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Non-invasive exclusion and diagnosis of pulmonary embolism by sequential use of the rapid ELISA D-dimer assay, clinical score and spiral CT.
Int Angiol. 2003 Mar; 22(1):1-14.IA

Abstract

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%.

Authors+Show Affiliations

Hemostasis Thrombosis Research, Department of Hematology, University Hospital, Antwerp, Belgium. postbus@goodheartcenter.demon.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

12771850

Citation

Michiels, J J., et al. "Non-invasive Exclusion and Diagnosis of Pulmonary Embolism By Sequential Use of the Rapid ELISA D-dimer Assay, Clinical Score and Spiral CT." International Angiology : a Journal of the International Union of Angiology, vol. 22, no. 1, 2003, pp. 1-14.
Michiels JJ, Schroyens W, De Backer W, et al. Non-invasive exclusion and diagnosis of pulmonary embolism by sequential use of the rapid ELISA D-dimer assay, clinical score and spiral CT. Int Angiol. 2003;22(1):1-14.
Michiels, J. J., Schroyens, W., De Backer, W., van der Planken, M., Hoogsteden, H., & Pattynama, P. M. (2003). Non-invasive exclusion and diagnosis of pulmonary embolism by sequential use of the rapid ELISA D-dimer assay, clinical score and spiral CT. International Angiology : a Journal of the International Union of Angiology, 22(1), 1-14.
Michiels JJ, et al. Non-invasive Exclusion and Diagnosis of Pulmonary Embolism By Sequential Use of the Rapid ELISA D-dimer Assay, Clinical Score and Spiral CT. Int Angiol. 2003;22(1):1-14. PubMed PMID: 12771850.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Non-invasive exclusion and diagnosis of pulmonary embolism by sequential use of the rapid ELISA D-dimer assay, clinical score and spiral CT. AU - Michiels,J J, AU - Schroyens,W, AU - De Backer,W, AU - van der Planken,M, AU - Hoogsteden,H, AU - Pattynama,P M T, PY - 2003/5/29/pubmed PY - 2003/11/1/medline PY - 2003/5/29/entrez SP - 1 EP - 14 JF - International angiology : a journal of the International Union of Angiology JO - Int Angiol VL - 22 IS - 1 N2 - 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%. SN - 0392-9590 UR - https://www.unboundmedicine.com/medline/citation/12771850/Non_invasive_exclusion_and_diagnosis_of_pulmonary_embolism_by_sequential_use_of_the_rapid_ELISA_D_dimer_assay_clinical_score_and_spiral_CT_ L2 - http://www.diseaseinfosearch.org/result/2504 DB - PRIME DP - Unbound Medicine ER -