Abstract
Although spiral computed tomography (CT) is being used increasingly as the first-line imaging procedure in the diagnostic workup of patients with clinically suspected pulmonary embolism (PE), the diagnostic value of negative findings, at least when using the four-detector row scanners, is still controversial. A total of 702 consecutive patients with clinical symptoms suggestive of PE underwent four-slice CT. Patients with negative findings received the determination of D-dimer. Those with positive D-dimer underwent further diagnostic workup to confirm or rule out the diagnosis of PE. Those with negative D-dimer were followed-up to 6 months to detect the development of symptomatic venous thromboembolism (VTE). The CT test was interpreted as negative in 536 patients (76.3%). These patients had the D-dimer determination, which was positive in 279 and negative in the remaining 257 patients. Of the former, PE subsequently was documented in 55 patients (19.7%). Of the latter, symptomatic VTE in the follow-up period developed in three patients (1.17%; 95% confidence interval, 0.24 to 3.38%). In conclusion, when using the four-detector row, the negative predictive value of CT findings in patients with clinically suspected PE and positive D-dimer is low. In contrast, it is safe to withhold anticoagulation from patients with negative findings and negative D-dimer.
| Original language | English |
|---|---|
| Pages (from-to) | 831-837 |
| Number of pages | 7 |
| Journal | Seminars in Thrombosis and Hemostasis |
| Volume | 32 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - Nov 2006 |
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Keywords
- D-dimer
- Diagnosis
- Pulmonary embolism
- Spiral computed tomography
- Venous thromboembolism
ASJC Scopus subject areas
- Hematology
- Cardiology and Cardiovascular Medicine
Cite this
The value of four-detector row spiral computed tomography for the diagnosis of pulmonary embolism. / Vigo, Mario; Pesavento, Raffaele; Bova, Carlo; Porro, Fernando; Ghirarduzzi, Angelo; Bazzan, Mario; Polverosi, Roberta; Frulla, Michela; Noto, Alfonso; Castelli, Roberto; Giovanardi, Franco; Angelini, Federico; Pagnan, Antonio; Prandoni, Paolo.
In: Seminars in Thrombosis and Hemostasis, Vol. 32, No. 8, 11.2006, p. 831-837.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The value of four-detector row spiral computed tomography for the diagnosis of pulmonary embolism
AU - Vigo, Mario
AU - Pesavento, Raffaele
AU - Bova, Carlo
AU - Porro, Fernando
AU - Ghirarduzzi, Angelo
AU - Bazzan, Mario
AU - Polverosi, Roberta
AU - Frulla, Michela
AU - Noto, Alfonso
AU - Castelli, Roberto
AU - Giovanardi, Franco
AU - Angelini, Federico
AU - Pagnan, Antonio
AU - Prandoni, Paolo
PY - 2006/11
Y1 - 2006/11
N2 - Although spiral computed tomography (CT) is being used increasingly as the first-line imaging procedure in the diagnostic workup of patients with clinically suspected pulmonary embolism (PE), the diagnostic value of negative findings, at least when using the four-detector row scanners, is still controversial. A total of 702 consecutive patients with clinical symptoms suggestive of PE underwent four-slice CT. Patients with negative findings received the determination of D-dimer. Those with positive D-dimer underwent further diagnostic workup to confirm or rule out the diagnosis of PE. Those with negative D-dimer were followed-up to 6 months to detect the development of symptomatic venous thromboembolism (VTE). The CT test was interpreted as negative in 536 patients (76.3%). These patients had the D-dimer determination, which was positive in 279 and negative in the remaining 257 patients. Of the former, PE subsequently was documented in 55 patients (19.7%). Of the latter, symptomatic VTE in the follow-up period developed in three patients (1.17%; 95% confidence interval, 0.24 to 3.38%). In conclusion, when using the four-detector row, the negative predictive value of CT findings in patients with clinically suspected PE and positive D-dimer is low. In contrast, it is safe to withhold anticoagulation from patients with negative findings and negative D-dimer.
AB - Although spiral computed tomography (CT) is being used increasingly as the first-line imaging procedure in the diagnostic workup of patients with clinically suspected pulmonary embolism (PE), the diagnostic value of negative findings, at least when using the four-detector row scanners, is still controversial. A total of 702 consecutive patients with clinical symptoms suggestive of PE underwent four-slice CT. Patients with negative findings received the determination of D-dimer. Those with positive D-dimer underwent further diagnostic workup to confirm or rule out the diagnosis of PE. Those with negative D-dimer were followed-up to 6 months to detect the development of symptomatic venous thromboembolism (VTE). The CT test was interpreted as negative in 536 patients (76.3%). These patients had the D-dimer determination, which was positive in 279 and negative in the remaining 257 patients. Of the former, PE subsequently was documented in 55 patients (19.7%). Of the latter, symptomatic VTE in the follow-up period developed in three patients (1.17%; 95% confidence interval, 0.24 to 3.38%). In conclusion, when using the four-detector row, the negative predictive value of CT findings in patients with clinically suspected PE and positive D-dimer is low. In contrast, it is safe to withhold anticoagulation from patients with negative findings and negative D-dimer.
KW - D-dimer
KW - Diagnosis
KW - Pulmonary embolism
KW - Spiral computed tomography
KW - Venous thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=33845649406&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33845649406&partnerID=8YFLogxK
U2 - 10.1055/s-2006-955470
DO - 10.1055/s-2006-955470
M3 - Article
C2 - 17171597
AN - SCOPUS:33845649406
VL - 32
SP - 831
EP - 837
JO - Seminars in Thrombosis and Hemostasis
JF - Seminars in Thrombosis and Hemostasis
SN - 0094-6176
IS - 8
ER -