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Non-invasive diagnosis of pulmonary embolism, anno 2005.
Acta Chir Belg. 2005 Feb; 105(1):26-34.AC

Abstract

Pulmonary angiography is the gold standard for segmental pulmonary embolism (PE) but no longer for 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 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%.

Authors+Show Affiliations

Goodheart Institute and Foundation, Hemostasis Thrombosis and Vascular Research, Goodheart Institute, Rotterdam, The Netherlands. postbus@goodheartcenter.demon.nlNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

15790199

Citation

Michiels, J J., et al. "Non-invasive Diagnosis of Pulmonary Embolism, Anno 2005." Acta Chirurgica Belgica, vol. 105, no. 1, 2005, pp. 26-34.
Michiels JJ, Hoogsteden H, Pattynama PM. Non-invasive diagnosis of pulmonary embolism, anno 2005. Acta Chir Belg. 2005;105(1):26-34.
Michiels, J. J., Hoogsteden, H., & Pattynama, P. M. (2005). Non-invasive diagnosis of pulmonary embolism, anno 2005. Acta Chirurgica Belgica, 105(1), 26-34.
Michiels JJ, Hoogsteden H, Pattynama PM. Non-invasive Diagnosis of Pulmonary Embolism, Anno 2005. Acta Chir Belg. 2005;105(1):26-34. PubMed PMID: 15790199.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Non-invasive diagnosis of pulmonary embolism, anno 2005. AU - Michiels,J J, AU - Hoogsteden,H, AU - Pattynama,P M T, PY - 2005/3/26/pubmed PY - 2005/6/29/medline PY - 2005/3/26/entrez SP - 26 EP - 34 JF - Acta chirurgica Belgica JO - Acta Chir. Belg. VL - 105 IS - 1 N2 - Pulmonary angiography is the gold standard for segmental pulmonary embolism (PE) but no longer for 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 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%. SN - 0001-5458 UR - https://www.unboundmedicine.com/medline/citation/15790199/Non_invasive_diagnosis_of_pulmonary_embolism_anno_2005_ L2 - http://www.diseaseinfosearch.org/result/2504 DB - PRIME DP - Unbound Medicine ER -