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A diagnostic strategy for pulmonary embolism based on standardised pretest probability and perfusion lung scanning: a management study

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Pulmonary embolism remains a challenging diagnostic problem. We developed a simple diagnostic strategy based on combination of assessment of the pretest probability with perfusion lung scan results to reduce the need for pulmonary angiography. We studied 390 consecutive patients (78% in-patients) with suspected pulmonary embolism. The pretest probability was rated low (<10%), intermediate (>10%, ≤50%), moderately high (>50%, ≤90%) or high (>90%) according to a structured clinical model. Perfusion lung scans were independently assigned to one of four categories: normal; near-normal; abnormal, suggestive of pulmonary embolism (wedge-shaped perfusion defects); abnormal, not suggestive of pulmonary embolism (perfusion defects other than wedge shaped). Pulmonary embolism was diagnosed in patients with abnormal scans suggestive of pulmonary embolism and moderately high or high pretest probability. Patients with normal or near-normal scans and those with abnormal scans not suggestive of pulmonary embolism and low pretest probability were deemed not to have pulmonary embolism. All other patients were allocated to pulmonary angiography. Patients in whom pulmonary embolism was excluded were left untreated. All patients were followed up for 1 year. Pulmonary embolism was diagnosed non-invasively in 132 patients (34%), and excluded in 191 (49%). Pulmonary angiography was required in 67 patients (17%). The prevalence of pulmonary embolism was 41% (n=160). Patients in whom pulmonary embolism was excluded had a thrombo-embolic risk of 0.4% (95% confidence interval: 0.0%–2.8%). Our strategy permitted a non-invasive diagnosis or exclusion of pulmonary embolism in 83% of the cases (95% confidence interval: 79%–86%), and appeared to be safe.

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Acknowledgements

The authors wish to thank Dr. Matteo Bottai for statistical advice, and Marco Salvadori for excellent technical assistance. This work was supported in part by the Ministry of Health and the Ministry of University and Scientific and Technological Research of Italy.

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Authors and Affiliations

  1. Istituto di Fisiologia, Clinica del Consiglio Nazionale delle Ricerche, Via G. Moruzzi 1, 56124, Pisa, Italy

    Massimo Miniati, Simonetta Monti, Carolina Bauleo, Elvio Scoscia, Lucia Tonelli, Alba Dainelli, Giosuè Catapano, Bruno Formichi, Giorgio Di Ricco, Renato Prediletto, Laura Carrozzi & Carlo Marini

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  1. Massimo Miniati
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  2. Simonetta Monti
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  3. Carolina Bauleo
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  4. Elvio Scoscia
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  5. Lucia Tonelli
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  6. Alba Dainelli
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  7. Giosuè Catapano
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  8. Bruno Formichi
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  9. Giorgio Di Ricco
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  10. Renato Prediletto
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  11. Laura Carrozzi
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  12. Carlo Marini
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Correspondence to Massimo Miniati.

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Miniati, M., Monti, S., Bauleo, C. et al. A diagnostic strategy for pulmonary embolism based on standardised pretest probability and perfusion lung scanning: a management study. Eur J Nucl Med Mol Imaging 30, 1450–1456 (2003). https://doi.org/10.1007/s00259-003-1253-7

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  • DOI: https://doi.org/10.1007/s00259-003-1253-7

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