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Ann Intern Med. 2001 Jul 17;135(2):88-97.

Performance of helical computed tomography in unselected outpatients with suspected pulmonary embolism.

Author information

1
Medical Clinic 1, Department of Internal Medicine, Geneva University Hospital, Rue Micheli-du-Crest 24, CH-1211 Geneva 14, Switzerland. Arnaud.Perrier@medecine.unige.ch

Abstract

BACKGROUND:

Helical computed tomography (CT) is commonly used to diagnose pulmonary embolism, although its operating characteristics have been insufficiently evaluated.

OBJECTIVE:

To assess the sensitivity and specificity of helical CT in suspected pulmonary embolism.

DESIGN:

Observational study.

SETTING:

Emergency department of a teaching and community hospital.

PATIENTS:

299 patients with clinically suspected pulmonary embolism and a plasma D -dimer level greater than 500 microgram/L.

INTERVENTION:

Pulmonary embolism was established by using a validated algorithm that included clinical assessment, lower-limb compression ultrasonography, lung scanning, and pulmonary angiography.

MEASUREMENTS:

Sensitivity, specificity, and likelihood ratios of helical CT and interobserver agreement. Helical CT scans were withheld from clinicians and were read 3 months after acquisition by radiologists blinded to all clinical data.

RESULTS:

118 patients (39%) had pulmonary embolism. In 12 patients (4%), 2 of whom had pulmonary embolism, results of helical CT were inconclusive. For patients with conclusive results, sensitivity of helical CT was 70% (95% CI, 62% to 78%) and specificity was 91% (CI, 86% to 95%). Interobserver agreement was high (kappa = 0.823 to 0.902). The false-negative rate was lower for helical CT used after initial negative results on ultrasonography than for helical CT alone (21% vs. 30%). Use of helical CT after normal results on initial ultrasonography and nondiagnostic results on lung scanning had a false-negative rate of only 5% and a false-positive rate of only 7%.

CONCLUSION:

Helical CT should not be used alone for suspected pulmonary embolism but could replace angiography in combined strategies that include ultrasonography and lung scanning.

PMID:
11453707
[Indexed for MEDLINE]

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