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Multidetector computed tomographic pulmonary angiography in patients with a high clinical probability of pulmonary embolism.
J Thromb Haemost. 2016 Jan; 14(1):114-20.JT

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.

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.

Authors+Show Affiliations

F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD, USA.Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.Department of Internal Medicine, Instituto Ramon y Cajal de Investigacion Sanitaria IRYCIS, Ramón y Cajal Hospital, Madrid, Spain.Radiology Department, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Ramón y Cajal Hospital, Madrid, Spain.Radiology Department, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Ramón y Cajal Hospital, Madrid, Spain.Respiratory Department, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Ramón y Cajal Hospital, Alcala de Henares University, Madrid, Spain.Emergency Department, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Ramón y Cajal Hospital, Madrid, Spain.Divisions of Pulmonary and Critical Care Medicine, Cedars-Sinai, Los Angeles, CA, USA.Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St Louis, MO, USA.Respiratory Department, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Ramón y Cajal Hospital, Alcala de Henares University, Madrid, Spain.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26559176

Citation

Moores, L, et al. "Multidetector Computed Tomographic Pulmonary Angiography in Patients With a High Clinical Probability of Pulmonary Embolism." Journal of Thrombosis and Haemostasis : JTH, vol. 14, no. 1, 2016, pp. 114-20.
Moores L, Kline J, Portillo AK, et al. Multidetector computed tomographic pulmonary angiography in patients with a high clinical probability of pulmonary embolism. J Thromb Haemost. 2016;14(1):114-20.
Moores, L., Kline, J., Portillo, A. K., Resano, S., Vicente, A., Arrieta, P., Corres, J., Tapson, V., Yusen, R. D., & Jiménez, D. (2016). Multidetector computed tomographic pulmonary angiography in patients with a high clinical probability of pulmonary embolism. Journal of Thrombosis and Haemostasis : JTH, 14(1), 114-20. https://doi.org/10.1111/jth.13188
Moores L, et al. Multidetector Computed Tomographic Pulmonary Angiography in Patients With a High Clinical Probability of Pulmonary Embolism. J Thromb Haemost. 2016;14(1):114-20. PubMed PMID: 26559176.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multidetector computed tomographic pulmonary angiography in patients with a high clinical probability of pulmonary embolism. AU - Moores,L, AU - Kline,J, AU - Portillo,A K, AU - Resano,S, AU - Vicente,A, AU - Arrieta,P, AU - Corres,J, AU - Tapson,V, AU - Yusen,R D, AU - Jiménez,D, Y1 - 2015/12/14/ PY - 2015/08/06/received PY - 2015/11/01/accepted PY - 2015/11/13/entrez PY - 2015/11/13/pubmed PY - 2016/12/22/medline KW - diagnosis KW - diagnostic imaging KW - multidetector computed tomography KW - probability KW - pulmonary embolism SP - 114 EP - 20 JF - Journal of thrombosis and haemostasis : JTH JO - J Thromb Haemost VL - 14 IS - 1 N2 - UNLABELLED: 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. 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. SN - 1538-7836 UR - https://www.unboundmedicine.com/medline/citation/26559176/Multidetector_computed_tomographic_pulmonary_angiography_in_patients_with_a_high_clinical_probability_of_pulmonary_embolism_ L2 - https://doi.org/10.1111/jth.13188 DB - PRIME DP - Unbound Medicine ER -