Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED).
Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED).
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DOI：
10.1001/jama.1990.03440200057023
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发表时间：
1990-05
期刊：
影响因子：
--
通讯作者：
P. Investigators
中科院分区：
文献类型：
--
作者：
P. Investigators
为了确定通气/灌注肺扫描对急性肺栓塞的敏感性和特异性，前瞻性研究了1493例患者中的933例。931人接受了肺动脉造影，755人接受了肺动脉造影; 755人中有251人（33%）证实了肺栓塞。几乎所有的肺栓塞患者都有高、中、低概率的异常扫描，但大多数无肺栓塞的患者也有异常扫描（敏感性98%，特异性10%）。在116例高概率扫描和明确血管造影的患者中，102例（88%）有肺栓塞，但只有少数肺栓塞患者有高概率扫描（敏感性，41%;特异性，97%）。在322例中等概率扫描和确定性血管造影中，105例（33%）有肺栓塞。随访和血管造影共同提示肺栓塞发生在12%的低概率扫描患者中。临床评估结合通气/灌注扫描仅对少数患者建立了肺栓塞的诊断或排除-那些具有明确和一致的临床和通气/灌注扫描结果的患者。
To determine the sensitivities and specificities of ventilation/perfusion lung scans for acute pulmonary embolism, a random sample of 933 of 1493 patients was studied prospectively. Nine hundred thirty-one underwent scintigraphy and 755 underwent pulmonary angiography; 251 (33%) of 755 demonstrated pulmonary embolism. Almost all patients with pulmonary embolism had abnormal scans of high, intermediate, or low probability, but so did most without pulmonary embolism (sensitivity, 98%; specificity, 10%). Of 116 patients with high-probability scans and definitive angiograms, 102 (88%) had pulmonary embolism, but only a minority with pulmonary embolism had high-probability scans (sensitivity, 41%; specificity, 97%). Of 322 with intermediate-probability scans and definitive angiograms, 105 (33%) had pulmonary embolism. Follow-up and angiography together suggest pulmonary embolism occurred among 12% of patients with low-probability scans. Clinical assessment combined with the ventilation/perfusion scan established the diagnosis or exclusion of pulmonary embolism only for a minority of patients--those with clear and concordant clinical and ventilation/perfusion scan findings.