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The value of four-detector row spiral computed tomography for the diagnosis of pulmonary embolism.

Research paper by Mario M Vigo, Raffaele R Pesavento, Carlo C Bova, Fernando F Porro, Angelo A Ghirarduzzi, Mario M Bazzan, Roberta R Polverosi, Michela M Frulla, Alfonso A Noto, Roberto R Castelli, Franco F Giovanardi, Federico F Angelini, Antonio A Pagnan, Paolo P Prandoni,

Indexed on: 16 Dec '06Published on: 16 Dec '06Published in: Seminars in thrombosis and hemostasis



Abstract

Although spiral computed tomography (CT) is being used increasingly as the first-line imaging procedure in the diagnostic workup of patients with clinically suspected pulmonary embolism (PE), the diagnostic value of negative findings, at least when using the four-detector row scanners, is still controversial. A total of 702 consecutive patients with clinical symptoms suggestive of PE underwent four-slice CT. Patients with negative findings received the determination of D-dimer. Those with positive D-dimer underwent further diagnostic workup to confirm or rule out the diagnosis of PE. Those with negative D-dimer were followed-up to 6 months to detect the development of symptomatic venous thromboembolism (VTE). The CT test was interpreted as negative in 536 patients (76.3%). These patients had the D-dimer determination, which was positive in 279 and negative in the remaining 257 patients. Of the former, PE subsequently was documented in 55 patients (19.7%). Of the latter, symptomatic VTE in the follow-up period developed in three patients (1.17%; 95% confidence interval, 0.24 to 3.38%). In conclusion, when using the four-detector row, the negative predictive value of CT findings in patients with clinically suspected PE and positive D-dimer is low. In contrast, it is safe to withhold anticoagulation from patients with negative findings and negative D-dimer.