Canadian Association of General Surgeons evidence based reviews in surgery. 3. Helical computed tomography versus pulmonary arteriography in pulmonary embolism.

Question: How does dual-section helical computed tomography compare to selective pulmonary arteriography (SPA) in diagnosing pulmonary embolism (PE)? Design: A prospective cross-sectional study. Setting: Cardiology and intensive care units of a university teaching hospital in Paris, France. Patients: Two hundred and four consecutive patients were clinically suspected of having an acute PE. Of these, 158 were enrolled (mean age [and standard deviation (SD)], 58 [14] ). Eligibility criteria included a clinical suspicion of acute PE (dyspnea, chest pain, hemoptysis, syncope, risk factors for thromboembolic disease, abnormal findings on chest radiography or electrocardiography, or abnormal arterial blood-gas test results), and the mental ability to give informed consent. Description of test and diagnostic standard: All patients underwent dual-section helical CT and SPA within 12 hours of each other. Each image was analyzed by 2 blinded radiologists who determined image quality and the presence of PE. A third blinded radiologist was used to settle any differences. Main outcome measures: Sensitivity, specificity, positive and negative predictive values for PE. Main results: SPA was considered optimal in 147 (93%), suboptimal in 10 (6%) and inconclusive in 1 (0.6%). Dual-section helical CT findings were considered technically optimal in 140 (89%), suboptimal in 11 (7%) and inconclusive in 6 (4%). SPA demonstrated PE in 62 patients. Table 1 shows the sensitivity, specificity, and positive and negative predictive values of dual-section helical CT (based on SPA as the reference standard). Conclusions: Dualsection helical CT offers high sensitivity and specificity for the detection of PE and may replace pulmonary arteriography for the direct demonCorrespondence to: Ms. Marg McKenzie, RN, Administrative Assistant, CAGS-EBRS, Mount Sinai Hospital, 1560–600 University Ave., Toronto ON M5G 1X5; fax 416 586-5932 Evidence-Based Surgery Chirurgie factuelle Canadian Association of General Surgeons Evidence Based Reviews in Surgery. 3. Helical computed tomography versus pulmonary arteriography in pulmonary embolism Harry J.A. Henteleff, MD; John W. Drover, MD; for Members of the CAGS Evidence Based Reviews