HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gottschalk, A. Articles by Relyea, B. Search for Related Content PubMed PubMed Citation Articles by Gottschalk, A. Articles by Relyea, B.

Matched Ventilation, Perfusion and Chest Radiographic Abnormalities in Acute Pulmonary Embolism

Michigan State University, East Lansing, Michigan and Henry Ford Heart and Vascular Institute, Detroit, Michigan

Correspondence: For correspondence or reprints contact: Alexander Gottschalk, MD, Michigan State University, B220 Clin. Science Bldg., East Lansing, MI 48224.

ABSTRACT

This investigation assessed the positive predictive value of matched ventilation/perfusion (V/Q) and chest radiographic defects (triple-matched defects) for the detection of acute pulmonary embolism (PE). Methods: Data are from the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). Only patients randomized for obligatory pulmonary angiography were included. Lungs were excluded if they showed any mismatched V/Q defect or any pleural effusion. Results: Positive predictive values of triple-matched defects in the upper plus middle zones, 1 of 27 (4%), were less frequent than in the lower zones, 13 of 57 (23%) (p < 0.05). Triple-matched defects that involved 25–50% of a zone showed PE in 12 of 38 (32%) which was a higher positive predictive value than with smaller or larger triple-matched defects, 2 of 46 (4%) (p < 0.001). Conclusion: Refinement of the PIOPED data by elimination of nonrandomized patients, elimination of lungs with mismatched perfusion defects and elimination of lungs with a pleural effusion indicate that triple matches with PE (radiographic pulmonary infarcts) are infrequent in the upper and middle lung zones. When a triple match with PE occurs, it is most likely to be 25–50% of a zone.

Key Words: pulmonary embolism • thromboembolism • pulmonary scintiscans • ventilaton/perfusion lung scans

This article has been cited by other articles:

				H. D. Sostman, P. D. Stein, A. Gottschalk, F. Matta, R. Hull, and L. Goodman Acute Pulmonary Embolism: Sensitivity and Specificity of Ventilation-Perfusion Scintigraphy in PIOPED II Study Radiology, March 1, 2008; 246(3): 941 - 946. [Abstract] [Full Text] [PDF]

				A. Gottschalk, P. D. Stein, H. D. Sostman, F. Matta, and A. Beemath Very Low Probability Interpretation of V/Q Lung Scans in Combination with Low Probability Objective Clinical Assessment Reliably Excludes Pulmonary Embolism: Data from PIOPED II J. Nucl. Med., September 1, 2007; 48(9): 1411 - 1415. [Abstract] [Full Text] [PDF]

				B. Harris, D. Bailey, S. Miles, E. Bailey, K. Rogers, P. Roach, P. Thomas, M. Hensley, and G. G. King Objective Analysis of Tomographic Ventilation-Perfusion Scintigraphy in Pulmonary Embolism Am. J. Respir. Crit. Care Med., June 1, 2007; 175(11): 1173 - 1180. [Abstract] [Full Text] [PDF]

				R G McLean, M Carolan, C Bui, O Arvela, J C Ford, M Chew, S Wadhwa, and B S Elison Comparison of new clinical and scintigraphic algorithms for the diagnosis of pulmonary embolism Br. J. Radiol., May 1, 2004; 77(917): 372 - 376. [Abstract] [Full Text] [PDF]

				P. D. Stein and A. Gottschalk Review of Criteria Appropriate for a Very Low Probability of Pulmonary Embolism on Ventilation-Perfusion Lung Scans: A Position Paper RadioGraphics, January 1, 2000; 20(1): 99 - 105. [Abstract] [Full Text] [PDF]