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[Pulmonary embolism: is scintigraphy useful after initial angio-CT?]
J F Paul1, J N Fiessinger, A Hernigou
1Service de radiologie vasculaire, Hôpital Broussais, 96, rue Didot, 75674 Paris Cedex 14. paul@hbroussais.fr
Purpose:
To assess the value of ventilation-perfusion scintigraphy after an initial helical CT with absence of pulmonary embolism (PE).
Material:
and methods. Twenty eight consecutive patients with clinical suspicion of pulmonary embolism underwent helical CT scan to look for an intra-luminal clot. When the CT-scan was positive for PE, diagnosis was retained. If the result was negative, a ventilation-perfusion scintigraphy was performed. If the result was also negative, diagnosis of PE was excluded. In case of discrepancy, a pulmonary angiography was performed and used as gold-standard.
Results:
Twenty-one patients showed PE at CT-angio and 7 did not. Two of these 7 had normal or low probability scintigraphy, excluding diagnosis of PE. One had intermediate V/P scan and 4 had high probability V/P scan. For these 5 discrepancies, none of them had PE on angiography.
Conclusion:
In this population, scintigraphy was not appropriate after a negative CT-angio for PE. In case of persistent doubt after a normal initial helical CT, pulmonary angiography is required