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Henry Ford Heart and Vascular Institute, Detroit, Michigan
Michigan State University, East Lansing, Michigan
Correspondence: For correspondence or reprints contact: Paul D. Stein, MD, Henry Ford Heart and Vascular Institute, New Center Pavilion, Room 1107, 2921 W. Grand Blvd., Detroit, MI 48202-2691.
ABSTRACT
The purpose of this investigation was to identify characteristics or combinations of characteristics of the ventilation-perfusion (V/Q) scan in patients with suspected acute pulmonary embolism (PE) that can be used for a "very low probability" interpretation (<10% positive predictive value). Methods: Data were culled from individual lungs of 532 patients in the randomized arm of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study and 205 patients in the referred arm. All patients had a <20% consensus probability estimate of PE based on V/Q scan results, and all underwent pulmonary angiography. Results: Nonsegmental perfusion abnormalities, perfusion defects smaller than opacities on the chest radiograph, a combination of these types of perfusion abnormalities, and matched V/Q abnormalities in two or three zones of a single lung had a positive predictive value < 10%. These criteria can therefore be used for a very low probability interpretation. A matched V/Q defect in only one zone of the lung had a positive predictive value greater than 10% and is not a criterion for very low probability classification but can be considered a criterion for low probability. Perfusion defects associated with small pleural effusions (obliteration of the costophrenic angle) had a positive predictive value of 25%–33%, depending on the group studied, and are a criterion for intermediate probability. Conclusion: Criteria appropriate for very low probability (<10% positive predictive value) interpretation of V/Q scans in patients with suspected acute PE have been identified.
Key Words: pulmonary embolism • thromboembolism • ventilation-perfusion lung scans
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