Jm. Holbert et al., Role of spiral computed tomography in the diagnosis of pulmonary embolism in the emergency department, ANN EMERG M, 33(5), 1999, pp. 520-528
Recently a debate has developed in the medical community as radiologists in
some centers suggest the selective substitution of spiral computed tomogra
phy (CT) for ventilation;perfusion (V/Q) nuclear medicine imaging as a scre
ening test for the diagnosis of acute pulmonary embolism. Proponents of spi
ral CT argue that it is more accurate than the usual practice of combining
the (V/Q) scan and the physician's best clinical judgment. V/Q scans classi
fy patients into groups according to the probability of pulmonary emboli, w
hereas the thrombus is visible with spiral CT. Opponents point our that lar
ge-scale patient outcome studies using spiral CT have not been completed, b
ut such information is available for (V/Q) scans. Most clinicians are famil
iar with the strengths and limitations of an assessment that relies primari
ly on the (V/Q) scan, because this examination has been available for many
years. Although spiral CT does Rot perform as well as pulmonary arteriograp
hy in detecting subsegmental emboli, the importance of smaller peripheral e
mboli is controversial. This review explores the advantages and disadvantag
es of investigations currently available for the diagnosis of acute pulmona
ry embolism from the perspective of the emergency physician, presenting the
view that spiral CT is likely to have an increasingly important place in p
atient evaluation.