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Clin Imaging. 2008 Sep-Oct;32(5):335-41. doi: 10.1016/j.clinimag.2008.01.028.

64-Multidetector-row spiral CT in pulmonary embolism with emphasis on incidental findings.

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  • 1Department of Radiology, Georg-August-University Goettingen, Göttingen, Germany.

Abstract

AIM:

In this retrospective study, we assess the current role and future potential of computed tomography (CT) in the diagnostic algorithm of acute pulmonary embolism (PE).

MATERIALS AND METHODS:

Two hundred patients underwent 64-multidetector-row spiral CT of the chest, pelvis, and thigh for suspected PE. CT scans were reviewed, and the degree of contrast enhancement and the presence of PE and/or (deep) venous thrombosis were recorded. In the case of PE, the level of thrombus was noted as central, main, or lobar. If the scan yielded a positive result for thrombosis, intravenous localization was also determined. Patient age, length of admission, clinical course, clinical indication, and incidental findings were registered as well.

RESULTS:

PE was detected in 60 of the 200 patients with a high clinical probability of having PE (30%). Thirty-four patients had a positive CT scan result for venous thrombosis (17%). Twenty-four of the 60 patients had proximal deep venous thrombosis (40%), and 2 patients had arm venous thrombosis (3%). Thirty-four of the 60 patients had PE without venous thrombosis (57%). Eight of the 200 patients had deep venous thrombosis without suspicion of PE (4%). The distribution of the proximal thrombi showed 15 in a central artery (25%), 13 in a main pulmonary artery (22%), and 32 in a lobar segmental artery (53%). There was diffuse allocation of the thrombus in all lobes. Furthermore, CT scan noted a total of 120 incidental findings.

CONCLUSION:

Our study indicates the potential clinical use of a diagnostic strategy for ruling out PE based on D-dimer testing and multidetector-row CT. A larger outcome study is needed before this approach can be adopted.

[PubMed - indexed for MEDLINE]
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