SPIRAL COMPUTED TOMOGRAPHY IN THE EVALUATION OF PULMONARY EMBOLISM - 08/09/11

Doi : 10.1016/S0272-5231(05)70252-5

Randolph J. Lipchik, MD ^a, Lawrence R. Goodman, MD ^b

^a Division of Pulmonary and Critical Care Medicine, Department of Medicine (RJL)

^b Department of Radiology (LRG), Medical College of Wisconsin, Milwaukee, Wisconsin

Resumen

It is well known that clinical judgment alone is unreliable in making the diagnosis of pulmonary embolism (PE). Nuclear scintigraphy (V/Q scanning) is the most common initial study when PE is suspected, although it often results in diagnostic uncertainty. Unless the V/Q scan is normal, excluding PE, or high probability (in conjunction with a high clinical likelihood), considerable doubt remains about the presence or absence of PE. Approximately 67% of patients evaluated in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study fell into nondiagnostic categories.^{32 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

Haga clic aquí para ir a la sección de Referencias} This was particularly true for patients with chronic obstructive lung disease, in whom 90% of V/Q scans are nondiagnostic.^{15 Lesser B.A., Leeper K.V., Stein P.D. , y al. The diagnosis of acute pulmonary embolism in patients with chronic obstructive pulmonary disease Chest 1992 ; 102 : 17-22 [cross-ref]

Haga clic aquí para ir a la sección de Referencias} Diagnostic algorithms using V/Q scans, lower extremity imaging by ultrasonography or impedance plethysmography, and pulmonary angiography have been published, but are still underused. ^{10 Henschke C.I., Mateescu I., Yankelevitz D.F. Changing practice patterns in the workup of pulmonary embolism Chest 1995 ; 107 : 940-945 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 27 Sostman H.D., Ravin C.E., Sullivan D.C. , y al. Use of pulmonary angiography for suspected pulmonary embolism: Influence of scintigraphic diagnosis AJR 1982 ; 139 : 673-677

Haga clic aquí para ir a la sección de Referencias} The inescapable problem with the current noninvasive diagnostic strategies is their inability to directly visualize the pulmonary vasculature. Pulmonary angiography, still the diagnostic gold standard, is invasive, expensive, underused, and not universally available. A less invasive, more specific way to assess for thrombus in pulmonary arteries, therefore, would be a welcome advance. Spiral (or helical) CT technology offers direct visualization of the pulmonary vasculature and, as a substitute for V/Q or angiography, may play a major role in the detection of both acute and chronic thromboembolic disease.