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Pulmonary Embolism Revealed on Helical CT Angiography

Comparison with Ventilation—Perfusion Radionuclide Lung Scanning

H. Blachere1, V. Latrabe1, M. Montaudon1, N. Valli2, T. Couffinhal3, C. Raherisson4, F. Leccia2 and F. Laurent1,5

1 Department of Radiology, Unité d'Imagerie Thoracique et Cardiovasculaire, CHU Bordeaux, Hôpital Cardiologique Haut-Lévêque, Ave. de Magellan, 33604 Pessac, France.
2 Department of Nuclear Medicine, CHU Bordeaux, Hôpital Haut-Lévêque, 33604 Pessac, France.
3 Department of Cardiology, CHU Bordeaux, Hôpital Haut-Lévêque, 33604 Pessac, France.
4 Department of Pneumology, CHU Bordeaux, Hôpital Haut-Lévêque, 33604 Pessac, France.
5 Laboratoire de physiologie cellulaire respiratoire, INSERM E 9937, Université Victor Ségalen, Bordeaux 2, France.



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  		Fig. 1. —Flow chart shows how final diagnoses of patients with concordant positive findings on helical CT angiography (HCTA) and ventilation—perfusion radionuclide lung scanning (V-P) were obtained.

 


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  		Fig. 2. —Flow chart shows how final diagnoses of patients with positive findings on helical CT angiography (HCTA) and intermediate- or low-probability ventilation—perfusion radionuclide lung scanning (V-P) were obtained.

 


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  		Fig. 3. —Flow chart shows how final diagnoses of patients with indeterminate findings on helical CT angiography (HCTA) were obtained. V-P = ventilation—perfusion radionuclide lung scanning.

 


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  		Fig. 4. —Flow chart shows how final diagnoses of patients with negative findings on helical CT angiography (HCTA) were obtained. V-P = ventilation—perfusion radionuclide lung scanning.

 


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  		Fig. 5A. —73-year-old woman with chronic obstructive bronchopathy, acute exacerbation of dyspnea, and chest pain. Helical CT angiogram shows intraluminal filling defect of mediastinal superior lobar artery (arrow) and of left interlobar artery for which both observers made true-positive interpretation on helical CT angiography. Interpretations of ventilation—perfusion radionuclide lung scanning (not shown) were of intermediate probability (observer 1) and low probability (observer 2).

 


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  		Fig. 5B. —73-year-old woman with chronic obstructive bronchopathy, acute exacerbation of dyspnea, and chest pain. CT scan obtained 3 months after A shows complete resolution of clots.

 


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  		Fig. 6A. —54-year-old man with acute onset of dyspnea. Helical CT angiogram shows irregular filling defect of left anterior segmental artery (arrow) falsely interpreted as positive by both observers. Pulmonary angiogram (not shown) was obtained and showed normal left arterial tree.

 


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  		Fig. 6B. —54-year-old man with acute onset of dyspnea. Retrospective overlapping reconstruction using initial raw data shows normal lumen.

 

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