Treatment of patients with suspected pulmonary embolism and intermediate-probability lung scans: is diagnostic imaging underused?

Khorasani, Ramin; Gudas, Thomas F.; Nikpoor, Neda; Polák, J

doi:10.2214/ajr.169.5.9353458

Cited by 44 publications

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“…In 1982, Sostman et al [2] described finding that only 50 (12%) of 434 patients underwent pulmonary angiography despite unresolved diagnosis after scintigraphy. More recently, Khorasani et al [3] found that 63% of patients with lung scansshowing in termediate probability of embolism had treatment decisions made without benefit of a definitive imaging diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosis of pulmonary embolism is basedlargely on noninvasiveimaging such as ventilationâ€"perfusion scintigraphy and lower extremity venous sonography, with a limited useof pulmonaryangiography [2,3]. Despite excellent results for helical and elec tron beam CT in central or segmental yes sels, with a sensitivity of 86â€"100% and a specificityof 78â€"95% [5, 7, 8], andcompara ble results for gadolinium-enhanced MR an giography (sensitivity, 75â€"100%; specificity, 95â€"100%) [9], little change has occurred in the diagnostic algorithm for pulmonary em bolism.…”

Section: Discussionmentioning

confidence: 99%

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Effect of anatomic distribution of pulmonary emboli on interobserver agreement in the interpretation of pulmonary angiography.

Diffin

Leyendecker

Johnson

et al. 1998

American Journal of Roentgenology

206

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Oanie@ C.Diffin1 JohnR.Leyendecker1'2 Stephen R Johnson1 RyanJ. Zucker1 Paul J.Grebe3 OBJECTIVE.This study examines the anatomic distribution of emboli on pulmonary an giography and attempts to determine the relationship of vessel size to interobserver agree ment, two factors having important implications in comparing pulmonary angiography with cross-sectional imaging for pulmonary embolism. MATERIALS AND METHODS.One hundred twenty-five consecutive pulmonary an giograms were reviewed retrospectively by three interventional radiologists. Initial interpreta tions were recorded and compared to determine interobserver agreementon a per-patient and per-embolus basis. Discordant interpretations were reviewed by all radiologists for a consen sus interpretation. RESULTS. Unanimous per-patient agreement occurred in 91 % ( I 14/I 25) of initial inter

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of anatomic distribution of pulmonary emboli on interobserver agreement in the interpretation of pulmonary angiography.

Diffin

Leyendecker

Johnson

et al. 1998

American Journal of Roentgenology

206

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“…Whether the findings of the examinations would have been positive is a matter for speculation, because the lower ex tremity veins were not examined in the autop sies. Khorasani et al [14] recently showed that, in up to 49% of a population of patients with intermediate-probability lung scintigra phy, additional imaging with either sonogra phy or pulmonary arteriography was not done to exclude the diagnosis of pulmonary embo lism. These data are for patients with a 30-40%…”

Section: Diagnostic Imaging and Autopsy Findings For Pulmonary Embolismmentioning

confidence: 99%

Correlation of diagnostic imaging and subsequent autopsy findings in patients with pulmonary embolism.

Patriquin¹,

Khorasani²,

Polák³

1998

American Journal of Roentgenology

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who underwent lung scintigraphy for suspected pulmonary embolism and for whom the pul monary embolism was proven at autopsy. MATERIALS AND METHODS. Weperformed a longitudinal follow-upstudyof 1210consecutive patients who underwent scintigraphic imaging for suspected pulmonary embo lism. Patients for whom pulmonary embolism was proven at autopsy within 30 days of lung scintigraphy were studied. Diagnostic testing and risk factors were compared in patients with and without an antemortem diagnosis of pulmonary embolism. RESULTS. The antemortem diagnosis wasmadein fourof eightpatients with autopsyproven pulmonary embolism, yielding a sensitivity of 0.5 (95% confidence interval, 0.16-0.84). The diagnosis was made by high-probability lung scintigraphy in two patients, by pulmonary arteriography in one patient, and by lower extremity venous sonography in another patient. The imaging investigation for suspected pulmonary embolism included only lung scintigra phy in four patients in whom the antemortem diagnosis was incorrect: two with low-probabil ity scintigraphy and two with intermediate-probability scintigraphy. Risk factors were similar for patients with and without pulmonary embolism. CONCLUSION. In thiscohortstudyof patients suspected of havingpulmonary embolism, the antemortem diagnosis was not made in 50% of patients in whom pulmonary embo lism was later proven at autopsy. Underuse of diagnostic testing may have been to blame. We therefore believe that further study is needed to help identify patients with suspected pulmo nary embolism who may benefit from additional diagnostic testing after low-or intermediate probability lung scintigraphy.Lara Patriquin' has been to identify pulmonary embolism pa tients who were autopsied and then to deter mine the clinical characteristics relating to the diagnosis of thromboembolic disease.The diagnostic approaches for suspected pulmonary embolism have broadened to in dude diagnostic testing of the lower extremity veins in addition to pulmonary arteriography [5,6]. Although pulmonary angiography re mains the gold standard for diagnosing pul Autopsy studies have looked at the out come, death from pulmonary embolism, and then determined possible clinical indicators that might have been useful in making the an temortem diagnosis [2,3]. To our knowledge, no studies have looked at autopsy-proven pul monary embolism as the outcome for patients who had been examined for suspected pulmo nary embolism. We therefore longitudinally followed up a cohort of consecutive patients who had been examined for suspected pul monary embolism with ventilationâ€"perfusion scintigraphy. Materials and MethodsWe studied 1210consecutivepatientsseen at the Brigham and Women's Hospital in a 22-month in tervalwho underwentventilationâ€"perfusion scintig

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“…If the diagnosis is still unclear, the patient would undergo pulmonary angiography, a procedure which carries a small but definite risk [15]. This diagnostic algorithm, however, was generally underused [4,16,17,18,19]. In the beginning of the 1990s it was stressed that there is a clear need for a technique, which is accurate, safe, noninvasive, easily and rapidly performed, widely accepted, and cost-effective, for direct detection and demonstration of intraluminal PE [20,21,22].…”

Section: Introductionmentioning

confidence: 99%

Non-traumatic thoracic emergencies: CT diagnosis of acute pulmonary embolism: the first 10 years

2002

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Over the past 10 years, spiral CT angiography of the pulmonary arteries has reached a high accuracy in the evaluation of pulmonary embolism. Major advantages of CT compared with ventilation/perfusion lung scintigraphy and pulmonary angiography is direct visualization of clots in the pulmonary arteries, and to provide alternative findings or diagnosis. The recent introduction of multislice CT has improved the evaluation of peripheral pulmonary arteries, enabling high-resolution CT examinations over the entire thorax in a short breathhold. The examination techniques, imaging findings, pitfalls, and results of CT in the diagnosis of pulmonary embolism are reviewed in comparison with other diagnostic tests.

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Treatment of patients with suspected pulmonary embolism and intermediate-probability lung scans: is diagnostic imaging underused?

Cited by 44 publications

References 0 publications

Effect of anatomic distribution of pulmonary emboli on interobserver agreement in the interpretation of pulmonary angiography.

Effect of anatomic distribution of pulmonary emboli on interobserver agreement in the interpretation of pulmonary angiography.

Correlation of diagnostic imaging and subsequent autopsy findings in patients with pulmonary embolism.

Non-traumatic thoracic emergencies: CT diagnosis of acute pulmonary embolism: the first 10 years

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