CHAPTER 73 CT IMAGING FOR ACUTE PE: THE PIOPED II TRIAL

Multidetector Computed Tomography for Acute Pulmonary Embolism

Stein PD, Fowler SE, Goodman LR, et al. NEJM. 2006;354(22):2317–2327

BACKGROUND

Pulmonary embolism (PE) is associated with significant mortality and can pose a diagnostic challenge in the ED. In the early 2000s, ventilation/perfusion scan (V/Q scan) and pulmonary angiography were the primary modalities for the diagnosis of PE. Early single-slice CT had sensitivities ranging from 60% to 100%, but an inability to reliably assess segmental and subsegmental pulmonary arteries limited the ability to rule out PE. Multislice computed tomographic angiography (CTA) emerged as a novel, rapid, and noninvasive alternative, but its diagnostic accuracy was unknown. The PIOPED II study evaluated the reliability CTA for detection of acute PE in broad populations of patients spanning the inpatient, outpatient, and ED setting.

OBJECTIVE

To determine whether CTA, with and without the addition of computed tomographic venous-phase imaging (CTV), could reliably detect and rule out PE.

METHODS

Prospective, observation study across eight centers, between 2001 and 2003.

Participants

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