Non-Invasive Diagnosis of Pulmonary Embolism,Anno 2005 |
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Authors: | J J Michiels H Hoogsteden P M T Pattynama |
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Institution: | 1. Goodheart Institute and Foundation, Hemostasis Thrombosis and Vascular Research, Goodheart Institute, Erasmus Medical Center, Rotterdam, The Netherlands.;2. Rotterdam, Departments of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, The Netherlands.;3. Rotterdam, Radiology, Erasmus Medical Center, Rotterdam, The Netherlands. |
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Abstract: | Pulmonary angiography is the gold standard for segmental pulmonary embolism (PE) but no longer for sub-segmental 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 is 85 to 88% for a high probability ventilation-perfusion lung scan (VP-scan) and > 95% for helical spiral CT. The prevalence of PE in management studies of symptomatic patients with a non-diagnostic VP-scan is 20 to 24%. Helical spiral CT detects all clinically relevant PE and a large number of alternative diagnoses in symptomatic patients with a non-diagnostic VP-scan or a high probability VP-scan. Single-slice helical CT as the primary diagnostic test in patients with suspected PE in three retrospective studies and in two prospective management study indicate that the negative predictive value of a normal helical spiral CT, a negative compression ultrasonography of the legs (CUS) together with a low or intermediate pre-test clinical probability is > 99%. Therefore, 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%. |
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Keywords: | Pulmonary embolism deep vein thrombosis venous thromboembolism ventilation perfusion scan spiral CT ELISA D-dimer clinical score assessment |
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