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Comprehensive Analysis of the Results of the PIOPED Study

Division of Nuclear Medicine, Vancouver Hospital and Health Sciences Center, Vancouver, Canada
Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

Correspondence: For correspondence contact: Daniel Worsley, MD, Division of Nuclear Medicine, Vancouver Hospital and Health Sciences Center, 855 West 12th Ave., Vancouver, Canada V5Z 1M9.

Correspondence: For reprints contact: Abass Alavi, MD, Division of Nuclear Medicine, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.

ABSTRACT

The goals of this review were to summarize the published data from the National Heart, Lung and Blood Institute sponsored Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study, present new data from the entire population and provide a comprehensive criteria for ventilation-perfusion (V/Q) lung scan interpretation. Methods: Data from the PIOPED frequent user tape and journal articles published between 1990 and 1994 and indexed on Medline that presented data from the PIOPED study were reviewed. Results: Anormal V/Q lung scan excludes the diagnosis of clinically significant PE. The usefulness of the V/Q lung scan was optimized when interpreted as representing a very low, low or high probability of PE with a concordant clinical likelihood of PE. Patients with a V/Q lung scan interpreted as representing an intermediate probability of PE or patients with discordant clinical likelihood of PE and lung scan interpretation will often require further investigations to diagnose or exclude acute venous thromboembolism. Conclusion: The results of the PIOPED study support the use of V/Q lung scanning in the diagnostic evaluation of patients with suspected PE. Amendments to the original PIOPED interpretation criteria should reinforce the role of V/Q lung scanning in patients with suspected PE.

Key Words: technetium-99m-aggregated albumin • venous thromboembolism • thrombosis

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