Computed Tomography Scan Versus Ventilation-perfusion ... - PubMed

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Abstract

This study compared the sensitivity and specificity of computed tomography (CT) scan and ventilation-perfusion (V-P) scan in detecting pulmonary embolism (PE) with pulmonary angiogram (AG) as the reference standard. Following a comprehensive search of the indexed medical literature, CT scan studies related to PE diagnosis were systematically evaluated to select those using AG as the reference standard and meeting specified methodologic criteria. Studies were further grouped by those reporting results for central PE findings only versus central and peripheral PE combined. A composite analysis of data derived from seven selected publications yielded sensitivity and specificity estimates for CT scan in detecting PE, which were statistically compared to the published results of a multi-center study reporting the sensitivity and specificity of the V-P scan with pulmonary AG as the reference standard. The calculated CT scan sensitivity was 77% for central PE only data and 81% for central and peripheral PE combined data, and the CT scan specificity was 91% and 98%, respectively. High-probability V-P scan sensitivity was 41% and specificity 97%; high- and intermediate-probability V-P scans combined yielded sensitivity 83% and specificity 52%. The sensitivity for PE detection was significantly greater for CT scan than for high-probability V-P scan; CT scan sensitivity was equivalent to V-P when high- and intermediate-probability scans were considered together. CT scan specificity for central and peripheral PE combined was equivalent to that of the high-probability V-P scan, but significantly greater than that of high- and intermediate-probability V-P scans considered together. Considering that only a small proportion of patients with suspected PE yield high-probability V-P scan results (which are usually indicative of PE), while as many as one-half of patients may yield intermediate-probability results (which are commonly not useful in PE diagnosis), our results suggest the CT scan may be an appropriate study for use by Emergency Physicians in the clinical evaluation of suspected PE.

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• Computed tomography scan versus ventilation-perfusion lung scan in the detection of pulmonary embolism. Mosely DS, Knight DA, Kacprowicz R, Christopher FL, Hunter CJ. Mosely DS, et al. J Emerg Med. 2002 Aug;23(2):205-6; author reply 206. doi: 10.1016/s0736-4679(02)00493-6. J Emerg Med. 2002. PMID: 12359293 No abstract available.

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• Pulmonary embolism: diagnosis with spiral CT and ventilation-perfusion scanning--correlation with pulmonary angiographic results or clinical outcome. Garg K, Welsh CH, Feyerabend AJ, Subber SW, Russ PD, Johnston RJ, Durham JD, Lynch DA. Garg K, et al. Radiology. 1998 Jul;208(1):201-8. doi: 10.1148/radiology.208.1.9646814. Radiology. 1998. PMID: 9646814
• Noncontrast perfusion single-photon emission CT/CT scanning: a new test for the expedited, high-accuracy diagnosis of acute pulmonary embolism. Lu Y, Lorenzoni A, Fox JJ, Rademaker J, Vander Els N, Grewal RK, Strauss HW, Schöder H. Lu Y, et al. Chest. 2014 May;145(5):1079-1088. doi: 10.1378/chest.13-2090. Chest. 2014. PMID: 24798835
• Acute pulmonary embolism: sensitivity and specificity of ventilation-perfusion scintigraphy in PIOPED II study. Sostman HD, Stein PD, Gottschalk A, Matta F, Hull R, Goodman L. Sostman HD, et al. Radiology. 2008 Mar;246(3):941-6. doi: 10.1148/radiol.2463070270. Epub 2008 Jan 14. Radiology. 2008. PMID: 18195380
• Noninvasive diagnosis of pulmonary embolism. Perrier A. Perrier A. Haematologica. 1997 May-Jun;82(3):328-31. Haematologica. 1997. PMID: 9234581 Review.
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