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AJR Am J Roentgenol. 1995 Jun;164(6):1369-74.

Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: helical CT versus angiography.

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  • 1Department of Radiology, Medical College of Wisconsin, Milwaukee 53226-3512, USA.

Abstract

OBJECTIVE:

This study was designed to prospectively compare helical CT with pulmonary angiography in the detection of pulmonary embolism in patients with an unresolved clinical and scintigraphic diagnosis.

SUBJECTS AND METHODS:

Twenty patients with an unresolved suspicion of pulmonary embolism were evaluated with contrast-enhanced helical CT and with selective pulmonary angiography. An average of 11 hr separated the two studies. The CT scans were obtained during one 24-sec or two 12-sec breath-holds. CT scans were interpreted without knowledge of the results of scintigraphy or angiography. Selective pulmonary angiograms were obtained with knowledge of the findings on the ventilation/perfusion scan only. The sensitivity and specificity of CT were compared with those of angiography for central vessels (segmental and larger) only and for all vessels.

RESULTS:

Eleven of the 20 patients had proved pulmonary embolism (seven in central vessels and four in subsegmental vessels only). When only central vessels were analyzed, CT sensitivity was 86%, specificity was 92%, and the likelihood ratio was 10.7. However, when subsegmental vessels were included, CT results were 63%, 89%, and 5.7, respectively.

CONCLUSION:

In our subset of patients, helical CT was only 63% sensitive. Subsegmental emboli are difficult to diagnose. Pulmonary angiography remains the study of choice. CT has a limited role in the evaluation of acute pulmonary embolism.

PMID:
7754875
DOI:
10.2214/ajr.164.6.7754875
[PubMed - indexed for MEDLINE]
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