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Small Perfusion Defects in Suspected Pulmonary Embolism

Henry Ford Heart and Vascular Institute, Detroit and 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 assess the diagnostic value of 1 to 3 versus >3 small subsegmental defects on perfusion lung scans of patients with suspected acute pulmonary embolism (PE). Methods: Data from the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) were evaluated from patients with suspected acute PE. Angiograms, follow-up data and outcome classifications were used to determine PE status. The perfusion scan of included patients showed only small subsegmental defects (<25% of a segment) in the presence of a regionally normal chest radiograph. Findings on the ventilation scan were irrelevant. Results: The positive predictive value for PE of perfusion lung scans with 1–3 small subsegmental defects was 1% to 3%, depending on the group analyzed. The positive predictive value for PE of perfusion lung scans with >3 small subsegmental defects was 11% to 17% depending on the group analyzed. Conclusion: Perfusion lung scans with 1–3 small subsegmental defects satisfy the criterion for a very low probability (<10% positive predictive value) for PE and perfusion lung scans with >3 small subsegmental defects satisfy the criteria for a low probability (<20% positive predictive value) for PE.

Key Words: pulmonary embolism • ventilation/perfusionlung scan • thromboembolic disease

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]

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