修正Geneva量表及D-二聚体对慢性阻塞性肺疾病急性加重合并肺血栓栓塞症的预测价值

目的评价修正Geneva量表结合D-二聚体在诊断慢性阻塞性肺疾病急性加重期（AECOPD）合并肺血栓栓塞症（PTE）中的诊断价值。方法收集2011年1月至2013年5月于我院急诊及住院的AECOPD疑似合并PTE的210例患者进行前瞻性研究,对患者临床资料,并分别以修正Geneva量表、D-二聚体测定以及两者结合评估合并肺栓塞的可能性,并与最终确诊的诊断结果进行分析比较。结果其中41例患者确诊PTE。AECOPD＋PTE组与单纯AECOPD组在症状、体征上仅不对称下肢水肿有统计学差异。D-二聚体〈500μg／L的阴性预测值为96．1％,而阳性预测值仅34．3％,特异度58．0％灵敏度90．2％。修正Geneva量表可能性高组阳性预测值为64．0％,可能性低组阴性预测值为94．7％;两者结合的阳性预测率为42．5％,阴性预测值96．9％。结论修正Geneva量表和血浆D-二聚体测对慢性阻塞性肺疾病急性加重期合并肺栓塞早期筛选具有价值,两种方法结合可以提高诊断的准确性,降低漏诊率。     

快速D-二聚体检测对急性冠状动脉综合征的早期诊断价值

目的:评价快速D-二聚体检测对急性冠状动脉综合征(ACS)的早期诊断价值.方法:急诊胸痛患者按最终诊断分为ACS组、大血管疾病组(包括急性主动脉夹层、肺栓塞等)和非心源性胸痛组.在对这3类胸痛患者D-二聚体测定的基础上,绘制ROC曲线找出区分ACS、大血管疾病和非心源性胸痛患者的D-二聚体取值的最佳点.ACS组按发病后就诊时间分组,同时检测肌钙蛋白,比较两者的诊断准确性和在不同时间段的敏感性.结果:当D-二聚体取值>0.75 mg/L时,诊断ACS的敏感性是68%,特异性是60%,阳性预测值是54%,阴性预测值是73%.当D-二聚体取值>3.5 mg/L时,诊断大血管疾病的敏感性是87%,特异性是99%,阳性预测值是93%,阴性预测值是99%.当D-二聚体取值>3.5 mg/L时,区分ACS和大血管疾病的敏感性是87%,特异性是98%,阳性预测值是93%,阴性预测值是97%.在ACS发生2 h内,血浆D-二聚体较肌钙蛋白敏感性高,两者比较差异有统计学意义.结论:D-二聚体有望成为一个更有用的筛查ACS患者的指标.     

疑似肺栓塞患者肾功能损伤对D-二聚体水平的影响

目的:探讨肾功能损伤对疑似肺栓塞患者D-二聚体水平及其诊断价值的影响。方法:回顾性收集2013年1月至2013年12月,北京安贞医院住院且Wells评分为低-中度疑似肺栓塞的患者664例。通过肺血管造影计算机断层显像和/或核素肺通气-灌注扫描明确其是否存在肺栓塞。将患者分为肾功能正常组(GFR>90m L/分钟)、肾功能轻度受损组(GFR 60~89m L/分钟)和肾功能中度受损组(GFR 30~59m L/分钟)。应用多种统计学指标,包括D-二聚体阴性排除肺栓塞诊断的敏感性、特异性及每排除一例患者需要进行D-二聚体检测的例数(NNT),评价D-二聚体检测筛查肺栓塞的诊断价值。结果:D-二聚体水平随肾功能受损程度的增加而升高。以年龄调整界值为标准,在肾功能正常组、轻度受损组和中度受损组D-二聚体阴性比例分别为65.4%、51.2%和29.9%,差异有统计学意义(P<0.001);D-二聚体阴性排除肺栓塞的敏感性为93.8%~100%,而其特异性分别为70.5%,52%和39%;每排除一例肺栓塞患者需要进行D-二聚体检测的例数分别为3、3.6和4.8。结论:在疑似肺栓塞患者中,肾功能损害可导致D-二聚体水平显著升高,从而使得D-二聚体对肺栓塞的诊断效率显著下降。     

