Pulmonary embolism at multi-detector row CT of chest: one-year survival of treated and untreated patients.

Engelke, C; Rummeny, EJ; Marten, K

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journal article

Title:: Pulmonary embolism at multi-detector row CT of chest: one-year survival of treated and untreated patients.
Document type:: journal article
Author(s):: Engelke, C; Rummeny, EJ; Marten, K
Abstract:: PURPOSE: To retrospectively assess outcome in patients with clinically unsuspected pulmonary embolism (PE) at chest multi-detector row computed tomography (CT). MATERIALS AND METHODS: Institutional review board approval and informed consent were not required. PE was assessed in consecutive CT scans in 1966 patients (mean age, 60 years; range, 15-96 years; male-female ratio, 1.79) and graded with severity score. Studies with true-positive and false-negative radiologic diagnoses were determined. Coexisting morbidity, anticoagulant therapy (ACT), complications, and 1-year outcome were reviewed. Statistical evaluation included Mann-Whitney U test, chi(2) test, Poisson regression, and Kaplan-Meier statistics. RESULTS: Scans were PE positive in 117 patients. Clinical data review was complete in 96 patients; 63 of 96 patients had malignancy; in 58, PE was not suspected. In 38 of these 58 patients, radiology report findings were false-negative (mean severity score, 20.21 +/- 17.88 [standard deviation] and 9.55 +/- 7.12 for those with true-positive and false-negative findings, respectively; P = .012). Forty-nine patients received therapeutic ACT; 21, prophylactic ACT; and 26, no treatment. PE severity was higher in patients with therapeutic ACT versus those without (P< .001). Bleeding complications were more frequent with therapeutic ACT (two early deaths, five major nonfatal hemorrhages) than without (one minor hemorrhage; P = .037). There were eight early deaths (therapeutic ACT, seven; without ACT, one; P = .037). Positive predictors of early death included severity score>28, use of systemic thrombolytic therapy, occurrence of major hemorrhage, and new-onset cardiac or renal failure (P = .001-.043). Negative predictors were report with false-negative findings and no therapeutic ACT (P = .007-.037). Predictors of late death (n = 25) were older age, malignancy, and renal failure (P = .001-.043). CONCLUSION: Clinically unsuspected PE may remain undetected at routine chest CT; these patients have favorable short-term outcome without therapeutic ACT.
Journal title abbreviation:: Radiology
Year:: 2006
Journal volume:: 239
Journal issue:: 2
Pages contribution:: 563-75
Language:: eng
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/16569782
Print-ISSN:: 0033-8419
TUM Institution:: Institut für Radiologie
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Institut für Diagnostische und Interventionelle Radiologie (Prof. Makowski)Institut für Radiologie und Nuklearmedizin 2006

mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Ehemalige Einrichtungen Lehrstuhl für Röntgendiagnostik (Prof. Rummeny)