An important trial will appears in the Journal of the American Medical Association (JAMA) of a prospective randomized trial comparing CT pulmonary angiography (CTPA) to V/Q (ventillation/perfusion) scans to exclude pulmonary embolus. CT scans were not found to be inferior to V/Q scans at detecting pulmonary emboli and were actually found to be more sensitive at detecting emboli. The authors concluded that further research would be required to determine whether all pulmonary emboli detected by CTPA should be managed with anticoagulant therapy.
Given the speed and convenience of CT scanners coupled with avoidance of receiving "indeterminant" V/Q scan results, CT scans are likely to preempt V/Q scans in the diagnosis of pulmonary embolus in many patients (with the exception of patients with renal insufficiency in whom iodinated contrast agents might prove dangerous).
Dr. Wes, due to the high radiation doses associated with intravenous contrast, and especially the CT P/E protocol, our local radiologists still prefer to do PE rule outs of young females of child bearing age with V/Q scans.
I don't blame them.
For everyone else, it's always been CT for me (except in those with kidney issues, as you point out)
Great point, Happy Hospitalist.
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