D-二聚体阴性的肺栓塞诊断探讨

目的 探讨血浆D-二聚体（DD）含量检测对肺栓塞（PE）的诊断价值.方法 69例第一诊断为肺栓塞的患者,测定入院时第一次采血的D-二聚体,其中D-二聚体阴性9例,阳性60例,对D-二聚体阴性及阳性的两组患者进行临床资料对比观察.结果 9例D-二聚体阴性肺栓塞患者的D-二聚体含量为（0.9±0.4）μg/ml,阴性率为13％（9/69）;D-二聚体阳性肺栓塞患者的D-二聚体含量为（16.5±14.2）μg/ml,阳性率为87％（60/69）.D-二聚体阴性与阳性两组之间在D-二聚体含量、发病时间及血栓栓塞部位等方面比较差异有统计学意义（P＜0.01）;而性别、年龄、肺动脉压、下肢静脉曲张及血栓形成等各指标比较差异无统计学意义（P＞0.05）.结论 血浆D-二聚体阴性并非100％排除肺栓塞,临床对高度怀疑肺栓塞的患者,不要只关注D-二聚体水平,还要进行肺动脉相关检查.     

D-二聚体在急性肺栓塞快速临床诊断中的价值

目的探讨血浆D-二聚体、下肢深静脉血栓在急性肺栓塞(acute pulmonary embolism,APE)快速临床诊断中的价值。方法回顾性分析疑诊为APE的178例患者的计算机(X线)断层摄影扫描肺血管造影或右心导管选择性肺动脉造影的临床资料、血浆D-二聚体浓度及下肢深静脉彩色多普勒检查结果。结果 APE患者血浆D-二聚体浓度阳性者59例(96.72%,59/61),非APE患者阳性32例(27.4%,32/117),两者比较差异有统计学意义(P0.05)。APE患者经彩色多普勒超声检查发现下肢深静脉血栓形成(deep venous thrombosis,DVT)50例(82.0%,50/61),非APE患者DVT 6例(5.0%,6/117),两组比较差异有统计学意义(P0.05)。48例(78.7%,48/61)APE患者血浆D-二聚体浓度阳性合并DVT,两项指标同为阳性时诊断APE的特异性99.1%,阳性预测值98.0%。血浆D-二聚体浓度阳性诊断APE的敏感性96.7%,特异性72.6%,阳性似然比3.54,阴性似然比0.04,阳性预测值64.8%,阴性预测值97.7%。结论血浆D-二聚体、下肢深静脉彩色多普勒检查值得作为常规方法为快速诊断及治疗APE提供依据。     

临床评分、D-二聚体检测对急性肺栓塞的诊断价值

目的探讨临床评分、D-二聚体对急性肺栓塞的诊断价值。方法以CT肺动脉血管造影作为诊断急性肺栓塞的＂金标准＂,应用受试者工作特征（ROC）曲线及诊断试验常见评价指标,评价Wells评分、改良Geneva评分、D-二聚体检测以及这两种临床评分方法与D-二聚体检测相结合对急性肺栓塞的诊断价值。结果共102例患者确诊为急性肺栓塞,Wells评分、改良Geneva评分高度可能的阳性预测值分别为90.2%、100%,低度可能的阴性预测值分别为84.2%、88.1%,且Wells评分、改良Geneva评分低度可能与血浆D-二聚体阴性结合可进一步提高阴性预测值,分别为95.1%和97.3%。临床评分和D-二聚体的ROC曲线下面积分别为：Wells评分为0.817,改良Geneva评分为0.850,D-二聚检测为0.773,除改良Geneva评分和D-二聚体检测ROC曲线下面积有统计学差异外（Z=2.369,P=0.018）,其余两两间均无统计学差异。结论 Wells评分、改良Geneva评分可以对急性肺栓塞作出较为准确的预测,两者之间的预测价值相似。Wells评分、改良Geneva评分结合血浆D-二聚体检测是一种安全且实用的管理肺栓塞疑似患者的诊断策略。     

