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ARTICLE

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

Arnaud Perrier, MD; Nigel Howarth, MD; Dominique Didier, MD; Pierre Loubeyre, MD; Pierre-François Unger, MD; Philippe de Moerloose, MD; Daniel Slosman, MD; Alain Junod, MD; and Henri Bounameaux, MD

17 July 2001 | Volume 135 Issue 2 | Pages 88-97

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 µg/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 ( = 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.

Author and Article Information

From Geneva University Hospital, Geneva, Switzerland.

Acknowledgments: The authors thank A. Bigaroni, MD, and S. Bernard Bagattini, MD, for data management; Ph. Minazio and G. Reber, PhD, for laboratory assistance; and P. Bachmann for invaluable help in managing all technical aspects of helical computed tomography. They also thank all the residents of Medical Clinics 1 and 2 for their assistance in including and working up the patients in the study, and all the residents and technicians from the radiodiagnosis division who participated in the study.

Grant Support: By the Swiss National Research Foundation (32-52798.97) and by an unrestricted grant from Roche Pharma Switzerland.

Requests for Single Reprints: Arnaud Perrier, MD, Medical Clinic 1, Department of Internal Medicine, Geneva University Hospital, Rue Micheli-du-Crest 24, CH-1211 Geneva 14, Switzerland; e-mail, Arnaud.Perrier{at}medecine.unige.ch

Current Author Addresses: Drs. Perrier and Junod: Medical Clinic 1, Department of Internal Medicine, Geneva University Hospital, Rue Micheli-du-Crest 24, CH-1211 Geneva 14, Switzerland.

Drs. Howarth, Didier, and Loubeyre: Division of Radiodiagnosis, Department of Radiology, Geneva University Hospital, Rue Micheli-du-Crest 24, CH-1211 Geneva 14, Switzerland.

Dr. Unger: Division of Medical and Surgical Emergencies, Department of Internal Medicine, Geneva University Hospital, Rue Micheli-du-Crest 24, CH-1211 Geneva 14, Switzerland.

Drs. de Moerloose and Bounameaux: Division of Angiology and Hemostasis, Department of Internal Medicine, Geneva University Hospital, Rue Micheli-du-Crest 24, CH-1211 Geneva 14, Switzerland.

Dr. Slosman: Division of Nuclear Medicine, Department of Radiology, Geneva University Hospital, Rue Micheli-du-Crest 24, CH-1211 Geneva 14, Switzerland.

Author Contributions: Conception and design: A. Perrier, N. Howarth, P.-F. Unger, P. de Moerloose, D. Slosman, A. Junod, H. Bounameaux.

Analysis and interpretation of the data: A. Perrier, N. Howarth, D. Didier, P. Loubeyre, A. Junod, H. Bounameaux.

Drafting of the article: A. Perrier, H. Bounameaux.

Critical revision of the article for important intellectual content: A. Perrier, N. Howarth, P.-F. Unger, P. de Moerloose, D. Slosman, A. Junod, H. Bounameaux.

Final approval of the article: A. Perrier, N. Howarth, D. Didier, P. Loubeyre, P.-F. Unger, P. de Moerloose, D. Slosman, A. Junod, H. Bounameaux.

Provision of study materials or patients: A. Perrier, N. Howarth, D. Didier, P. Loubeyre, D. Slosman, H. Bounameaux.

Obtaining of funding: A. Perrier, N. Howarth, A. Junod, H. Bounameaux.

Administrative, technical, or logistic support: N. Howarth, P. Loubeyre, P.-F. Unger, P. de Moerloose, D. Slosman, H. Bounameaux.

Collection and assembly of data: A. Perrier, N. Howarth, P. Loubeyre, H. Bounameaux.

Related articles in Annals:

Summaries for Patients
Detecting Pulmonary Emboli with Helical Computed Tomography

Annals 2001 135: S22. [Full Text]  

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