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CT Pulmonary Angiography and V/Q Lung Scans Similarly Accurate for Excluding PE
Computed tomographic pulmonary angiography (CTPA) rules out pulmonary embolism as accurately as ventilation-perfusion (V/Q) lung scanning, JAMA reports.
In a multicenter, noninferiority trial, some 1400 adults (mostly outpatients) with a high likelihood of pulmonary embolism based on clinical criteria and D-dimer testing were randomized to CTPA or V/Q scanning. More CTPA patients than V/Q patients were diagnosed with venous thromboembolism (19% vs. 14%) and subsequently received anticoagulation therapy. The rest of the patients, in whom pulmonary embolism was considered excluded, did not receive treatment.
During 3 months' follow-up, the primary outcome — the proportion of patients who developed symptomatic pulmonary embolism or proximal deep venous thrombosis after pulmonary embolism was initially excluded — did not differ significantly between the groups (CTPA, 0.4%; V/Q, 1.0%).
The authors note that some of the excess emboli initially found with CTPA could be clinically unimportant, possibly leading to unnecessary anticoagulation.
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Published in Physician's First Watch December 19, 2007
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