Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED)

JAMA. 1990 May 23-30;263(20):2753-9. doi: 10.1001/jama.1990.03440200057023.

Abstract

To determine the sensitivities and specificities of ventilation/perfusion lung scans for acute pulmonary embolism, a random sample of 933 of 1493 patients was studied prospectively. Nine hundred thirty-one underwent scintigraphy and 755 underwent pulmonary angiography; 251 (33%) of 755 demonstrated pulmonary embolism. Almost all patients with pulmonary embolism had abnormal scans of high, intermediate, or low probability, but so did most without pulmonary embolism (sensitivity, 98%; specificity, 10%). Of 116 patients with high-probability scans and definitive angiograms, 102 (88%) had pulmonary embolism, but only a minority with pulmonary embolism had high-probability scans (sensitivity, 41%; specificity, 97%). Of 322 with intermediate-probability scans and definitive angiograms, 105 (33%) had pulmonary embolism. Follow-up and angiography together suggest pulmonary embolism occurred among 12% of patients with low-probability scans. Clinical assessment combined with the ventilation/perfusion scan established the diagnosis or exclusion of pulmonary embolism only for a minority of patients--those with clear and concordant clinical and ventilation/perfusion scan findings.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Female
  • Follow-Up Studies
  • Humans
  • Lung / diagnostic imaging
  • Male
  • Methods
  • Middle Aged
  • Observer Variation
  • Outcome and Process Assessment, Health Care
  • Predictive Value of Tests
  • Probability
  • Prospective Studies
  • Pulmonary Artery / diagnostic imaging
  • Pulmonary Embolism / diagnostic imaging*
  • Radiography
  • Radionuclide Imaging
  • Random Allocation