Multidetector computed tomographic pulmonary angiography in patients with a high clinical probability of pulmonary embolism

L. Moores, Jeffrey Kline, A. K. Portillo, S. Resano, A. Vicente, P. Arrieta, J. Corres, V. Tapson, R. D. Yusen, D. Jiménez

Research output: Contribution to journalArticle

16 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)114-120
Number of pages7
JournalJournal of Thrombosis and Haemostasis
Volume14
Issue number1
DOIs
StatePublished - Jan 1 2016

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Pulmonary Embolism
Angiography
Lung
Venous Thromboembolism
Confidence Intervals
Tomography
Multidetector Computed Tomography
Venous Thrombosis

Keywords

  • Diagnosis
  • Diagnostic imaging
  • Multidetector computed tomography
  • Probability
  • Pulmonary embolism

ASJC Scopus subject areas

  • Hematology

Cite this

Multidetector computed tomographic pulmonary angiography in patients with a high clinical probability of pulmonary embolism. / Moores, L.; Kline, Jeffrey; Portillo, A. K.; Resano, S.; Vicente, A.; Arrieta, P.; Corres, J.; Tapson, V.; Yusen, R. D.; Jiménez, D.

In: Journal of Thrombosis and Haemostasis, Vol. 14, No. 1, 01.01.2016, p. 114-120.

Research output: Contribution to journalArticle

Moores, L, Kline, J, Portillo, AK, Resano, S, Vicente, A, Arrieta, P, Corres, J, Tapson, V, Yusen, RD & Jiménez, D 2016, 'Multidetector computed tomographic pulmonary angiography in patients with a high clinical probability of pulmonary embolism', Journal of Thrombosis and Haemostasis, vol. 14, no. 1, pp. 114-120. https://doi.org/10.1111/jth.13188
Moores, L. ; Kline, Jeffrey ; Portillo, A. K. ; Resano, S. ; Vicente, A. ; Arrieta, P. ; Corres, J. ; Tapson, V. ; Yusen, R. D. ; Jiménez, D. / Multidetector computed tomographic pulmonary angiography in patients with a high clinical probability of pulmonary embolism. In: Journal of Thrombosis and Haemostasis. 2016 ; Vol. 14, No. 1. pp. 114-120.
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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.",
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AU - Moores, L.

AU - Kline, Jeffrey

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.

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N2 - 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.

AB - 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.

KW - Diagnosis

KW - Diagnostic imaging

KW - Multidetector computed tomography

KW - Probability

KW - Pulmonary embolism

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