A randomized trial of spiral CT and ventilation perfusion scintigraphy for the diagnosis of pulmonary embolism

Clinical Radiology
J J CrossA K Dixon

Abstract

To compare spiral computed tomographic pulmonary angiography (SCTA) with lung ventilation-perfusion scintigraphy (VQS) as the initial investigation of patients with suspected pulmonary embolism (PE). Prospective randomized trial of 78 patients with suspected pulmonary embolism. Patients underwent either SCTA or lung VQS as their initial investigation for PE. Cross-over between groups meant that 50 patients received both examinations. The clinicians' assessment of overall clinical likelihood of PE was also collected. (1) It was possible to make a confident diagnosis in a significantly larger proportion of patients when SCTA was used as the initial investigation (35/39, 90%) compared with using VQS first (21/39, 54% P<0.001). The main difference between the two groups was that SCTA demonstrated lesions other than pulmonary embolism considered responsible for the patients' symptoms in 13/39 patients (33%) randomized to SCTA as the initial investigation and following a non-diagnostic VQS in 10/39 patients (25%) randomized to VQS as the initial investigation. (2) There was no difference in the prevalence or detection of PE in the two groups. SCTA demonstrated pulmonary emboli in 6/39 patients (16%) in the SCTA first group and VQS wa...Continue Reading

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