Comparison of Biello, McNeil, and PIOPED criteria for the diagnosis of pulmonary emboli on lung scans

The McNeil, Biello, and newly proposed PIOPED (from the National Institutes of Health-sponsored study, Prospective Investigation of Pulmonary Embolism Detection) interpretive methods for detection of pulmonary embolism on lung scans were compared in 96 patients who also underwent pulmonary angiography. Segmental findings on ^99mTc perfusion and aerosol ventilation scans, chest radiographs, and pulmonary angiograms obtained within 48 hr of each other were encoded along with other information into a data base to facilitate analysis. The McNeil, Biello, and PIOPED criteria were applied to the encoded data. Although the PIOPED set of criteria yielded the most favorable likelihood ratio for predicting an angiogram showing pulmonary emboli and a favorable likelihood ratio for predicting an angiogram not showing pulmonary emboli, it had the highest number of indeterminate studies. The McNeil criteria demonstrated the least favorable likelihood for predicting pulmonary emboli on an angiogram. The Biello and McNeil criteria showed the most favorable likelihood ratio for predicting an angiogram not showing pulmonary emboli. Analysis of receiver-operating-characteristic (ROC) curves yielded the greatest area under the ROC curve for the Biello criteria, but there were no statistically significant differences among the three sets of criteria. This study suggests that the Biello scheme represents the best compromise of the sets of criteria studied.