Role of spiral volumetric computed tomographic scanning in the assessment of patients with clinical suspicion of pulmonary embolism and an abnormal ventilation/perfusion lung scan.

Rossum, A. B. Van; Treurniet, F. E. E.; Kieft, G. J.; Smith, S. J.; Schepers-Bok, Relinde

doi:10.1136/thx.51.1.23

Cited by 131 publications

(54 citation statements)

References 17 publications

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“…As CT technology continues to evolve, there may be a corresponding impact on the accuracy of spiral CT [22,23,24,25]. Whether or not spiral CT can supplement, supplant, or be combined with other technologies, such as conventional duplex imaging, is still controversial.…”

Section: Discussionmentioning

confidence: 99%

Impact of Spiral Computed Tomography on the Diagnosis of Pulmonary Embolism in a Community Hospital Setting

et al. 2004

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Background: While the optimal role of spiral CT angiography (CTA) in the diagnosis of pulmonary embolism (PE) remains controversial, this technology is already being widely utilized in the community setting. Objectives: To assess the impact CTA has had on angiography utilization rates and the overall diagnostic rate of PE. Methods: All patients evaluated for PE during a 4-year period were studied. PE was defined as either a high-probability V/Q scan, a positive conventional angiogram, or a CTA with emboli in the segmental or larger pulmonary vessels. Diagnostic rates of PE per 1,000 hospital admissions were determined and analyzed for time periods before and after the introduction of CTA. CT reports were compared with their concurrent chest radiograph (CXR) reports and additional findings that were not apparent on CXR were abstracted. Results: The diagnostic rate of PE per 1,000 hospital admissions was 1.8 prior to the introduction of CTA and increased to 2.8 per 1,000 admissions after the introduction of CTA (p < 0.0001). Total costs for diagnostic testing per PE diagnosis made went from $2,518 to $2,572. While the number of PE diagnosed by V/Q scan remained constant, the number of PE diagnosed by conventional angiography decreased while the number diagnosed by CTA increased. In patients with intermediate probability V/Q scan results, the percentage of patients receiving subsequent angiography (conventional or CTA) increased from 17 to 26% (p = 0.043). When conventional angiography was performed, CT imaging of the chest still had to be ordered for other reasons 38% of the time. Additional information was obtained in 78% of cases when CTA was performed. Conclusions: Increased utilization of CTA was associated with an increase in angiography utilization rates and diagnostic rates of PE, was cost effective, and often provided additional, useful, and unanticipated diagnostic information.

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Section: Discussionmentioning

confidence: 99%

Impact of Spiral Computed Tomography on the Diagnosis of Pulmonary Embolism in a Community Hospital Setting

et al. 2004

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“…The (36). Subsequently, a total of 12 studies assessed sensitivity and specificity using lung scintigraphy (45), pulmonary angiography ~~:6-~-5 ~') or a combination of lung scintigraphy and pulmonary angiography (39,40,(52)(53)(54) as reference method. These studies are summarized in Table 1.…”

Section: J L~gh-~~~-r~ba~ility ~R~~~ S~~ñmentioning

confidence: 99%

Lung Scintigraphy and Helical Computed Tomography for the Diagnosis of Pulmonary Embolism: A Meta-Analysis

Beek

Brouwers

Song

et al. 2001

Clin Appl Thromb Hemost

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To assess the diagnostic value of lung scintigraphy and helical computed tomography (hCT) in patients with suspected pulmonary embolism (PE), all English-language articles that described lung scintigraphy and hCT in patients with suspected PE were retrieved. Articles were assessed for strength of methodology, based on nine a priori-defined criteria. Parameters of diagnostic accuracy and results of management studies were calculated and evaluated. Lung scintigraphy is diagnostic in approximately 50% of patients with suspected PE. A normal perfusion scan has a chance of recurrent PE in two of 693 patients (0.3%; 95% CI: 0.2-0.4%; fatal in 0.15%). A high-probability lung scan is corrected with angiographically proven PE in 308 of 350 patients (88%; 95% CI: 84-91%). Pulmonary embolism was proven in 385 of 1529 patients (25%; 95% CI: 24-28%) with a nondiagnostic lung scan. Helical CT studies were compared with angiography and lung scintigraphy in 1171 patients, with a prevalence of PE of 39%. The sensitivity and specificity of hCT was 283/320 (88%; 95% CI: 83-91%) and 374/408 (92%; 95% CI:89-94%), respectively. Only one prospective management study using hCT was available. In patients in whom anticoagulants were withheld based on a normal hCT study, recurrent thromboembolic events occurred in six of 109 patients (5.5%; 95% CI: 2-12%), with one fatality (1%; 95% CI: 0.02-4.3%). Lung scintigraphy is evaluated extensively and yields a diagnostic result in 50% of patients. Helical CT has similar positive predictive value to a high-probability lung scan. However, the exact role of hCT in the management of patients with suspected PE needs to be determiined in prospective studies.

