mo. The prevalence of PE in the 228 patients who could be evaluated was 42% (96 of 228). PE was confirmed by spiral CT in 73% of the patients, by a high-probability lung scan in 4%, and by findings on US in 23%. PE was ruled out by a normal lung scan in 14% of the patients, by a normal DD concentration (< 500 ng/ml) in 31%, by an obvious differential diagnosis on spiral CT in 18%, by a similar prior lung scan in 11%, and by the combination of normal spiral CT findings, a nondiagnostic lung scan, a DD concentration > 500 ng/ml, and normal US in 26%. Pulmonary angiography was performed in only two patients, both of whom had a normal spiral CT scan and a high-probability lung scan, and was normal. The 3-mo risk of thromboembolism in patients not given anticoagulants, based on the results of the diagnostic protocol, was 1.7% (95% confidence interval: 1.5 to 2.3%). There were no deaths. The noninvasive strategy of combining spiral CT, lung scanning, DD measurement, and in some cases US, in patients with suspected PE yielded a definite diagnosis in 99% of patients, and appeared to be safe. SN - 1073-449X UR - https://www.unboundmedicine.com/medline/citation/11029354/A_noninvasive_diagnostic_strategy_including_spiral_computed_tomography_in_patients_with_suspected_pulmonary_embolism_ L2 - http://www.atsjournals.org/doi/full/10.1164/ajrccm.162.4.9909109?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -