Multi-Detector Row Computed Tomography in Suspected Pulmonary Embolism

Perier, A.; Roy, Preety Mittal; Sanchez, Olivier

doi:10.1016/j.jvs.2005.07.022

Cited by 8 publications

(18 citation statements)

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“…Following this selection process, 14 studies comparing spiral CT to PA [3,14,18–29] and four prospective pragmatic studies [6,30–32] remained for analysis; one additional prospective pragmatic study, initially published as an abstract, but subsequently in full was also included [7]. Agreement between both authors exceeded 95% of all extracted data; discrepancies were resolved by consensus.…”

Section: Resultsmentioning

confidence: 99%

“…Data from the five prospective outcome studies are shown in Table 4. In three studies, spiral CT was applied as a first‐line test [30–32], whereas in the remaining two studies, D‐dimer testing or a lower limb proximal compression ultrasonography (CUS) were used as screening tests [6,7]. All studies analyzed the spiral CT images down to the subsegmental level.…”

Section: Resultsmentioning

confidence: 99%

“…In the ‘Evaluation du Scanner Spiralé dans l'Embolie Pulmonaire (ESSEP) study [31], isolated subsegmental perfusion defects, either unique or multiple, were considered inconclusive in patients with a normal lower limb CUS (14 patients, 10 with unique image, and four with multiple images) and further tests were performed (V/Q lung scanning and/or PA). In the remaining two studies from Geneva [6,7], patients with multiple isolated SSP defects were classified as having PE and treated by anticoagulants (respectively two and 14 patients), a confirmation test being required for cases of a unique isolated SSP defect (two patients in the latest study). The percentage of isolated SSP images was significantly higher in studies using multi‐detector CT (17 of the 770 CT scans, 2.2%) compared with those using single‐detector CT (22 of the 2232, 1.0%; P =0.01).…”

Section: Resultsmentioning

confidence: 99%

“…Interestingly, in comparison studies on the accuracy of single‐detector CT, the sensitivity was markedly poorer at the segmental and subsegmental levels [4,5]. Likewise, all outcome studies using a highly sensitive enzyme‐ linked immunosorbent assay (ELISA) D‐dimer assay have shown a similar 1% 3‐month thromboembolic risk in patients left untreated based on a negative D‐dimer result [6–8]. However, in the only comparison study in which all patients underwent both such a D‐dimer assay and pulmonary angiography, the false‐negative rate of D‐dimer was 25% in the 37% of patients with SSP embolism [9].…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis and management of subsegmental pulmonary embolism

Gal

Righini

Parent

et al. 2006

Journal of Thrombosis and Haemostasis

143

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Summary. Introduction: Although the advent of multi‐detector row computed tomography (CT) has enabled better visualization of subsegmental pulmonary (SSP) arteries, SSP embolism is of uncertain clinical significance. We aimed at answering the following questions: Is spiral CT an accurate method to detect SSP embolism? How are subsegmental perfusion defects managed in outcome studies including spiral CT? What are the main characteristics and outcomes of patients in whom CT detects isolated subsegmental defects? Methods: We performed a Medline search on July 1, 2004, using the keywords ‘pulmonary embolism’ and ‘computed tomography’. We limited our search to English language prospective studies comparing CT to pulmonary angiography, and to prospective outcome studies including CT in a diagnostic strategy, with at least a 3‐month follow‐up. Results: Fourteen studies comparing CT to pulmonary angiography, and five prospective management studies using CT were retrieved. The sensitivity of single‐detector CT for detecting subsegmental defects compared with pulmonary angiography was low (25%). The proportion of isolated SSP images was significantly higher in management studies using multi‐detector CT (17 of 770 scans, 2.2%) compared with those using single‐detector CT (22 of 2232, 1.0%; P = 0.01). No straightforward attitude regarding anticoagulation therapy for isolated subsegmental defects emerged from the available literature. Finally, important clinical differences were found between patients having subsegmental and segmental or more proximal defects. Conclusions: These findings underline the uncertainty regarding the clinical significance of SSP embolism, and the management of patients with such findings.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnosis and management of subsegmental pulmonary embolism

Gal

Righini

Parent

et al. 2006

Journal of Thrombosis and Haemostasis

143

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“…We analyzed the combined data from two prospective multicenter cohort studies, that included 1721 consecutive patients admitted to the emergency ward with suspected PE [1,10]. These outcome studies were designed to evaluate diagnostic strategies for PE, combining clinical probability assessment, plasma D‐dimer measurement, lower limb venous CUS, and CT.…”

Section: Methodsmentioning

confidence: 99%

Differential value of risk factors and clinical signs for diagnosing pulmonary embolism according to age

Gal

Righini²,

Roy³

et al. 2005

Journal of Thrombosis and Haemostasis

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Summary. Introduction: The diagnostic value of clinical presentation of pulmonary embolism (PE) is uncertain in the elderly, who often have concomitant cardiopulmonary diseases that may mimic PE. The aim of our study was to assess the differential value of risk factors, symptoms and clinical signs of venous thromboembolism, results of electrocardiogram and chest X‐ray for the diagnosis of PE in suspected patients according to age. Methods: We analyzed data from two outcome studies which enrolled 1721 consecutive patients presenting in the emergency department with clinically suspected PE defined as acute onset of new or worsening shortness of breath or chest pain without any other obvious etiology. All patients underwent a sequential diagnostic work‐up and a 3‐month follow‐up. Results: The proportion of confirmed PE was 24.2% (416 of 1721). Strength of the association with PE did not differ according to age group for history of venous thromboembolism (VTE), recent surgery, tachypnea at admission or right ventricular strain on electrocardiogram. Active malignancy, hemoptysis, tachycardia, hemidiaphragmatic elevation and pleural effusion at chest X‐ray were no more associated with PE in the patients aged of 75 years or more. Finally, symptoms and signs of deep venous thrombosis, and an alternative diagnosis less probable than PE were associated with PE in all age groups, but the strength of this association decreased significantly with advancing age. Conclusion: Some risk factors, symptoms and signs of VTE are less strongly or even not at all associated with PE in the elderly. Physicians should take this into account when attending elderly patients suspected of PE and when assessing their clinical probability of PE.

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