Clinically Suspected Pulmonary Embolism: Utility of Spiral CT

PURPOSE: To prospectively determine the utility of contrast material–enhanced spiral computed tomography (CT) in the examination of patients clinically suspected of having pulmonary embolism (PE).

MATERIALS AND METHODS: One hundred ten patients clinically suspected of having PE were examined with contrast-enhanced spiral CT and at least one other imaging modality: ventilation-perfusion scintigraphy, Doppler ultrasonography of deep leg veins, or pulmonary angiography. Chart review or telephone contact with the referring clinician was used to evaluate the contribution of spiral CT to the final clinical diagnosis.

RESULTS: Spiral CT helped correctly identify 23 of 25 patients with PE (sensitivity, 92%). In 57 (67%) of the 85 patients without PE, spiral CT provided additional information that suggested or confirmed the alternate clinical diagnosis: pneumonia (n = 14), cardiovascular disease (n = 10), pulmonary fibrosis (n = 7), trauma (n = 6), malignancy (n = 5), pleural disease (n = 4), postoperative changes (n = 4), and other (n = 7). In the remaining 28 patients, spiral CT scans were normal (n = 12), failed to produce findings supportive of the final clinical diagnosis (n = 13), or were false-positive for PE (n = 3; specificity, 96%).

CONCLUSION: Spiral CT has good sensitivity and specificity for the diagnosis of PE. In the majority of patients who do not have PE, it also provides important ancillary information for the final diagnosis.


  • 1 Matsumoto AH, Tegtmeyer CJ. Contemporary diagnostic approaches to acute pulmonary emboli. Radiol Clin North Am 1995; 33: 167-183.
  • 2 Hull RD, Raskob GE, Carter CJ, et al. Pulmonary embolism in outpatients with pleuritic chest pain. Arch Intern Med 1988; 148: 838-844.
  • 3 Patil S, Henry JW, Rubenfire M, Stein PD. Neural network in the clinical diagnosis of acute pulmonary embolism. Chest 1993; 104: 1685-1689.
  • 4 Remy-Jardin M, Remy J, Wattinne L, Giraud F. Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the single-breath-hold technique—comparison with pulmonary angiography. Radiology 1992; 185: 381-387.
  • 5 Remy-Jardin M, Remy J, Deschildre F, et al. Diagnosis of pulmonary embolism with spiral CT: comparison with pulmonary angiography and scintigraphy. Radiology 1996; 200: 699-706.
  • 6 Goodman LR, Curtin JJ, Mewissen MW, et al. Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: helical CT versus angiography. AJR 1995; 164: 1369-1374.
  • 7 Van Rossum AB, Pattynama PMT, Tjin A, et al. Pulmonary embolism: validation of spiral CT angiography in 149 patients. Radiology 1996; 201: 467-470.
  • 8 Hansell DM, Padley SPG. Continuous volume computed tomography in pulmonary embolism: the answer or just another test? (editorial). Thorax 1996; 51: 1-2.
  • 9 Mayo JR, Remy-Jardin M, Müller NL, et al. Pulmonary embolism: prospective comparison of spiral CT with ventilation-perfusion scintigraphy. Radiology 1997; 205: 447-452.
  • 10 Goodman LR, Lipchik RJ. Diagnosis of acute pulmonary embolism: time for a new approach (editorial). Radiology 1996; 199: 25-27.
  • 11 The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism: results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). JAMA 1990; 263: 2753-2759.
  • 12 Worsley DF, Alavi A. Comprehensive analysis of the results of the PIOPED study. J Nucl Med 1995; 36: 2380-2387.

Article History

Accepted: Oct 14 1998
Received: Mar 24 1998
Revision received: June 16 1998
Revision received: July 31 1998
Published in print: Mar 1999