REPLY
Defining the Role of Computed Tomographic Pulmonary Angiography in Suspected Pulmonary Embolism
Lisa K. Moores, MD, and
William L. Jackson, Jr, MD
3 May 2005 | Volume 142 Issue 9 | Page 802
IN RESPONSE:
We appreciate the comments regarding our meta-analysis and the opportunity to clarify our conclusions. As stated in the Discussion, "the role of CTPA without concomitant lower-extremity imaging is still undefined." We agree with both Dr. Frost and Dr. Girard that the literature to date does not support definitive exclusion of venous thromboembolism with CTPA alone, and we recommend concurrent lower-extremity imaging before withholding anticoagulation in patients with suspected clots. While advancements in imaging technology may eventually improve diagnostic accuracy of CTPA and allow for a single test, in our opinion further study is required before this can be recommended. Moreover, the emergence of simultaneous computed tomographic venography might ultimately permit rapid, accurate assessment of the lower extremities in a combined, single-modality study (1-4), rendering moot the role of isolated imaging of the chest in venous thromboembolism.
We agree with both Dr. Frost and Dr. Girard that our abstract should have been written more explicitly to match our ultimate conclusions.
In response to Drs. Kamphuisen and Agnelli, we did not endorse CTPA as an initial diagnostic test. On the contrary, we acknowledged that "pretest probability assessments should be used to select patients for CTPA, since recent publications support the exclusion of PE based on a low pretest probability and negative results on D-dimer testing."
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Author and Article Information
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From Walter Reed Army Medical Center, Washington, DC 20307.
Disclaimer: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Department of the Army or the U.S. Department of Defense.
Potential Financial Conflicts of Interest: None disclosed.
1. Loud PA, Katz DS, Bruce DA, Klippenstein DL, Grossman ZD. Deep venous thrombosis with suspected pulmonary embolism: detection with combined CT venography and pulmonary angiography. Radiology. 2001;219:498-502. [PMID: 11323478].
2. Cham MD, Yankelevitz DF, Shaham D, Shah AA, Sherman L, Lewis A, et al. Deep venous thrombosis: detection by using indirect CT venography. The Pulmonary Angiography-Indirect CT Venography Cooperative Group. Radiology. 2000;216:744-51. [PMID: 10966705].
3. Ghaye B, Dondelinger RF. Non-traumatic thoracic emergencies: CT venography in an integrated diagnostic strategy of acute pulmonary embolism and venous thrombosis. Eur Radiol. 2002;12:1906-21. [PMID: 12136309].
4. Lim KE, Hsu YY, Hsu WC, Huang CC. Combined computed tomography venography and pulmonary angiography for the diagnosis PE and DVT in the ED. Am J Emerg Med. 2004;22:301-6. [PMID: 15258873].
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