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What is the current recommendation for the evaluation of
patients suspected of having pulmonary embolism? |
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Dr. Peter Buetow
responds:
Contrast-enhanced spiral CT is emerging as the study of choice for patients
suspected of having pulmonary embolism. In most studies, spiral CT has shown
a sensitivity and specificity in the diagnosis of pulmonary embolism equal
to or greater than that of pulmonary arteriography and ventilation/perfusion
scintigraphy. In addition, spiral CT offers an added feature (for patients
who do not have PE): it provides important ancillary information to account
for the patient's symptoms. Other algorithms used in the evaluation of suspected
pulmonary embolism include the use of ventilation/perfusion imaging in patients
with a normal chest x-ray and spiral CT in patients with an abnormal chest
x-ray. Spiral CT has been shown to be effective in the diagnosis of clinically
significant pulmonary embolism. Even if small peripheral emboli are not
diagnosed through this method, they have been shown to have no long-term
clinical sequelae. Most importantly, spiral CT of pulmonary embolism needs
to be performed with appropriate technique and can be performed in an expeditious
fashion.
References
1. Remy-Jardin M; Remy J. Spiral CT angiography of the pulmonary circulation.
Radiology . 1999 Sep;212(3):615-36.
2. Remy-Jardin M; Remy J; Artaud D; Fribourg M; Beregi JP. Spiral CT of
pulmonary embolism: diagnostic approach, interpretive pitfalls and current
indications. Eur Radiol . 1998;8(8):1376-90.
3. Shah AA; Davis SD; Gamsu G; Intriere L. Parenchymal and pleural findings
in patients with and patients without acute pulmonary embolism detected
at spiral CT. Radiology . 1999 Apr;211(1):147-53.
4. Kin K. Radiology . 1999; 210 (3): 693-697.
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