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Computed tomography pulmonary angiography as a single imaging test to rule out pulmonary embolism.
MedLine Citation:
PMID:  21681098     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: The aim is to review the evidence on the diagnostic value of computed tomography pulmonary angiography (CTPA) as a single test to rule out acute pulmonary embolism by focussing on the most recent literature and potential alternative and additional imaging modalities or diagnostic strategies. RECENT FINDINGS: Clinical outcome studies have demonstrated that, using algorithms with sequential diagnostic tests, pulmonary embolism can be safely ruled out in patients with a clinical probability indicating pulmonary embolism to be unlikely and a normal D-dimer test result. This obviates the need for additional radiological imaging tests in around one-third of patients. CTPA has been shown to have a high sensitivity and specificity for the diagnosis of pulmonary embolism. Several emerging tests with potential diagnostic or other advantages over CTPA need further validation before they can be implemented in routine clinical care. SUMMARY: CTPA is the imaging test of first choice. The presence or absence of pulmonary embolism can be determined with sufficient certainty without the need for additional imaging tests after a negative CTPA. Compression ultrasonography and ventilation-perfusion scintigraphy is reserved for patients with concomitant symptomatic deep vein thrombosis or a stringent contraindication for CTPA, respectively. Currently, magnetic resonance pulmonary angiography is not a suitable alternative for CTPA.
Authors:
Frederikus A Klok; Inge Cm Mos; Lucia Jm Kroft; Albert de Roos; Menno V Huisman
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-6-15
Journal Detail:
Title:  Current opinion in pulmonary medicine     Volume:  -     ISSN:  1531-6971     ISO Abbreviation:  -     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-6-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9503765     Medline TA:  Curr Opin Pulm Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
aSection of Vascular Medicine, Department of General Internal Medicine - Endocrinology, LUMC, Leiden, The Netherlands bDepartment of Internal Medicine, Bronovo, The Netherlands cDepartment of Internal Medicine, MC Haaglanden, Den Haag, The Netherlands dDepartment of Radiology, LUMC, Leiden, The Netherlands *Frederikus A. Klok and Inge C.M. Mos contributed equally to the writing of the article.
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