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

L. Moores, J. 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 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Hematology

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    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, 14(1), 114-120. https://doi.org/10.1111/jth.13188