血浆D-二聚体和血气分析测定在肺栓塞中的临床价值

目的回顾急性肺栓塞时动脉血气指标Pa O2和血浆D-二聚体的变化,探讨动脉血气指标Pa O2联合血浆D-二聚体测定对急性肺栓塞诊断价值。方法回顾性分析14例急性肺栓塞患者的性别、年龄、高危因素、临床表现,与对照组对照血浆D-二聚体值、动脉血气分析测定结果。结果临床表现为胸痛8例,咯血4例,血压降低3例,咳嗽12例,心悸3例,紫绀2例,单侧下肢水肿2例。肺栓塞组血浆中D-二聚体明显高于对照组,动脉血气分析Pa O2明显低于对照组。肺栓塞组患者中血浆D-二聚体和Pa O2分别检测与血浆D-二聚体和Pa O2联合检测的灵敏度比较,联合检测的灵敏度明显增高。结论血浆D-二聚体和Pa O2联合检测可以提高肺栓塞诊断的灵敏度,对肺栓塞的诊断和有重要意义。     

血浆D-二聚体在急性主动脉夹层诊断中的价值

目的探讨血浆D-二聚体在急性主动脉夹层诊断中的价值。方法回顾分析2005年1月至2011年10月在我院确诊的69例急性主动脉夹层患者（简称主动脉夹层组）、同期70例急性肺栓塞患者（肺栓塞组）和70例因胸痛住院的其他患者（胸痛组）的血浆D-二聚体等临床资料,比较D-二聚体在不同类型患者中的水平差异,分析D-二聚体水平与急性主动脉夹层预后的关系。结果所有急性主动脉夹层患者D-二聚体均超过500μg／L,敏感性100％;死亡患者血浆D-二聚体浓度高于存活患者（P〈0．05）。血浆D-二聚体浓度主动脉夹层组、肺栓塞组和胸痛组分别为（3479．2±2200．0）μg／L、（1560．7±940．0）μg／L和（179．8±167．0）txg／L,三组比较P〈0．01,每两组比较P〈0．05。结论急性主动脉夹层患者血浆D-二聚体明显升高,其平均浓度超过急性肺栓塞患者。D-二聚体阴性有助于排除急性主动脉夹层的诊断;D二聚体升高对判断预后有-定的指导价值。     

临床评分和D-二聚体检查在下肢深静脉血栓中的应用

目的 评价临床Wells评分和(或)D-二聚体检查能否安全、可靠地排除或诊断下肢深静脉血栓(DVT).方法 回顾性收集两家医院疑诊DVT的住院患者,所有患者均在48 h内进行临床评价、D-二聚体检查和双侧下肢静脉加压超声检查.比较单独应用临床评分或D-二聚体检查,以及临床评分结合D-二聚体检查诊断DVT的敏感性、特异性、阳性预测值和阴性预测值.描述性资料采用频数分析,组间比较采用卡方检验,以P<0.05为差异有统计学意义.结果 共有274例患者纳入研究.以低度可能性为阴性结果,中、高度可能性为阳性结果,临床Wells评分诊断DVT的敏感性、特异性、阳性预测值和阴性预测值分别为78.4%、66.1%、52.3%和86.6%;以D-二聚体≥500μg/L为阳性结果,D-二聚体检查诊断DVT的敏感性、特异性、阳性预测值和阴性预测值分别为73.9%、66.1%、50.8%和84.2%;以低度可能性同时D-二聚体<500μg/L为阴性结果,中、高度可能性同时D-二聚体≥500μg/L为阳性结果,临床Wells评分结合D-二聚体检查诊断DVT的敏感性、特异性、阳性预测值和阴性预测值分别为88.3%、76.8%、67.1%和92.5%.结论 针对临床疑诊DVT的患者,单独应用临床Wells评分或D-二聚体检查,以诊断或排除DVT是不准确的;联合应用临床Wells评分和D-二聚体检查,才能对患者是否患有DVT作出较为准确的判断.     

多种检测措施在肺栓塞中的诊断价值

目的探讨多种检测方法在肺栓塞中的诊断价值。方法 110例疑为肺栓塞者行肺动脉血管照影(CTA),分析CTA联合血清D-二聚体的诊断价值,并根据D-二聚体和CRP水平分为高危组和低危组。结果依据临床标准,46例确诊肺栓塞;依据CTA确诊41例,另17例为非确定诊断,其诊断的灵敏性和特异性分别为89.13%和81.25%,当以血清D-二聚体500 mg/L为临界值,17例非确定诊断中有8例被确诊为阴性,两者联合使诊断的特异性提高至93.75%。高危组肺梗死占10.52%,心肌损伤26.32%,与低危组比差异有统计学意义(P0.05)。结论血清D-二聚体可辅助确诊CTA中的不确定性诊断病例,从而提高诊断特异性和判断预后。     

