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Too Much of a Good Thing?

Jeffrey Glassroth, MD

JAMA. 2007;298(23):2788-2789.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The study by Anderson and colleagues¹ in this issue of JAMA convincingly demonstrates that computed tomographic pulmonary angiography (CTPA) is not inferior to ventilation-perfusion (/) lung scanning for the exclusion of pulmonary embolism (PE). Confirmation on this point is comforting because CTPA has had a wide range of sensitivities reported for detection of PE² but nevertheless has largely supplanted /scanning for several years for this purpose.³

This study is also notable for a number of additional reasons. First, the investigators' study design and management algorithms use D-dimer testing,⁴ structured pretest probability (of PE) assessment,⁵ and venous ultrasound of the lower extremities to identify deep venous thrombosis. In essence, the study represented a unique head-to-head comparison of / scanning and CTPA conducted in a manner that duplicated real-world best-practice conditions. Moreover, because this was a multicenter randomized study with a large number of participants, these . . . [Full Text of this Article]

Author Affiliations: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

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