Clinical validity of helical CT being interpreted as negative for pulmonary embolism: Implications for patient treatment

OBJECTIVE. The purpose of our study was to assess the clinical usefulness o f helical CT findings that are interpreted as negative for pulmonary emboli sm. MATERIALS AND METHODS. One hundred twenty-six patients underwent 132 helica l CT examinations and 352 patients underwent ventilation-perfusion scanning for suspected acute pulmonary embolism over a 17-month period at a single institution. Findings from clinical follow-up at a minimum of 6 months were assessed, with a special focus on the presence of recurrent thromboembolis m and mortality in 78 consecutive patients in whom helical CT findings were interpreted as negative for pulmonary embolism and anticoagulant therapy w as not administered (group I). During the same 17-month period, 46 patients underwent ventilation-perfusion scanning that was interpreted as normal (g roup II), and 132 patients underwent ventilation-perfusion scanning that wa s interpreted as showing a very low to low probability for pulmonary emboli sm (group III). Patients in groups II and III did not undergo helical CT or pulmonary angiography and did not receive anticoagulant therapy. However, clinical follow-up was solicited. Patients from groups II and ZU: were used as control subjects. RESULTS. Nine patients in group I died, one of whom was found to have a mic roscopic pulmonary embolism at autopsy. In group II, four patients died, no ne of whom were shown to have a missed or recurrent pulmonary embolism. Of the 18 patients in group III who died, three had a recurrent or missed pulm onary embolism (mean interval, 9 days), and two were found to have deep vei n thrombosis on sonography of the leg (mean interval, 12 weeks). Negative p redictive values for helical CT, normal lung scanning, and low-probability ventilation-perfusion scanning were 99%, 100%, and 96%, respectively (p = . 299). CT provided either additional findings or an alternate diagnosis in 4 2 (53.8%) of the 78 patients in whom helical CT findings had been interpret ed as negative for pulmonary embolism. CONCLUSION. A helical CT scan can be effectively used to rule out clinicall y significant pulmonary emboli and may prevent further investigation or unn ecessary treatment of most patients.