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How accurate are ventilation-perfusion scans for pulmonary embolism?
B F Caracci1, P M Rumbolo, S Mainini
1Department of Surgery, St. Louis University Medical Center, Missouri 63104.
American Journal of Surgery
|December 1, 1988
Summary
Ventilation-perfusion scans show inaccuracy in diagnosing pulmonary embolism. Angiography confirmation revealed lower diagnostic accuracy than expected, suggesting a need for institutional review of interpretation methods.
Area of Science:
- Radiology
- Pulmonary Medicine
- Diagnostic Imaging
Background:
- Pulmonary embolism (PE) is a significant cause of morbidity and mortality.
- Accurate diagnosis of PE is crucial for timely and appropriate treatment.
- Ventilation-perfusion (V/Q) scanning is a common imaging modality used in PE diagnosis.
Purpose of the Study:
- To evaluate the diagnostic accuracy of ventilation-perfusion scanning compared to pulmonary arteriography in patients with suspected pulmonary embolism.
- To assess the sensitivity and specificity of V/Q scans in diagnosing PE.
Main Methods:
- A comparative study involving 55 patients with suspected pulmonary embolism.
- Pulmonary arteriograms were performed and compared with pre-existing ventilation-perfusion scans.
- V/Q scans were categorized into normal, low, intermediate, and high probability based on standard guidelines.
Main Results:
- Of 34 high-probability V/Q scans, only 22 (65%) were confirmed positive by arteriography.
- Among 18 low or intermediate-probability scans, only 5 (28%) were positive at angiography.
- Overall sensitivity was 82% and specificity was 57% for V/Q scanning in diagnosing PE.
Conclusions:
- Ventilation-perfusion scanning demonstrates inaccuracy in the diagnosis of pulmonary embolism.
- Variability in interpretation at individual institutions may contribute to diagnostic discrepancies.
- Institutions should compare V/Q scan and angiography results to optimize patient selection and treatment strategies.