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Clin Appl Thromb Hemost. 2001 Apr;7(2):87-92.

Lung scintigraphy and helical computed tomography for the diagnosis of pulmonary embolism: a meta-analysis.

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  • 1Section of Academic Radiology, Royal Hallamshire Hospital, Sheffield, UK.

Abstract

To assess the diagnostic value of lung scintigraphy and helical computed tomography (hCT) in patients with suspected pulmonary embolism (PE), all English-language articles that described lung scintigraphy and hCT in patients with suspected PE were retrieved. Articles were assessed for strength of methodology, based on nine a priori-defined criteria. Parameters of diagnostic accuracy and results of management studies were calculated and evaluated. Lung scintigraphy is diagnostic in approximately 50% of patients with suspected PE. A normal perfusion scan has a chance of recurrent PE in two of 693 patients (0.3%; 95% CI: 0.2-0.4%; fatal in 0.15%). A high-probability lung scan is correlated with angiographically proven PE in 308 of 350 patients (88%; 95% CI: 84-91%). Pulmonary embolism was proven in 385 of 1529 patients (25%; 95% CI: 24-28%) with a nondiagnostic lung scan. Helical CT studies were compared with angiography and lung scintigraphy in 1171 patients, with a prevalence of PE of 39%. The sensitivity and specificity of hCT was 283/320 (88%; 95% CI: 83-91%) and 374/408 (92%; 95% CI: 89-94%), respectively. Only one prospective management study using hCT was available. In patients in whom anticoagulants were withheld based on a normal hCT study, recurrent thromboembolic events occurred in six of 109 patients (5.5%; 95% CI: 2-12%), with one fatality (1%; 95% CI: 0.02-4.3%). Lung scintigraphy is evaluated extensively and yields a diagnostic result in 50% of patients. Helical CT has similar positive predictive value to a high-probability lung scan. However, the exact role of hCT in the management of patients with suspected PE needs to be determined in prospective studies.

PMID:
11292198
[PubMed - indexed for MEDLINE]
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