Subsequent Pulmonary Embolism: Risk after a Negative Helical CT Pulmonary Angiogram— Prospective Comparison with Scintigraphy

Abstract

The frequency of clinical diagnoses of PE after a negative CT scan was low and similar to that after a negative or low-probability V-P scan. Helical CT is a reliable imaging tool for excluding clinically important PE.

O papel dos exames de imagem na avaliação da circulação pulmonar

“…(34)(35)(36) This is explained by the various advantages of CT angiography: its high resolution allows the visualization of arteries and filling defects up to the distal portion of the pulmonary vasculature, reaching subsegmental vessels of 2-3 mm ( Figure 6); it has excellent interobserver agreement, far superior to that of scintigraphy; its sensitivity is so high that a negative test result allows the safe discontinuation of anticoagulation therapy. (37) One must be alert, however, to the dangers inherent in the method. Technical or pathophysiological factors might lead to the interpretation of pseudo-filling defects, providing false-positive results.…”

Imaging in Acute Pulmonary Embolism With Special Clinical Scenarios

“…Goodman et al 30 found, using single detector CT, that the prevalence of clinically evident PE after negative CTPA using was 1.0%. Even the value of 1% (99% negative predictive value) may be conservative for a high image quality modern CTPA with MDCT.…”

“…Even the value of 1% (99% negative predictive value) may be conservative for a high image quality modern CTPA with MDCT. Goodman et al 30 concluded that a negative CTPA was reliable enough to withhold anticoagulation therapy; this is standard practice. Donato et al 31 found a rate of 1.7% embolic events in their cohort of 239 patients, concluding that a negative helical CT has an excellent prognosis for the absence of future venous thromboembolic disease.…”

Avaliação cintilográfica de diferentes dosagens de Tecnécio-99m na padronização da perfusão pulmonar em cães da raça Rottweiller

“…Embora autores como BAILE et al (2000), GOODMAN et al (2000) e WELLS & RODGER, (2003) tenham demonstrado a angiografia pulmonar como "padrão ouro" no diagnóstico de lesões pulmonares, especialmente tromboembolismos, este trabalho sustenta-se nas descrições realizadas por COOPER et al (1991) e SCHLUGER et al (1994, quando definiram essa técnica como um método invasivo. Além disso, a literatura recente (CRONIN et al, 2008;ATTENBERGER et al, 2009) tem descrito novas técnicas diagnósticas como opção na identificação de alterações de fluxo vascular pulmonar.…”