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; for the SCENIC Investigators Group

doi:10.1055/s-2006-955470

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2006; 32(8): 831-837
DOI: 10.1055/s-2006-955470

The Value of Four-Detector Row Spiral Computed Tomography for the Diagnosis of Pulmonary Embolism

Mario Vigo¹ , Raffaele Pesavento² , Carlo Bova⁴ , Fernando Porro⁵ , Angelo Ghirarduzzi⁶ , Mario Bazzan⁸ , Roberta Polverosi¹ , Michela Frulla² , Alfonso Noto⁴ , Roberto Castelli⁵ , Franco Giovanardi⁷ , Federico Angelini³ , Antonio Pagnan² , Paolo Prandoni²

¹Department of Radiology, Hospital of Bassano del Grappa, Italy
²Department of Medical and Surgical Sciences
³Department of Radiology, University Hospital of Padua, Padua, Italy
⁴Department of Medicine, University Hospital of Cosenza, Italy
⁵Department of Emergency Medicine, University Hospital Mangiagalli and Regina Elena, Milano, Italy
⁶Department of Medicine
⁷Thromboembolism Unit and Department of Radiology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
⁸Hematology and Thromboembolism Unit, Cellini Humanitas, Torino, Italy
⁹additional investigators of the Spiral Computed tomography in pulmonary Embolism, National Italian Cohort (SCENIC) Group are listed in Acknowledgments

Abstract

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.

KEYWORDS

Pulmonary embolism - spiral computed tomography - D-dimer - venous thromboembolism - diagnosis

Full Text

References

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Dr.
Paolo Prandoni

Department of Medical and Surgical Sciences, 2nd Chair of Internal Medicine, Via Ospedale Civile

105, 35128 - Padua, Italy

Email: paoloprandoni@tin.it