[Наталья П.]

Ресурсы по диагностике ТЭЛА

Сообщение от yananshs

Результаты оригинального PIOPED опубликованы в JAMA: [Ссылки доступны только зарегистрированным пользователям ]

"The Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study (34), published in 1990, comprised 933 patients (randomly chosen from 1,493), 931 of whom had V/Q radionuclide lung scans and 755 of whom had pulmonary arteriograms obtained. Of these, 251 (33%) had PE. The likelihood of PE was related to V/Q radionuclide lung scan interpretation: 102 of 116 (88%) patients with high-probability scans had PE, 105 of 322 (33%) patients with intermediate-probability scans had PE, and 39 of 238 (16%) patients with low-probability scans had PE, but many patients with low-probability scans did not undergo arteriography and had no evidence of PE on follow-up. Therefore, approximately 12% of patients with radionuclide lung scans interpreted as low-probability for PE were considered to have had PE. The investigators concluded that (i) a high-probability scan usually indicates PE, but only a minority of patients with PE have high probability scans, (ii) a history of PE decreases the accuracy of diagnoses based on high-probability scans, (iii) a low-probability scan with strong clinical suspicion that PE is not likely makes PE a remote possibility, (iv) near-normal/normal radionuclide lung scans make the diagnosis of acute PE very unlikely (five of 131 [4%] in their series), (v) an intermediate-probability (indeterminate) scan is not of help in establishing a diagnosis, and (vi) that V/Q radionuclide lung scan combined with clinical assessment permitted noninvasive diagnosis or exclusion of acute PE for a minority of patients. "


Сейчас в связи с появлением спирального КТ и изменением стандартов диагностики идет, вернее завершается новое исследование [Ссылки доступны только зарегистрированным пользователям ]
" Multi-center study of patients with suspected pulmonary embolism (PE) in order to determine the sensitivity, specificity, positive predictive value, and negative predictive value of contrast enhanced spiral computed tomography (spiral CT) for the diagnosis of acute PE...Appropriate use of spiral CT in a diagnostic strategy could reduce or eliminate the need for more invasive tests such as ventilation/perfusion lung scans, compression ultrasound of the lower extremities, and digital subtraction angiography"
In a mean time:
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