The value of four-detector row spiral computed tomography for the diagnosis of pulmonary embolism

Mario Vigo, Raffaele Pesavento, Carlo Bova, Fernando Porro, Angelo Ghirarduzzi, Mario Bazzan, Roberta Polverosi, Michela Frulla, Alfonso Noto, Roberto Castelli, Franco Giovanardi, Federico Angelini, Antonio Pagnan, Paolo Prandoni

Research output: Contribution to journalArticlepeer-review

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 languageEnglish
Pages (from-to)831-837
Number of pages7
JournalSeminars in Thrombosis and Hemostasis
Volume32
Issue number8
DOIs
Publication statusPublished - Nov 2006

Keywords

  • D-dimer
  • Diagnosis
  • Pulmonary embolism
  • Spiral computed tomography
  • Venous thromboembolism

ASJC Scopus subject areas

  • Hematology
  • Cardiology and Cardiovascular Medicine

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