Annals of Emergency Medicine
Volume 33, Issue 5 , Pages 520-528 , May 1999

Role of Spiral Computed Tomography in the Diagnosis of Pulmonary Embolism in the Emergency Department

Received 3 November 1998 ,Revised 5 January 1999 ,Accepted 8 February 1999.

References 

  1. Weiss K. Pulmonary thromboembolism: Epidemiology and techniques of nuclear medicine. Semin Thromb Hemost. 1996;22:27–32
  2. Goldhaber SZ. Thrombolysis for pulmonary embolism. Progr Cardiovasc Dis. 1991;34:113–134
  3. The PIOPED Investigators . Value of the ventilation/perfusion scan in acute pulmonary embolism: Results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). JAMA. 1990;263:2753–2759
  4. Goodman LR, Lipchik RL, Kuzo RS. Acute pulmonary embolism: The role of computed tomographic imaging. J Thorac Imag. 1997;12:83–86
  5. Goodman LR, Lipchik RJ, Kuzo RS. Reply to opinions. J Thorac Imag. 1997;12:100–102
  6. Goodman LR. CT of acute pulmonary emboli: Where does it fit?. RadioGraphics. 1997;17:1037–1042
  7. Gurney JW. No fooling around: Direct visualization of pulmonary embolism. Radiology. 1993;188:618–619
  8. Hull RD, Raskob GE, Pineo GF, et al.  The low-probability lung scan: A need for change in nomenclature. Arch Intern Med. 1995;155:1845–1851
  9. Cronan JJ. Venous thromboembolic disease: The role of US. Radiology. 1993;186:619–630
  10. Polak JF. Doppler ultrasound of the deep leg veins: A revolution in the diagnosis of deep vein thrombosis and monitoring of thrombolysis. Chest. 1991;99:165S–172S
  11. Hull RD, Raskob GE, Coates G, et al.  A new noninvasive management strategy for patients with suspected pulmonary embolism. Arch Intern Med. 1989;149:2549–2555
  12. Hull RD, Raskob GE, Ginsberg JS, et al.  A noninvasive strategy for the treatment of patients with suspected pulmonary embolism. Arch Intern Med. 1994;154:289–297
  13. Dalen JE. When can treatment be withheld in patients with suspected pulmonary embolism? [editorial]. Arch Intern Med. 1993;153:1415–1418
  14. Rabinov K, Paulin S. Roentgen diagnosis of venous thrombosis in the leg. Arch Surg. 1972;104:134–144
  15. Kadir S. Diagnostic Angiography. In: Philadelphia: WB Saunders; 1986;p. 536–583
  16. Stein PD, Hull RD, Saltzman HA, et al.  Strategy for diagnosis of patients with suspected acute pulmonary embolism. Chest. 1993;103:1553–1559
  17. Kelley MA, Carson JL, Palevsky HI, et al.  Diagnosing pulmonary embolism: New facts and strategies. Ann Intern Med. 1991;114:300–306
  18. Stein PD. Wedge arteriography for the identification of pulmonary emboli in small vessels. Am Heart J. 1971;82:618–623
  19. Stein PD, Athanasoulis C, Alavi A, et al.  Complications and validity of pulmonary angiography in acute pulmonary embolism. Circulation. 1992;85:462–468
  20. The Urokinase Pulmonary Embolism Trial Study Group . Urokinase pulmonary embolism trial: Phase 1 results. JAMA. 1970;214:2163–2172
  21. Mills SR, Jackson DC, Older RA, et al.  The incidence, etiologies, and avoidance of complications of pulmonary angiography in a large series. Radiology. 1980;136:295–299
  22. Sostman HD, Ravin CE, Sullivan DC, et al.  Use of pulmonary angiography for suspected pulmonary embolism: Influence of scintigraphic diagnosis. AJR Am J Roentgenol. 1982;139:673–677
  23. Godwin JD, Webb WR, Gamsu G, et al.  Computed tomography of pulmonary embolism. AJR Am J Roentgenol. 1980;135:691–695
  24. Verschakelen JA, Vanwijck E, Bogaert J, et al.  Detection of unsuspected central pulmonary embolism with conventional contrast-enhanced CT. Radiology. 1993;188:847–850
  25. Winston CB, Wechsler RJ, Salazar AM, et al.  Incidental pulmonary emboli detected at helical CT: Effect on patient care. Radiology. 1996;201:23–27
  26. Kalender WA, Seissler W, Klotz E, et al.  Spiral volumetric CT with single-breath-hold technique, continuous transport, and continuous scanner rotation. Radiology. 1990;176:181–183
  27. Remy-Jardin M, Remy J, Deschildre F, et al.  Diagnosis of pulmonary embolism with spiral CT: Comparison with pulmonary angiography and scintigraphy. Radiology. 1996;200:699–706
