Performance of Helical Computed Tomography in Unselected Outpatients With Suspected Pulmonary Embolism

Ann Intern Med. 2001 Jul 17;135(2):88-97. doi: 10.7326/0003-4819-135-2-200107170-00008.

Abstract

Background: Helical computed tomography (CT) is commonly used to diagnose pulmonary embolism, although its operating characteristics have been insufficiently evaluated.

Objective: To assess the sensitivity and specificity of helical CT in suspected pulmonary embolism.

Design: Observational study.

Setting: Emergency department of a teaching and community hospital.

Patients: 299 patients with clinically suspected pulmonary embolism and a plasma D -dimer level greater than 500 microgram/L.

Intervention: Pulmonary embolism was established by using a validated algorithm that included clinical assessment, lower-limb compression ultrasonography, lung scanning, and pulmonary angiography.

Measurements: Sensitivity, specificity, and likelihood ratios of helical CT and interobserver agreement. Helical CT scans were withheld from clinicians and were read 3 months after acquisition by radiologists blinded to all clinical data.

Results: 118 patients (39%) had pulmonary embolism. In 12 patients (4%), 2 of whom had pulmonary embolism, results of helical CT were inconclusive. For patients with conclusive results, sensitivity of helical CT was 70% (95% CI, 62% to 78%) and specificity was 91% (CI, 86% to 95%). Interobserver agreement was high (kappa = 0.823 to 0.902). The false-negative rate was lower for helical CT used after initial negative results on ultrasonography than for helical CT alone (21% vs. 30%). Use of helical CT after normal results on initial ultrasonography and nondiagnostic results on lung scanning had a false-negative rate of only 5% and a false-positive rate of only 7%.

Conclusion: Helical CT should not be used alone for suspected pulmonary embolism but could replace angiography in combined strategies that include ultrasonography and lung scanning.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Canada
  • Decision Trees*
  • Emergency Service, Hospital*
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Observer Variation
  • Prospective Studies
  • Pulmonary Embolism / diagnosis
  • Pulmonary Embolism / diagnostic imaging*
  • Sensitivity and Specificity
  • Single-Blind Method
  • Tomography, X-Ray Computed / methods*

Substances

  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D