The rehabilitation of clinical assessment for the diagnosis of pulmonary embolism

Pulmonary angiography is the gold standard for diagnosis of segmental pulmonary embolism, but no longer for subsegmental pulmonary embolism because the inter-observer agreement for angiographically documented subsegmental pulmonary embolism is only 60%. A normal rapid ELISA VIDAS D-dimer test result and a normal perfusion scan exclude pulmonary embolism with a negative predictive value of >99%, irrespective of clinical score. The positive predictive value for pulmonary embolism of a high probability VP-scan compared to pulmonary angiography is 87% indicating that 13% of patients with a high probability VP-scan do not have pulmonary embolism. The combination of a negative CUS, a low clinical score, and a non-diagnostic VP-scan safely excludes pulmonary embolism. Patients with a non-diagnostic VP-scan, a negative CUS, but a moderate to high clinical score are candidates for pulmonary angiography. The positive predictive value of helical spiral CT is >95 to 99%. The combination of a negative CUS, a low clinical score, and the presence of a clear alternative diagnosis is predicted to safely exclude pulmonary embolism. Helical spiral CT detects all clinical relevant pulmonary emboli and a large number of alternative diagnoses in symptomatic patients with a non-diagnostic or a high-probability VP-scan. The negative predictive value during 3 months followup after a negative spiral CT for pulmonary embolism in 4 retrospective studies and 1 prospective management study was >99%. Only a small group of patients (1-2%) with a non-diagnostic spiral CT are candidates for pulmonary angiography. Therefore, it is predicted that the spiral CT will replace both VP-scanning and pulmonary angiography to safely exclude or diagnose pulmonary emboli in patients with suspected pulmonary embolism.     

Non-invasive exclusion and diagnosis of pulmonary embolism by sequential use of the rapid ELISA D-dimer assay, clinical score and spiral CT.

Pulmonary angiography is the gold standard for segmental pulmonary embolism (PE) but no longer for its subsegmental PE, because the inter-observer agreement for angiographically documented subsegmental PE is only 60%. Two non-invasive tools exclude PE with a negative predictive value of > 99%: a normal perfusion lung scan and a normal rapid ELISA VIDAS D-dimer test. The positive predictive value of a high probability ventilation-perfusion lung scan (VP-scan) is only 85% to 87%. The combination of a low clinical score and a non-diagnostic VP-scan safely exclude PE without the need of angiography. The prevalence of PE and that of an alternative diagnosis in symptomatic patients with a non-diagnostic VP-scan are 10% to 20% and 30% to 45%, respectively. Helical spiral computed tomography (CT) detects all clinically relevant PE and a large number of alternative diagnoses in symptomatic patients with a non-diagnostic or high probability VP-scan. The positive predictive value of the spiral CT is > 95%. Single-slice helical CT as the primary diagnostic test in patients with suspected PE in retrospective outcome studies and in prospective multicenter management studies indicate that the negative predictive value of a negative spiral CT preceded or followed by a negative compression ultrasonography (CUS) is > 99%. Therefore, a helical spiral CT can replace both the VP-scan and pulmonary angiography to safely rule in and out PE. A negative rapid ELISA VIDAS D-dimer test result will reduce the need for helical spiral CT by 25% to 35%.     

Value of the association of D-dimer measurement and the evaluation of clinical probability in a non-invasive diagnostic strategy of pulmonary embolism

New diagnostic tools in suspected pulmonary embolism complete the classical diagnostic strategy of pulmonary scintigraphy and pulmonary angiography to limit the indications of these two invasive investigations. In a prospective series of 204 consecutive patients with suspected pulmonary embolism the association of D-dimer measurement and clinical probability was assessed for the exclusion of the diagnosis of pulmonary embolism. The D-DI Liatest is a new generation, unitary, rapid and quantitative latex test with a comparative diagnostic performance to that of the reference ELISA test, and well adapted to emergency situations.The clinical probability was assessed by a quantitative score based on past history, clinical symptoms and signs. The positive diagnosis of pulmonary embolism was made by spiral CT scanner and/or pulmonary angiography, associated with Duplex ultrasonography of the leg veins in nondiagnostic results. The prevalence of pulmonary embolism was 42.6% and the absence of anticoagulation in patients considered not to have pulmonary embolism was associated with a thrombo-embolic incidence of 0.9% at 3 months. Fifty-six patients had D-dimer concentrations equal or inferior to the threshold of 500 microg/L; the sensitivity was 99% and the specificity 47% with a negative predictive value of 98% to 100% in cases with a low clinical probability. D-dimer measurement is reliable and has a high cost-benefit value in ambulatory patients with suspected of pulmonary embolism and is even more valuable when the clinical probability of this diagnosis is low.     

