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Abstract

Aim: To determine whether the survival of patients with suspected acute pulmonary embolism (PE) relates to radiological probability of acute PE assessed using lung scintigraphy scans (LSS).

Methods: Lung scintigraphy scan results from a venous thromboembolism database were categorised as high, indeterminate or low probability using the modified PIOPED criteria and corresponding chest X-rays (CXRs) as normal or abnormal. Mortality data on these cases were obtained from the General Register Office for Scotland, and survival was analysed using the Kaplan-Meier method.

Results: Of the 1,818 LSS analysed, 941 (51.8%) were normal, 532 (29.3%) indeterminate and 345 (19.0%) high probability. After an adjustment for age and gender, no significant survival difference was found between patients with normal and high probability LSS (p=0.182). However, patients with indeterminate LSS had significantly lower survival than patients in the other groups. This difference persisted after adjustment for CXR result.

Conclusions: Indeterminate LSS results are associated with a poor prognosis. Careful follow-up of patients with inderminate LSS would appear to be justified.

Keywords

Lung scintigraphy scan outcome pulmonary embolism survival ventilation perfusion

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References

Stein

Fowler

Goodman

Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 2006; 354:2317–27. doi:10.1056/NEJMoa052367

Guilabert

Manzur

Tarrasa

Can multislice CT alone rule out reliably pulmonary embolism? A prospective study. Eur J Radiol 2007; 62:220–6. doi:10.1016/j.ejrad.2006.11.032

O’Neill

Wright

Murchison

JT.

Helical CTPA in the investigation of pulmonary embolism: a 6-year review. Clin Radiol 2004; 59:819–25. doi:10.1016/j.crad.2004.02.011

Gray

Neilly

JB.

The role and value of ventilation perfusion imaging in pulmonary embolism. In Oudkerk M, Van Beek EJ, ten Cate JW, editors. Pulmonary embolism. Berlin: Blackwell Science; 1999. p. 84–123.

Saltzman

Alavi

Greenspan

; 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– 9. doi:10.1001/jama.263.20.2753

Miniati

Pistolesi

Marini

Value of perfusion lung scan in the diagnosis of pulmonary embolism: results of the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis (PISA-PED). Am J Respir Crit Care Med 1996; 154:1387–93.

Anderson

Kahn

Rodger

Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism. A randomized controlled trial. JAMA 2007; 298:2743–53. doi:10.1001/jama.298.23.2743

Akaike

A new look at the statistical model identification. IEEE Trans Automat Contr 1976; AC-19:716–23.

Goldhaber

Visani

de Rosa

Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353:1386– 9. doi:10.1016/S0140-6736(98)07534-5

10.

10Hvitfeldt Poulsen S, Noer I, Moller JE Clinical outcome of patients with suspected pulmonary embolism. A follow-up study of 588 consecutive patients. J Intern Med 2001; 250:137–43. doi:10.1046/j.1365-2796.2001.00866.x

11.

Jacobson

Patel

Lewis

DH.

Clinical outcome of patients with intermediate probability lung scans during six-month follow-up. J Nucl Med 1997; 38:1593–6.

12.

12 Murchison

, GaVan DR, Reid JH. Clinical utilisation of the nondiagnostic lung scintigram. Clin Radiol 1997; 52:295–8. doi:10.1016/S0009-9260(97)80057-8

13.

Akram

Cowell

Logan

LJA

Clinically suspected acute pulmonary embolism: a comparison of presentation, radiological features and outcome in patients with and without PE. QJM 2009; 102:407–14. doi:10.1093/qjmed/hcp041

14.

Forbes

KPN

Reid

Murchison

JT.

Do preliminary chest X-ray findings define the optimum role of pulmonary scintigraphy in suspected pulmonary embolus? Clin Radiol 2001; 56:397–400. doi:10.1053/crad.2000.0670

15.

Hyers

TM.

Venous thromboembolism. Am J Respir Crit Care Med 1999; 159:1–14.

16.

Fleming

AD.

Scotland’s census 2001: statistics on migration. Edinburgh: General Register Office for Scotland; 2005.

Prognostic significance of the lung scintigraphy scan result and corresponding chest X-ray in patients with suspected pulmonary embolism

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