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Multidetector-row computed tomography in suspected pulmonary embolism.

Abstract

BACKGROUND

Single-detector-row computed tomography (CT) has a low sensitivity for pulmonary embolism and must be combined with venous-compression ultrasonography of the lower limbs. We evaluated whether the use of D-dimer measurement and multidetector-row CT, without lower-limb ultrasonography, might safely rule out pulmonary embolism.

METHODS

We included 756 consecutive patients with clinically suspected pulmonary embolism from the emergency departments of three teaching hospitals and managed their cases according to a standardized sequential diagnostic strategy. All patients were followed for three months.

RESULTS

Pulmonary embolism was detected in 194 of the 756 patients (26 percent). Among the 82 patients with a high clinical probability of pulmonary embolism, multidetector-row CT showed pulmonary embolism in 78, and 1 patient had proximal deep venous thrombosis and a CT scan that was negative for pulmonary embolism. Of the 674 patients without a high probability of pulmonary embolism, 232 (34 percent) had a negative D-dimer assay and an uneventful follow-up; CT showed pulmonary embolism in 109 patients. CT and ultrasonography were negative in 318 patients, of whom 3 had a definite thromboembolic event and 2 died of possible pulmonary embolism during follow-up (three-month risk of thromboembolism, 1.7 percent; 95 percent confidence interval, 0.7 to 3.9). Two patients had proximal deep venous thrombosis and a negative CT scan (risk, 0.6 percent; 95 percent confidence interval, 0.2 to 2.2). The overall three-month risk of thromboembolism in patients without pulmonary embolism would have been 1.5 percent (95 percent confidence interval, 0.8 to 3.0) if the D-dimer assay and multidetector-row CT had been the only tests used to rule out pulmonary embolism and ultrasonography had not been performed.

CONCLUSIONS

Our data indicate the potential clinical use of a diagnostic strategy for ruling out pulmonary embolism on the basis of D-dimer testing and multidetector-row CT without lower-limb ultrasonography. A larger outcome study is needed before this approach can be adopted.

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  • Authors+Show Affiliations

    ,

    Service of General Internal Medicine, Geneva Faculty of Medicine and Geneva University Hospital, Geneva, Switzerland. arnaud.perrier@medecine.unige.ch

    , , , , , , , , ,

    Source

    The New England journal of medicine 352:17 2005 Apr 28 pg 1760-8

    MeSH

    Aged
    Aged, 80 and over
    Anticoagulants
    Female
    Femoral Vein
    Fibrin Fibrinogen Degradation Products
    Follow-Up Studies
    Humans
    Male
    Middle Aged
    Popliteal Vein
    Predictive Value of Tests
    Prospective Studies
    Pulmonary Artery
    Pulmonary Embolism
    Thromboembolism
    Tomography, X-Ray Computed
    Ultrasonography
    Venous Thrombosis

    Pub Type(s)

    Clinical Trial
    Journal Article
    Multicenter Study
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    15858185

    Citation

    Perrier, Arnaud, et al. "Multidetector-row Computed Tomography in Suspected Pulmonary Embolism." The New England Journal of Medicine, vol. 352, no. 17, 2005, pp. 1760-8.
    Perrier A, Roy PM, Sanchez O, et al. Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med. 2005;352(17):1760-8.
    Perrier, A., Roy, P. M., Sanchez, O., Le Gal, G., Meyer, G., Gourdier, A. L., ... Bounameaux, H. (2005). Multidetector-row computed tomography in suspected pulmonary embolism. The New England Journal of Medicine, 352(17), pp. 1760-8.
    Perrier A, et al. Multidetector-row Computed Tomography in Suspected Pulmonary Embolism. N Engl J Med. 2005 Apr 28;352(17):1760-8. PubMed PMID: 15858185.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Multidetector-row computed tomography in suspected pulmonary embolism. AU - Perrier,Arnaud, AU - Roy,Pierre-Marie, AU - Sanchez,Olivier, AU - Le Gal,Grégoire, AU - Meyer,Guy, AU - Gourdier,Anne-Laurence, AU - Furber,Alain, AU - Revel,Marie-Pierre, AU - Howarth,Nigel, AU - Davido,Alain, AU - Bounameaux,Henri, PY - 2005/4/29/pubmed PY - 2005/5/4/medline PY - 2005/4/29/entrez SP - 1760 EP - 8 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 352 IS - 17 N2 - BACKGROUND: Single-detector-row computed tomography (CT) has a low sensitivity for pulmonary embolism and must be combined with venous-compression ultrasonography of the lower limbs. We evaluated whether the use of D-dimer measurement and multidetector-row CT, without lower-limb ultrasonography, might safely rule out pulmonary embolism. METHODS: We included 756 consecutive patients with clinically suspected pulmonary embolism from the emergency departments of three teaching hospitals and managed their cases according to a standardized sequential diagnostic strategy. All patients were followed for three months. RESULTS: Pulmonary embolism was detected in 194 of the 756 patients (26 percent). Among the 82 patients with a high clinical probability of pulmonary embolism, multidetector-row CT showed pulmonary embolism in 78, and 1 patient had proximal deep venous thrombosis and a CT scan that was negative for pulmonary embolism. Of the 674 patients without a high probability of pulmonary embolism, 232 (34 percent) had a negative D-dimer assay and an uneventful follow-up; CT showed pulmonary embolism in 109 patients. CT and ultrasonography were negative in 318 patients, of whom 3 had a definite thromboembolic event and 2 died of possible pulmonary embolism during follow-up (three-month risk of thromboembolism, 1.7 percent; 95 percent confidence interval, 0.7 to 3.9). Two patients had proximal deep venous thrombosis and a negative CT scan (risk, 0.6 percent; 95 percent confidence interval, 0.2 to 2.2). The overall three-month risk of thromboembolism in patients without pulmonary embolism would have been 1.5 percent (95 percent confidence interval, 0.8 to 3.0) if the D-dimer assay and multidetector-row CT had been the only tests used to rule out pulmonary embolism and ultrasonography had not been performed. CONCLUSIONS: Our data indicate the potential clinical use of a diagnostic strategy for ruling out pulmonary embolism on the basis of D-dimer testing and multidetector-row CT without lower-limb ultrasonography. A larger outcome study is needed before this approach can be adopted. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/15858185/full_citation L2 - https://www.nejm.org/doi/10.1056/NEJMoa042905?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=www.ncbi.nlm.nih.gov DB - PRIME DP - Unbound Medicine ER -