心电图与D-二聚体在急性肺栓塞患者的诊断价值

目的探讨心电图与D-二聚体在急性肺栓塞患者的诊断价值。方法选择在我院接受诊治的经肺动脉血管造影检查确诊为急性肺栓塞患者58例作为研究对象,另外选取同期在我院治疗的经X线及细菌学检查确诊为慢性支气管炎患者53例作为对照组,所有患者均接受心电图、D-二聚体诊断,探讨心电图、D-二聚体对急性肺栓塞患者诊断价值。结果心电图检测对急性肺栓塞患者检测阳性率为93.10%,显著高于对慢性支气管炎检测阳性率(P0.05);D-二聚体检测对急性肺栓塞患者检测阳性率为89.66%,显著高于对慢性支气管炎检测阳性率(P0.05)。结论心电图与D-二聚体在急性肺栓塞诊断中均具有重要的诊断价值。     

A comparison of three rapid D-dimer methods for the diagnosis of venous thromboembolism

We compared three rapid D-dimer methods for the diagnosis of venous thromboembolism. Patients presenting to four teaching hospitals with the possible diagnosis of deep vein thrombosis or pulmonary embolism were investigated with a combination of clinical likelihood, D-dimer (SimpliRED) and initial non-invasive testing. Patients were assigned as being positive or negative for deep vein thrombosis or pulmonary embolism based on their three-month outcome and initial test results. The three D-dimer methods compared were: (a) Accuclot D-dimer (b) IL-Test D-dimer (c) SimpliRED D-dimer. Of 993 patients, 141 had objectively confirmed deep vein thrombosis or pulmonary embolism. The sensitivity of SimpliRED, Accuclot and IL-Test were 79, 90 and 87% respectively. All three D-dimer tests gave similar negative predictive values. The SimpliRED D-dimer was found to be less sensitive than the Accuclot or IL-Test. When combined with pre-test probability all three methods are probably acceptable for use in the diagnosis of venous thromboembolism.     

A critical appraisal of non-invasive diagnosis and exclusion of deep vein thrombosis and pulmonary embolism in outpatients with suspected deep vein thrombosis or pulmonary embolism: how many tests do we need?

The requirement for a safe diagnostic strategy should be based on an overall posttest incidence of venous thromboembolism of less than 1% during 3 month follow-up. Compression ultrasonography (CUS) has a negative predictive value (NPV) of 97% to 98% indicating the need of repeated CUS testing. Serial CUS testing is safe but you have to repeat 100 CUS to find 1 or 2 CUS positive for deep vein thrombosis (DVT), which is not cost-effective indicating the need to improve the diagnostic work-up of DVT by the use of clinical score assessment and D-dimer testing. The combination of a less sensitive D-dimer test (SimpliRed) and low clinical score does not, whereas the combination of a sensitive D-dimer test (ELISA VIDAS or Tinaquant) and low clinical score does safely exclude DVT without the need of CUS. The combination of a first negative CUS and a negative less sensitive D-dimer test (SimpliRed) or a sensitive ELISA D-dimer at a higher cut off level of 1,000 ng/ml safely excludes DVT with a NPV of > 99% without the need to repeated CUS in about 60%. The sequential use of a sensitive D-dimer and clinical score assessment will safely reduce the need for CUS testing by 40% to 60%. Large prospective outcome studies demonstrate that one negative examination with complete duplex color ultrasonography (CCUS) of the proximal and distal veins of the affected leg with suspected DVT is safe to withhold anticoagulant treatment with a NPV of 99.5%. This indicates that CCUS is equal or superior to serial CUS or the combined use of clinical score, D-dimer testing and CUS. Pulmonary angiography is the gold standard for segmental pulmonary embolism (PE) but not for subsegmental PE. A normal perfusion lung scan and a normal rapid ELISA VIDAS D-dimer test safely exclude PE. Helical spiral CT detects all clinically relevant PE and a large number of alternative diagnoses in symptomatic patients with a non-diagnostic ventilation perfusion scan (VP-scan) or a high probability VP-scan. Single-slice helical CT as the primary diagnostic test in patients with suspected PE in 5 retrospective studies and in 3 prospective management studies indicate that the NPV of a normal helical spiral CT, a negative CUS of the legs together with a low or intermediate pretest clinical probability is 99%. Helical spiral CT can replace both the VP-scan and pulmonary angiography to safely rule in and out PE. The combination of clinical assessment, a rapid ELISA VIDAS D-dimer followed by CUS will reduce the need for helical spiral CT by 40% to 50%.     