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“…The primary reason for the decline in lung ventilation and perfusion imaging is the development of spiral volumetric CT for detection of pulmonary embolism. According to van Rossum et al (6), spiral volumetric CT for pulmonary embolism has a sensitivity of 95% and a specificity of 97%; the positive and negative predictive values are 97% and 97%, respectively. Additionally, breathing artifacts are problematic in nuclear lung ventilation and perfusion imaging studies but do not occur with CT (7).…”

Section: Discussionmentioning

confidence: 99%

“…This study was presented at the Society of Nuclear Medicine Annual Meeting, San Diego, California, June [3][4][5][6][7] 2006.…”

Section: Acknowledgmentsmentioning

confidence: 99%

Trends of Radiopharmaceutical Use at Mayo Clinic Rochester

Mroczenski

Berent

Hall

et al. 2007

Journal of Nuclear Medicine Technology

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The field of radiology is continuously changing. The purpose of this study was to identify the effect of technologic advances on nuclear medicine during the past 15 y. Methods: The number of radiopharmaceutical doses dispensed at Mayo Clinic (Rochester, Minnesota) from 1990 through 2004 was tracked. The number of doses was equivalent to the number of scans performed. Results: Since 1990, the number of bone scans decreased by 38%. Brain scans using The field of radiology is continuously changing.Knowledge of these changes and why they occurred will allow us to predict future use trends in nuclear medicine. Physicians order specific tests on the basis of the patient's symptoms and probable diagnosis. As technology advances, new tests are compared with previously established methods to determine the best method of diagnosing certain diseases. If the new test is superior, it may replace the previously used examination method. The purpose of this study was to identify changes in nuclear medicine use at Mayo Clinic (Rochester, Minnesota) over the past 15 y and determine why those changes occurred. MATERIALS AND METHODSThe number of radiopharmaceutical doses dispensed at Mayo Clinic Rochester from 1990 through 2004 was tracked using Nuclear Pharmacy Manager software (Bristol-Myers Squibb). This program tracks all doses dispensed from our laboratory, and the values correspond to the number of studies performed using a specific radiopharmaceutical agent. We determined the total number of scans performed each year and the number of scans performed using specific radiopharmaceuticals. Data for PET tumor imaging were based on the number of clinical scans performed each year, not the number of doses dispensed.We measured the number of bone scans that used 99m Tcmedronate and 99m Tc-oxidronate; brain scans that used 99m Tcexametazime and 99m Tc-bicisate; myocardial perfusion scans that used 201 Tl-thallous chloride and 99m Tc-sestamibi; lung ventilation and perfusion scans that used 133 Xe gas and 99m Tc-macroaggregated albumin; kidney scans that used 99m Tc-mertiatide, 99m Tcsuccimer (dimercaptosuccinic acid [DMSA]), 99m Tc-pentetate (diethylenetriamine penta-acetic acid [DTPA]), and 131 I-hippuran; and tumor scans that used 111 In-pentetreotide and 18 F-FDG. These radiopharmaceuticals were chosen because of the prevalence of their use and because we suspected that their use patterns changed over time. Only radiopharmaceutical doses dispensed for clinical patients were included in our study (radiopharmaceuticals used in research studies were excluded). As new radiopharmaceuticals were developed, use of other pharmaceuticals typically diminished; older radiopharmaceuticals often were replaced completely by the new agents for imaging of a specific organ system. For example, 99m Tc-DTPA was replaced by 99m Tc-mercaptoacetyltriglycine in renal scintigraphy. When more than one type of radiopharmaceutical was used for a particular imaging modality, values were compared and summed to determine the total number of scans of that orga...

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Role of spiral volumetric computed tomographic scanning in the assessment of patients with clinical suspicion of pulmonary embolism and an abnormal ventilation/perfusion lung scan.

Cited by 131 publications

References 17 publications

Impact of Spiral Computed Tomography on the Diagnosis of Pulmonary Embolism in a Community Hospital Setting

Impact of Spiral Computed Tomography on the Diagnosis of Pulmonary Embolism in a Community Hospital Setting

Lung Scintigraphy and Helical Computed Tomography for the Diagnosis of Pulmonary Embolism: A Meta-Analysis

Trends of Radiopharmaceutical Use at Mayo Clinic Rochester

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