Published on:
    Journal of Cardiovascular Disease Research, 2013; 4(1):40-43
    Original Article | doi:10.1016/j.jcdr.2013.02.004

    Comparison of non-invasive diagnostic tests to multi-detector CT pulmonary angiography for the diagnosis of pulmonary embolism

    Authors:

    Naeem Firdous a, Prashant Nasa c,*, Avdhesh Bansal a, Deven Juneja c, Manjit Singh Kanwar a, Moti Lal Bera b

    a Department of Respiratory and Sleep Medicine, Indraprastha Apollo Hospital, India

    b Department of Radiodiagnosis, Indraprastha Apollo Hospital, India

    c Department of Critical Care Medicine, Max Super Speciality Hospital, 1, Press Enclave Road, Saket, New Delhi, India

    Abstract:

    Context: Acute pulmonary embolism (PE) remains a diagnostic and therapeutic challenge to physicians. There are various non-invasive diagnostic modalities been suggested to diagnose pulmonary embolism. Aim: We tried to find the performance of various non-invasive investigations in comparison to multidetector Computerized Tomography (MDCT pulmonary angiography for the diagnosis of PE). Settings and design: A prospective cohort study was conducted in 80 hospitalized medical patients. Materials and methods: There were 80 patients with Wells score > 2 who were included. The demographic data, non-invasive investigations, and MDCT pulmonary angiography were conducted in these patients. The sensitivity (SEN), specificity (SPE), positive predictive value (PPV), and negative predictive value (NPV) were calculated for each test. Results: Out of 80 patients, 77.5% patients were with Wells score 3-6 and 22.5% patients were withWells score more than 6. The test with highest sensitivity was D-dimer (SEN - 90%, P = 0.091) followed by PAH on TTE (SEN - 83%, PPV e 86%, P = 0.006). The most specific test was ECG showing S1Q3T3 (SPE - 100%, P = 0.421), followed by Wells score > 6 (SPE - 91%, P = 0.211). There was no test with sensitivity and specificity more than 90% Conclusion: In all patients with intermediate to high-risk probability MDCT pulmonary angiography is the most accurate test to diagnose PE and should be performed at the earliest. The combination of 2- dimensional ECHO and D-dimer can be used in patients with a high clinical suspicion of PE on pre-test probability where MDCT pulmonary angiography is not possible.

    Key words: MDCT pulmonary angiography, Non-invasive investigations, Pulmonary embolism.