The role of plasma D-dimer concentration in the exclusion of pulmonary embolism

Objective . To determine the role of four ELISA D-dimer assays in the exclusion of pulmonary embolism.
Design . Blinded comparison using pulmonary angiography and/or lung scintigraphy as a reference method.
Setting . A secondary and tertiary referral centre.
Patients and methods . Consecutive patients with suspected pulmonary embolism underwent lung scintigraphy, followed by angiography if a non-diagnostic result was obtained. Comorbid conditions resulting in elevated plasma D-dimer levels were defined a priori . Cut-off levels for 100% sensitivity were determined. A decision-analytic model was used to determine effectiveness and costs in the management pulmonary embolism.
Main outcome measures . The exclusion efficacy of the various assays at a sensitivity of 100%, and cost-effectiveness.
Results . A total of 179 patients were included (78 inpatients and 101 outpatients; 74 patients had comorbid conditions). Pulmonary embolism could be adequately excluded in between 8% and 18% of all patients, and in between 3% and 7% and 11% and 27% of inpatients and outpatients, respectively, depending on the assay used. D-dimer assays could exclude pulmonary embolism in <5% of patients with comorbid conditions, whereas this increased to 14–32% in outpatients without comorbid conditions. A cost-effectiveness analysis showed a cost reduction of 10% at a specificity of 30%, largely due to a 28% decrease in angiography requirements. Furthermore, for every 2% decrease in sensitivity, one per 1000 evaluated patients would die as a result of inadequately treated pulmonary embolism.
Conclusion . D-dimer ELISA assays may have a role in the exclusion of pulmonary embolism in symptomatic outpatients, where the application may reduce angiography by 30% and costs by 10%.     

The value of four-detector row spiral computed tomography for the diagnosis of pulmonary embolism

Although spiral computed tomography (CT) is being used increasingly as the first-line imaging procedure in the diagnostic workup of patients with clinically suspected pulmonary embolism (PE), the diagnostic value of negative findings, at least when using the four-detector row scanners, is still controversial. A total of 702 consecutive patients with clinical symptoms suggestive of PE underwent four-slice CT. Patients with negative findings received the determination of D-dimer. Those with positive D-dimer underwent further diagnostic workup to confirm or rule out the diagnosis of PE. Those with negative D-dimer were followed-up to 6 months to detect the development of symptomatic venous thromboembolism (VTE). The CT test was interpreted as negative in 536 patients (76.3%). These patients had the D-dimer determination, which was positive in 279 and negative in the remaining 257 patients. Of the former, PE subsequently was documented in 55 patients (19.7%). Of the latter, symptomatic VTE in the follow-up period developed in three patients (1.17%; 95% confidence interval, 0.24 to 3.38%). In conclusion, when using the four-detector row, the negative predictive value of CT findings in patients with clinically suspected PE and positive D-dimer is low. In contrast, it is safe to withhold anticoagulation from patients with negative findings and negative D-dimer.     

Plasma D-dimer in suspected pulmonary embolism: a comparison with pulmonary angiography and ventilation--perfusion scintigraphy

The diagnosis of pulmonary embolism remains a difficult issue. In a previous study of patients submitted to ventilation--perfusion (V-P) scintigraphy we suggested that measurement of D-dimer might be of value for ruling out the diagnosis of pulmonary embolism if the plasma level was less than 500 micrograms/l (ELISA). In the present paper, this cut-off was validated in a consecutive series of 21 patients who were submitted to pulmonary angiography. Sensitivity and specificity were 100% and 36%, respectively. When these data were pooled with the results obtained following V-P scintigraphy (total number of patients = 67), sensitivity, specificity, and positive and negative predictive values were 100%, 70%, 59% and 100%, respectively. It is therefore worthwhile to further evaluate the value of the plasma measurement of D-dimers, especially in patients with inconclusive lung scintigraphy.