  28. Remy-Jardin M, Remy J, Artaud D, et al.  Spiral CT of pulmonary embolism: Technical considerations and interpretive pitfalls. J Thorac Imag. 1997;12:103–117
  29. Drucker EA, Rivits SM, Shepard JAO, et al.  Acute pulmonary embolism: Assessment of helical CT for diagnosis. Radiology. 1998;209:235–241
  30. Goodman LR, Curtin JJ, Mewissen MW, et al.  Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: Helical CT versus angiography. AJR Am J Roentgenol. 1995;164:1369–1374
  31. Remy-Jardin M, Remy J, Wattinne L, et al.  Central pulmonary thromboembolism: Diagnosis with spiral volumetric CT with the single-breath-hold technique-comparison with pulmonary angiography. Radiology. 1992;185:381–387
  32. Mayo JR, Remy-Jardin M, Müller NL, et al.  Pulmonary embolism: Prospective comparison of spiral CT with ventilation-perfusion scintigraphy. Radiology. 1997;205:447–452
  33. Khorasani R, Gudas TF, Nikpoor N, et al.  Treatment of patients with suspected pulmonary embolism and intermediate-probability lung scans: Is diagnostic imaging underused?. AJR Am J Roentgenol. 1997;169:1355–1357
  34. van Rossum AB, Pattynama PMT, Ton ERTA. Pulmonary embolism: Validation of spiral CT angiography in 149 patients. Radiology. 1996;201:467–470
  35. Teigen CL, Maus TP, Sheedy PF, et al.  Pulmonary embolism: Diagnosis with electron-beam CT. Radiology. 1993;188:839–845
  36. Goodman LR, Lipchik RJ. Diagnosis of acute pulmonary embolism: Time for a new approach. Radiology. 1996;199:25–27
  37. Diffin DC, Leyendecker JR, Johnson SP, et al.  Effect of anatomic distribution of pulmonary emboli on interobserver agreement in the interpretation of pulmonary angiography. AJR Am J Roentgenol. 1998;171:1085–1089
  38. Novelline RA, Baltarowich OH, Athanasoulis CA, et al.  The clinical course of patients with suspected pulmonary embolism and a negative pulmonary arteriogram. Radiology. 1978;126:561–567
  39. Ferretti GR, Bossun J-L, Buffaz P-D, et al.  Acute pulmonary embolism: Role of helical CT in 164 patients with intermediate probability at ventilation-perfusion scintigraphy and normal results at duplex US of the legs. Radiology. 1997;205:453–458
  40. Mayo JR. Opinion response to acute pulmonary embolism: The role of computed tomographic imaging. J Thorac Imag. 1997;12:95–97
  41. Gefter WB, Palevsky HI. Opinion response to acute pulmonary embolism: The role of computed tomographic imaging. J Thorac Imag. 1997;12:97–100
  42. van Rossum AB, Treurniet FEE, Kieft GJ, et al.  Role of spiral volumetric computed tomographic scanning in the assessment of patients with clinical suspicion of pulmonary embolism and an abnormal ventilation/perfusion lung scan. Thorax. 1996;51:23–28
  43. van Erkel AR, van Rossum AB, Bloem JL, et al.  Spiral CT angiography for suspected pulmonary embolism: A cost-effectiveness analysis. Radiology. 1996;201:29–36
  44. Stein PD. Opinion response to acute pulmonary embolism: The role of computed tomographic imaging. J Thorac Imag. 1997;12:86–89
  45. Teigen CL, Maus TP, Sheedy PF, et al.  Pulmonary embolism: Diagnosis with contrast-enhanced electron-beam CT and comparison with pulmonary angiography. Radiology. 1995;194:313–319
  46. Lesser BA, Leeper KV, Stein PD, et al.  The diagnosis of acute pulmonary embolism in patients with chronic obstructive pulmonary disease. Chest. 1992;102:17–22
  47. Goodman LR. Questions and answers. AJR Am J Roentgenol. 1998;171:1153–1154

☆ Editor’s Note: This article continues a series of special contributions addressing state-of-the-art techniques, topics, or concepts. State-of-the-art articles will be featured in Annals on a regular basis in the next several volumes.

☆☆ Hoechst Marion Roussel provided honoraria to the authors of this state-of-the-art article. Annals is grateful to Hoechst Marion Roussel for their continued support of emergency medicine.

★ Address for reprints: J Michael Holbert, MD, UPMC Health Systems–Presbyterian, Department of Radiology, 200 Lothrop Street, Pittsburgh, PA 15213; 412-647-7288, fax 412-647-7795; E-mail holbertjm@radserv.arad.upmc.edu.

★★ 47/1/97702

PII: S0196-0644(99)70339-2

Annals of Emergency Medicine
Volume 33, Issue 5 , Pages 520-528 , May 1999

Article Tools

* Image Usage & Resolution