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Semin Thromb Hemost 2006; 32(8): 831-837
DOI: 10.1055/s-2006-955470
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

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
Further Information

Publication History

Publication Date:
15 December 2006 (online)

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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

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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