Combined CT venography of the lower limbs and spiral CT angiography of pulmonary arteries in acute pulmonary embolism: preliminary results of a prospective study.

PURPOSE: To determine the clinical accuracy of combined CT venography (CTV) and spiral CT angiography (SCTA) in patients suspicious of acute pulmonary thrombo-embolism.

MATERIALS AND METHODS: 278 consecutive patients referred for SCTA for suspicion of acute pulmonary embolism (APE) underwent subsequent evaluation of the veins of the lower limbs and abdomen (CTV) within one examination without additional injection of contrast medium. Sixty-nine patients had no further study. Two hundred and nine patients were included in the study, 199 had US and 51 phlebography (PG) within 48 hours from SCTA-CTV. The investigators were blinded to the results of CT. When results of CTV and US were discordant, phlebography was indicated.

RESULTS: SCTA was positive in 89 patients, negative in 119 and indeterminate in 1. CTV was positive in 99 patients, negative in 103 and indeterminate in 7. US was positive in 87 patients, negative in 97 and indeterminate in 15. PG was positive in 21 patients, negative in 29 and indeterminate in 1. Excellent correlation was found between CTV and US (k = 0.84) and moderate correlation between CTV and PG, and US and PG (k = 0.53).

CONCLUSIONS: Combined SCTA and CTV is a rapid and accurate one-session examination in patients suspicious of acute pulmonary thrombo-embolism.