Helical Computed Tomography and the Diagnosis of Pulmonary Embolism

Editorials1 February 2000Helical Computed Tomography and the Diagnosis of Pulmonary EmbolismShannon M. Bates, MD, FRCP(C) and Jeffrey S. Ginsberg, MD, FRCP(C)Shannon M. Bates, MD, FRCP(C)From McMaster University and Hamilton Civic Hospitals Research Centre; Hamilton, Ontario L8N 3Z5, CanadaSearch for more papers by this author and Jeffrey S. Ginsberg, MD, FRCP(C)From McMaster University and Hamilton Civic Hospitals Research Centre; Hamilton, Ontario L8N 3Z5, CanadaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-132-3-200002010-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Acute pulmonary embolism is a common and potentially life-threatening disorder (1). Treatment is highly effective (2) but not without complications, and the diagnosis of pulmonary embolism therefore requires a high degree of certainty. Conversely, if untreated, pulmonary embolism can be fatal.The clinical diagnosis alone is inaccurate for patients with suspected pulmonary embolism. Pulmonary angiography remains the diagnostic reference standard, but it is invasive and expensive, is not universally available, and is associated with morbidity (in 2% to 5% of patients) and death (in <1% of patients) (3). Ventilation-perfusion scanning, the most commonly used screening technique, provides a probability estimate for ...References1. Carson JL, Kelley MA, Duff A, Weg JG, Fulkerson WJ, Palevsky HI, et al . The clinical course of pulmonary embolism. N Engl J Med. 1992;326:1240-5. CrossrefMedlineGoogle Scholar2. Alpert JS, Smith R, Carlson J, Ockene IS, Dexter L, Dalen JE. Mortality in patients treated for pulmonary embolism. JAMA. 1976;236:1477-80. CrossrefMedlineGoogle Scholar3. Cheely R, McCartney WH, Perry JR, Delany DJ, Bustad L, Wynia VH, et al . The role of noninvasive tests versus pulmonary angiography in the diagnosis of pulmonary embolism. Am J Med. 1981;70:17-22. CrossrefMedlineGoogle Scholar4. The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA. 1990;263:2753-9. CrossrefMedlineGoogle Scholar5. Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, et al . Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med. 1998;129:997-1005. LinkGoogle Scholar6. Gerard SK, Hsu TC. Pulmonary embolism: diagnosis with spiral CT versus ventilation-perfusion scintigraphy [Letter]. Radiology. 1999;210:576-7. CrossrefMedlineGoogle Scholar7. Rathbun SW, Raskob GE, Whitsett TL. Sensitivity and specificity of helical computed tomography in the diagnosis of pulmonary embolism: a systematic review. Ann Intern Med. 2000;132:227-32. LinkGoogle Scholar8. Crawford CR, King KF. Computed tomography scanning with simultaneous patient translation. Med Phys. 1990;17:967-82. CrossrefMedlineGoogle Scholar9. Kauczor HU, Heussel CP, Thelen M. Update on diagnostic strategies of pulmonary embolism. Eur Radiol. 1999;9:262-75. CrossrefMedlineGoogle Scholar10. Dixon AK, Dendy P. Spiral CT: how much does radiation dose matter? Lancet. 1998;352:1082-3. CrossrefMedlineGoogle Scholar11. Remy-Jardin M, Remy J, Wattinne L, Giraud F. Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with single-breath-hold technique—comparison with pulmonary angiography. Radiology. 1992;185:381-7. CrossrefMedlineGoogle Scholar12. Kim KI, Muller NL, Mayo JR. Clinically suspected pulmonary embolism: utility of spiral CT. Radiology. 1999;210:693-7. CrossrefMedlineGoogle Scholar13. Greaves SM, Hart EM, Brown K, Young DA, Batra P, Aberle DR. Pulmonary thromboembolism: spectrum of findings on CT. AJR Am J Roentgenol. 1995;165:1359-63. CrossrefMedlineGoogle Scholar14. Christiansen F. Diagnostic imaging of acute pulmonary embolism. Acta Radiol Suppl. 1997;410:1-33. MedlineGoogle Scholar15. Mayo JR, Remy-Jardin M, Muller NL, Remy J, Worsley DF, Hossein-Foucher C, et al . Pulmonary embolism: prospective comparison of spiral CT with ventilation-perfusion scintigraphy. Radiology. 1997;205:447-52. CrossrefMedlineGoogle Scholar16. Goodman LR, Curtin JJ, Mewissen MW, Foley WD, Lipchik RJ, et al . Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: helical CT versus angiography. AJR Am J Roentgenol. 1995;164:1369-74. CrossrefMedlineGoogle Scholar17. Blum AG, Delfau F, Grignon B, Beurrier D, Chabot F, Claudon M, et al . Spiral-computed tomography versus pulmonary angiography in the diagnosis of acute massive pulmonary embolism. Am J Cardiol. 1994;74:96-8. CrossrefMedlineGoogle Scholar18. van Rossum AB, Treurniet FE, Kieft GJ, Smith SJ, Schepers-Bok R. 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. Thorax. 1996;51:23-8. CrossrefMedlineGoogle Scholar19. Oser RF, Zuckerman DA, Gutierrez FR, Brink JA. Anatomic distribution of pulmonary emboli at pulmonary angiography: implications for cross-sectional imaging. Radiology. 1996;199:31-5. CrossrefMedlineGoogle Scholar20. Stein PD, Henry JW. Prevalence of acute pulmonary embolism in central and subsegmental pulmonary arteries and relation to probability interpretation of ventilation-perfusion lung scans. Chest. 1997;111:1246-8. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Shannon M. Bates, MD, FRCP(C); Jeffrey S. Ginsberg, MD, FRCP(C)Affiliations: From McMaster University and Hamilton Civic Hospitals Research Centre; Hamilton, Ontario L8N 3Z5, CanadaGrant Support: Dr. Bates is a recipient of a Research Fellowship from the Heart and Stroke Foundation of Ontario. Dr. Ginsberg is a Career Investigator of the Heart and Stroke Foundation of Ontario.Corresponding Author: Jeffrey S. Ginsberg, MD, FRCP(C), Thromboembolism Unit, HHSC 3X28 McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada; e-mail, [email protected]csu.mcmaster.ca.Current Author Addresses: Dr. Bates: Thromboembolism Unit, HHSC Room, 3W15, McMaster University Medical Center, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.Dr. Ginsberg: Thromboembolism Unit, HHSC Room 3X28, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSensitivity and Specificity of Helical Computed Tomography in the Diagnosis of Pulmonary Embolism Suman W. Rathbun , Gary E. Raskob , and Thomas L. Whitsett Metrics Cited byDiagnosis and Management for deep vein thrombosis and pulmonary thromboembolismMeta-Analysis: Outcomes in Patients with Suspected Pulmonary Embolism Managed with Computed Tomographic Pulmonary AngiographyLisa K. Moores, MD, William L. Jackson Jr., MD, Andrew F. Shorr, MD, MPH, and Jeffrey L. 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