Assessing the utility of the ventilation phase in ventilation-perfusion imaging for acute pulmonary embolism.

Journal Article

PURPOSE: This study aims to identify patient characteristics that allow the exclusion of the ventilation phase in ventilation-perfusion imaging for the evaluation of acute pulmonary embolism (PE). MATERIALS AND METHODS: A total of 500 consecutive ventilation-perfusion reports with an indication for possible acute PE were retrospectively reviewed. Information on ventilation abnormalities, perfusion defects, PIOPED classification, age, sex, chest radiograph results, and presence of respiratory disease was recorded. Patients with moderate and large perfusion defects were analyzed to assess the utility of the ventilation phase on the final PIOPED classification. RESULTS: Moderate (n=39) or large (n=26) perfusion defects were seen in 65 (13%) studies. Of these, 46 studies (70.8%) had defects unmatched on ventilation and three (4.6%) had triple-match defects, resulting in 49 reports (75.4%) classified as intermediate (n=28) or high (n=21) probability for PE. There was a statistically significant association between unmatched defects and a clear chest radiograph (P=0.03) and an association approaching statistical significance with younger age (P=0.05). There was a strong association with respiratory disease (P=0.12) and no association with patient sex (P=0.82). The percentage of studies with unmatched defects increased from 70.8 to 76.7% (33/43, P=0.39) if patients with respiratory disease were excluded, to 82.4% (28/34, P=0.14) if abnormal chest radiographs were excluded, and to 95.7% (22/23, P=0.01) if both were excluded. CONCLUSION: There may be a subset of patients - younger patients with clear chest radiographs and no respiratory disease - for whom the ventilation phase can be excluded and the determination of a PE is based solely on perfusion abnormalities.

Full Text

Duke Authors

Cited Authors

  • Grimm, LJ; Coleman, RE

Published Date

  • January 2013

Published In

Volume / Issue

  • 34 / 1

Start / End Page

  • 1 - 4

PubMed ID

  • 23111382

Electronic International Standard Serial Number (EISSN)

  • 1473-5628

International Standard Serial Number (ISSN)

  • 0143-3636

Digital Object Identifier (DOI)

  • 10.1097/mnm.0b013e32835afb99

Language

  • eng