Subsegmental pulmonary embolism diagnosed by computed tomography: incidence and clinical implications. A systematic review and meta-analysis of the management outcome studies

M. Carrier 1, 2 D. R. Anderson 3 Grégoire Le Gal 4, 5, * A. Perrier 1 M. Righini 6 M. Rodger 1, 2 P. S. Wells 1
* Auteur correspondant
1 Thrombosis Program
2 Clinical Epidemiology Unit
3 DRA - Department of Medicine - Halifax
4 GETBO - Groupe d'Etude de la Thrombose de Bretagne Occidentale
5 CIC - Brest - Centre d'Investigation Clinique
6 MR - Service d'angiologie et d'hémostase
Abstract : Background: Multiple-detectors computed tomographic pulmonary angiography (CTPA) has a higher sensitivity for pulmonary embolism (PE) within the subsegmental pulmonary arteries as compared with single-detector CTPA. Multiple-detectors CTPA might increase the rate of subsegmental PE diagnosis. The clinical significance of subsegmental PE is unknown. We sought to summarize the proportion of subsegmental PE diagnosed with single- and multiple-detectors CTPA and assess the safety of diagnostic strategies based on single- or multiple-detectors CTPA to exclude PE. Patients and methods: A systematic literature search strategy was conducted using MEDLINE, EMBASE and the Cochrane Register of Controlled Trials. We selected 22 articles (20 prospective cohort studies and two randomized controlled trials) that included patients with suspected PE who underwent a CTPA and reported the rate of subsegmental PE. Two reviewers independently extracted data onto standardized forms. Results: The rate of subsegmental PE diagnosis was 4.7% [95% confidence interval (CI): 2.5-7.6] and 9.4 (95%CI: 5.5-14.2) in patients that underwent a single- and multiple-detectors CTPA, respectively. The 3-month thromboembolic risks in patients with suspected PE andwho were left untreated based on a diagnostic algorithm including a negative CTPA was 0.9% (95% CI: 0.4-1.4) and 1.1% (95% CI: 0.7-1.4) for single- and multiple-detectors CTPA, respectively. Conclusion: Multiple-detectors CTPA seems to increase the proportion of patients diagnosed with subsegmental PE without lowering the 3-month risk of thromboembolism suggesting that subsegmental PE may not be clinically relevant.
Keywords : Algorithms Cardiology/methods Cohort Studies Humans Incidence Outcome Assessment (Health Care) Pulmonary Embolism/*diagnosis/epidemiology/*radiography Randomized Controlled Trials as Topic Reproducibility of Results Risk Tomography X-Ray Computed/*methods Treatment Outcome
Type de document :
Article dans une revue
Journal of thrombosis and haemostasis : JTH, 2010, 8 (8), pp.1716-12. 〈10.1111/j.1538-7836.2010.03938.x〉
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http://hal.univ-brest.fr/hal-00690737
Contributeur : Ghislaine Calvez <>
Soumis le : mardi 24 avril 2012 - 12:06:25
Dernière modification le : lundi 28 mai 2018 - 18:06:02

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M. Carrier, D. R. Anderson, Grégoire Le Gal, A. Perrier, M. Righini, et al.. Subsegmental pulmonary embolism diagnosed by computed tomography: incidence and clinical implications. A systematic review and meta-analysis of the management outcome studies. Journal of thrombosis and haemostasis : JTH, 2010, 8 (8), pp.1716-12. 〈10.1111/j.1538-7836.2010.03938.x〉. 〈hal-00690737〉

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