A prospective,comparative study of ventilation-perfusion scintigraphy and clinical evaluation versus digital subtraction angiography in acute pulmonary thromboembolism |
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Authors: | B. Hedlund C. Lassvik S. Nilsson J. Ohlsson S. Stoméus |
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Affiliation: | (1) Department of Radiology, County Hospital Ryhov, S-551 85 Jönköping, Sweden;(2) Department of Clinical Physiology, University of Linköping, Sweden;(3) Department of Internal Medicine, County Hospital Ryhov, S-551 85 Jönköping, Sweden;(4) Department of Clinical Physiology, County Hospital Ryhov, S-551 85 Jönköping, Sweden |
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Abstract: | Patients with symptoms of acute pulmonary thromboembolism (APE) of short duration were investigated with digital subtraction angiography (DSA) and ventilation/perfusion lung scintigraphy (V/Q scan), and a standardised clinical evaluation was performed. Forty-six angiograms (96%) were diagnostic at the segmental level and were used as reference. In all V/Q scans classified as normal or of high probability for APE, a complete agreement with DSA was found. In scan categories with low or intermediate probability, where the incidence of APE was 32%, there was considerable inter-observer disagreement. Clinical assessment alone was of limited value, but in patients with low clinical suspicion no APE was found. The results indicate that normal and high probability V/Q scans are very reliable for excluding and identifying APE, respectively, but also that fairly large APE cannot be diagnosed with lung scanning. Subdivision of V/Q scans into more than three categories (normal, high probability and inconclusive) seems to be of no practical value. Using a pulsed sequence technique, high frame rate and central injection, DSA is a valuable clinical tool for diagnosing APE down to the segmental level.Correspondence to: B. Hedlund |
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Keywords: | Angiography, digital subtraction Lung, radionuclide imaging Pulmonary embolism |
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