• Jose Pamies Guilabert, Dolores Nauffal Manzur, Maria J Torres Tarrasa, Maximiliano Lloret Llorens, Petra Braun, and Maria P Bello Arques.
• Department of Diagnostic Imaging, Hospital Universitario La Fe, Spain. pamies_jos@gva.es
• Eur J Radiol. 2007 May 1; 62 (2): 220-6.

PurposeTo evaluate the safety of withholding anticoagulation in patients with suspected acute pulmonary embolism after negative multislice computed tomography (MSCT) pulmonary angiography and lower-limb venography.Materials And MethodsA total of 383 consecutive patients with suspected acute pulmonary embolism were prospectively studied. Patients underwent MSCT pulmonary angiography and lower-limb venography, as well as pulmonary scintigraphy and lower-limb ultrasound examination. Patients with negative MSCT results for both pulmonary embolism and venous thrombosis were not administered anticoagulants and were followed up for 6 months to rule out thromboembolism.ResultsAt MSCT, 156 patients were positive for pulmonary embolism, venous thrombosis, or both; 224 were negative; and findings were inconclusive in three. False-negatives were five patients with high probability scintigram and two with venous thrombosis detected at US. A total of 184 patients with negative MSCT and without anticoagulation were followed up for 6 months. During this period of time just one recurrence of pulmonary embolism was detected. The negative predictive value of MSCT pulmonary angiography plus lower-limb venography was 95.8% (183/191).ConclusionMSCT is efficacious in diagnosing pulmonary embolism, with negative predictive values reported in the literature ranging from 94% to 100%. This enables omission of anticoagulation in patients with suspected pulmonary embolism after negative MSCT findings without the need for other diagnostic tests.

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