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Defining the Role of Computed Tomographic Pulmonary Angiography in Suspected Pulmonary Embolism
- Lisa K. Moores, MD; and
- William L. Jackson, Jr, MD
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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.”
Lisa K. Moores, MD
William L. Jackson Jr., MD
Walter Reed Army Medical Center
Washington, DC 20307
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Article and Author Information
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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.
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Potential Financial Conflicts of Interest: None disclosed.
