The value of 64-detector row computed tomography for the exclusion of pulmonary embolism

Raffaele Pesavento; Giorgio de Conti; Isabella Minotto; Lucia Filippi; Marta Mongiat; Daniele de Faveri; Francesca Maurizi; Fabio Dalla Valle; Chiara Piovella; Antonio Pagnan; Paolo Prandoni; for the TACEP study

doi:10.1160/TH10-10-0638

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2011; 105(05): 901-907
DOI: 10.1160/TH10-10-0638

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

The value of 64-detector row computed tomography for the exclusion of pulmonary embolism

Authors

Raffaele Pesavento

¹Department of Cardiothoracic and Vascular Sciences, 2nd chair of Internal Medicine and Thromboembolism Unit, University of Padua, Padua, Italy
Giorgio de Conti

²Department of Radiology, University Hospital of Padua, Padua, Italy
Isabella Minotto

¹Department of Cardiothoracic and Vascular Sciences, 2nd chair of Internal Medicine and Thromboembolism Unit, University of Padua, Padua, Italy
Lucia Filippi

¹Department of Cardiothoracic and Vascular Sciences, 2nd chair of Internal Medicine and Thromboembolism Unit, University of Padua, Padua, Italy
Marta Mongiat

²Department of Radiology, University Hospital of Padua, Padua, Italy
Daniele de Faveri

²Department of Radiology, University Hospital of Padua, Padua, Italy
Francesca Maurizi

²Department of Radiology, University Hospital of Padua, Padua, Italy
Fabio Dalla Valle

¹Department of Cardiothoracic and Vascular Sciences, 2nd chair of Internal Medicine and Thromboembolism Unit, University of Padua, Padua, Italy
Chiara Piovella

¹Department of Cardiothoracic and Vascular Sciences, 2nd chair of Internal Medicine and Thromboembolism Unit, University of Padua, Padua, Italy
Antonio Pagnan

¹Department of Cardiothoracic and Vascular Sciences, 2nd chair of Internal Medicine and Thromboembolism Unit, University of Padua, Padua, Italy
Paolo Prandoni

¹Department of Cardiothoracic and Vascular Sciences, 2nd chair of Internal Medicine and Thromboembolism Unit, University of Padua, Padua, Italy

for the TACEP study

Abstract

Summary

Recently, a diagnostic strategy using a clinical decision rule, D-dimer testing and spiral computed tomography (CT) was found to be effective in the evaluation of patients with clinically suspected pulmonary embolism (PE). However, the rate of venous thromboembolic complications in the three-month follow-up of patients with negative CT was still substantial and included fatal events. It was the objective to evaluate the safety of withholding anticoagulants after a normal 64-detector row CT (64-DCT) scan from a cohort of patients with suspected PE. A total of 545 consecutive patients with clinically suspected first episode of PE and either likely pre-test probability of PE (using the simplified Wells score) or unlikely pre-test probability in combination with a positive D-dimer underwent a 64-DCT. 64-DCT scanning was inconclusive in nine patients (1.6%), confirmed the presence of PE in 169 (31%), and ruled out the diagnosis in the remaining 367. During the three-month follow-up of the 367 patients one developed symptomatic distal deep-vein thrombosis (0.27%; 95%CI, 0.0 to 1.51%) and none developed PE (0 %; 95%CI, 0 to 1.0%). We conclude that 64-DCT scanning has the potential to safely exclude the presence of PE virtually in all patients presenting with clinical suspicion of this clinical disorder.

Keywords

Pulmonary embolism - CT scan - diagnosis management - diagnostic strategy

Full Text

References

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