CT pulmonary angiogram compared with ventilation-perfusion scan for the diagnosis of pulmonary embolism in patients with cardiorespiratory disease
Date First Published:
June 27, 2002
Last Updated:
November 19, 2003
Report by:
Jonathan Costello, Specialist Registrar (Royal Preston Hospital, Manchester Royal Infirmary respectively)
Search checked by:
Kerstin Hogg, Royal Preston Hospital, Manchester Royal Infirmary respectively
Three-Part Question:
In [patients with chronic respiratory disease] does [V-Q scintigraphy have greater diagnostic utility than computed tomography] in the [investigation of pulmonary embolus]?
Clinical Scenario:
A 70 year old known COPD patient presents to your emergency department with pleuritic chest pain and dyspnoea suggestive of pulmonary embolus. Initial investigations do not exclude pulmonary embolus. As part of your diagnostic strategy, you wonder if V-Q scintigraphy has better diagnostic utility than CT for pulmonary embolus.
Search Strategy:
Medline 1966-07/03 using the OVID interface.
Search Details:
(exp Tomography, Spiral Computed OR exp Tomography, X-Ray Computed OR "CT".mp) AND (exp Ventilation-Perfusion Ratio OR "VQ".mp OR "V-Q".mp OR Ventilation Perfusion.mp OR Ventilation-Perfusion.mp OR perfusion.mp) AND (exp pulmonary embolism OR pulmonary embol$.mp OR "PE".mp OR Pulmonary infarct$.mp OR exp thromboembolism$ OR thromboembolism$.mp) LIMIT to human AND English.
Outcome:
Altogether 239 papers found of which 238 did not address the exact question. One paper was of relevance.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Effect of Chronic Obstructive Pulmonary Disease on the Performance of D-Dimer Testing, Ventilation/Perfusion Scintigraphy, Spiral Computed Tomographic Angiography, and Conventional Angiography. Hartmann I, Petronella H, Melissant C et al. 2000, Netherlands | 627 patients (91 COPD, 536 non-COPD) with suspected PE diagnosis PE Inclusion (angiography or high-probability V-Q) PE Exclusion (normal angiography or perfusion scintigraphy) |
Diagnostic study | Proportion of diagnostic VQ scans and CT pulmonary angiograms from both groups | 54% of VQ scans in COPD group ruled in/out PE vs 79% of VQ scans in non-COPD group | Observational groups not evenly matched Questional inclusion COPD criteria No power calculation |
| Sensitivity and specificity of VQ and CT in both groups | All CT pulmonary angiograms gave a rule in/rule out result. No statistical diffence between the two groups |
Author Commentary:
Surprisingly few comparative studies. Ultimately small number studied in the study in question. Rigid definition of study population and reporter bias pose difficulties in such a study group. Diagnostic utility of V-Q questionable owing to high proportion of inconclusive results - resource & economic factors are thus of relevance.
Bottom Line:
There is not enough evidence to support V-Q Scintigraphy as initial investigation of choice in COPD patients.
References:
- Hartmann I, Petronella H, Melissant C et al.. Effect of Chronic Obstructive Pulmonary Disease on the Performance of D-Dimer Testing, Ventilation/Perfusion Scintigraphy, Spiral Computed Tomographic Angiography, and Conventional Angiography.