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To the Editor: In their randomized trial, Dr Anderson and colleagues¹ investigated computed tomographic pulmonary angiography (CTPA) vs ventilation-perfusion (/) lung scanning in patients with suspected pulmonary embolism. They dichotomized the Wells score into pulmonary embolism likely vs unlikely. Because of the characteristics of / scanning, however, they still had to allocate a nondiagnostic (nonhigh probability) category. In their algorithm, patients in this category were excluded for pulmonary embolism if repeat leg vein ultrasonography was negative in 1 week, even with a likely clinical probability and a positive D-dimer.

In the PIOPED II (Prospective Investigation of Pulmonary Embolism Diagnosis II) study,² patients with a high clinical risk (Wells score >6), even with a negative CTPA in addition to a negative computed tomographic venogram, had a false-negative rate of 17%. Considering the excellent sensitivity and specificity of CTPA with computed tomographic venogram in PIOPED II (90% and 95%, respectively) . . . [Full Text of this Article]

Muhammad Ayaz Mir, MBBS
mmir@buffalo.edu
Division of Hematology
Department of Medicine
State University of New York at Buffalo

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