Multidetector-row computed tomography in suspected pulmonary embolism.

Abstract : BACKGROUND: Single-detector-row computed tomography (CT) has a low sensitivity for pulmonary embolism and must be combined with venous-compression ultrasonography of the lower limbs. We evaluated whether the use of D-dimer measurement and multidetector-row CT, without lower-limb ultrasonography, might safely rule out pulmonary embolism. METHODS: We included 756 consecutive patients with clinically suspected pulmonary embolism from the emergency departments of three teaching hospitals and managed their cases according to a standardized sequential diagnostic strategy. All patients were followed for three months. RESULTS: Pulmonary embolism was detected in 194 of the 756 patients (26 percent). Among the 82 patients with a high clinical probability of pulmonary embolism, multidetector-row CT showed pulmonary embolism in 78, and 1 patient had proximal deep venous thrombosis and a CT scan that was negative for pulmonary embolism. Of the 674 patients without a high probability of pulmonary embolism, 232 (34 percent) had a negative D-dimer assay and an uneventful follow-up; CT showed pulmonary embolism in 109 patients. CT and ultrasonography were negative in 318 patients, of whom 3 had a definite thromboembolic event and 2 died of possible pulmonary embolism during follow-up (three-month risk of thromboembolism, 1.7 percent; 95 percent confidence interval, 0.7 to 3.9). Two patients had proximal deep venous thrombosis and a negative CT scan (risk, 0.6 percent; 95 percent confidence interval, 0.2 to 2.2). The overall three-month risk of thromboembolism in patients without pulmonary embolism would have been 1.5 percent (95 percent confidence interval, 0.8 to 3.0) if the D-dimer assay and multidetector-row CT had been the only tests used to rule out pulmonary embolism and ultrasonography had not been performed. CONCLUSIONS: Our data indicate the potential clinical use of a diagnostic strategy for ruling out pulmonary embolism on the basis of D-dimer testing and multidetector-row CT without lower-limb ultrasonography. A larger outcome study is needed before this approach can be adopted.
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New England Journal of Medicine, Massachusetts Medical Society, 2005, 352 (17), pp.1760-8. 〈10.1056/NEJMoa042905〉
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http://hal.univ-brest.fr/hal-00722041
Contributeur : Ghislaine Calvez <>
Soumis le : mardi 31 juillet 2012 - 15:28:42
Dernière modification le : mardi 16 janvier 2018 - 15:55:31

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Arnaud Perrier, Pierre-Marie Roy, Olivier Sanchez, Grégoire Le Gal, Guy Meyer, et al.. Multidetector-row computed tomography in suspected pulmonary embolism.. New England Journal of Medicine, Massachusetts Medical Society, 2005, 352 (17), pp.1760-8. 〈10.1056/NEJMoa042905〉. 〈hal-00722041〉

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