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D-dimer assay to exclude pulmonary embolism in high-risk oncologic population: correlation with CT pulmonary angiography in an urgent care setting.
Radiology. 2008 Jun; 247(3):854-61.R

Abstract

PURPOSE

To prospectively evaluate (a) the diagnostic performance of D-dimer assay for pulmonary embolism (PE) in an oncologic population by using computed tomographic (CT) pulmonary angiography as the reference standard, (b) the association between PE location and assay sensitivity, and (c) the association between assay results and clinical factors that raise suspicion of PE.

MATERIALS AND METHODS

This HIPAA-compliant study had institutional review board approval; informed consent was obtained. Five hundred thirty-one consecutive patients were clinically suspected of having PE; 201 were enrolled (72 men, 129 women; median age, 61 years) and underwent CT pulmonary angiography and D-dimer assay. Relevant clinical history, symptoms, and signs were recorded. CT images were interpreted, and the location of emboli was recorded. The negative predictive value (NPV), positive predictive value (PPV), sensitivity, specificity, and diagnostic likelihood ratios of the D-dimer assay results were calculated.

RESULTS

Forty-three patients (21%) had pulmonary emboli at CT. D-Dimer results were positive in 171 patents (85%). The NPV and sensitivity were 97% and 98%, respectively. The specificity and PPV were 18% and 25%, respectively. No association was shown between clinical history, symptoms, or signs and NPV, PPV, sensitivity, or specificity or between location of PE and sensitivity.

CONCLUSION

D-Dimer results have high NPV and sensitivity for PE in oncologic patients and, if negative, can be used to exclude PE in this population. Combining the assay with clinical symptoms and signs did not substantially change NPV, PPV, sensitivity, or specificity.

Authors+Show Affiliations

Department of Radiology, Department of Medicine, Urgent Care Service, Department of Epidemiology and Biostatistics, and Clinical Laboratories, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18487539

Citation

King, Valencia, et al. "D-dimer Assay to Exclude Pulmonary Embolism in High-risk Oncologic Population: Correlation With CT Pulmonary Angiography in an Urgent Care Setting." Radiology, vol. 247, no. 3, 2008, pp. 854-61.
King V, Vaze AA, Moskowitz CS, et al. D-dimer assay to exclude pulmonary embolism in high-risk oncologic population: correlation with CT pulmonary angiography in an urgent care setting. Radiology. 2008;247(3):854-61.
King, V., Vaze, A. A., Moskowitz, C. S., Smith, L. J., & Ginsberg, M. S. (2008). D-dimer assay to exclude pulmonary embolism in high-risk oncologic population: correlation with CT pulmonary angiography in an urgent care setting. Radiology, 247(3), 854-61. https://doi.org/10.1148/radiol.2473070939
King V, et al. D-dimer Assay to Exclude Pulmonary Embolism in High-risk Oncologic Population: Correlation With CT Pulmonary Angiography in an Urgent Care Setting. Radiology. 2008;247(3):854-61. PubMed PMID: 18487539.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - D-dimer assay to exclude pulmonary embolism in high-risk oncologic population: correlation with CT pulmonary angiography in an urgent care setting. AU - King,Valencia, AU - Vaze,Anjali A, AU - Moskowitz,Chaya S, AU - Smith,Larry J, AU - Ginsberg,Michelle S, PY - 2008/5/20/pubmed PY - 2008/6/18/medline PY - 2008/5/20/entrez SP - 854 EP - 61 JF - Radiology JO - Radiology VL - 247 IS - 3 N2 - PURPOSE: To prospectively evaluate (a) the diagnostic performance of D-dimer assay for pulmonary embolism (PE) in an oncologic population by using computed tomographic (CT) pulmonary angiography as the reference standard, (b) the association between PE location and assay sensitivity, and (c) the association between assay results and clinical factors that raise suspicion of PE. MATERIALS AND METHODS: This HIPAA-compliant study had institutional review board approval; informed consent was obtained. Five hundred thirty-one consecutive patients were clinically suspected of having PE; 201 were enrolled (72 men, 129 women; median age, 61 years) and underwent CT pulmonary angiography and D-dimer assay. Relevant clinical history, symptoms, and signs were recorded. CT images were interpreted, and the location of emboli was recorded. The negative predictive value (NPV), positive predictive value (PPV), sensitivity, specificity, and diagnostic likelihood ratios of the D-dimer assay results were calculated. RESULTS: Forty-three patients (21%) had pulmonary emboli at CT. D-Dimer results were positive in 171 patents (85%). The NPV and sensitivity were 97% and 98%, respectively. The specificity and PPV were 18% and 25%, respectively. No association was shown between clinical history, symptoms, or signs and NPV, PPV, sensitivity, or specificity or between location of PE and sensitivity. CONCLUSION: D-Dimer results have high NPV and sensitivity for PE in oncologic patients and, if negative, can be used to exclude PE in this population. Combining the assay with clinical symptoms and signs did not substantially change NPV, PPV, sensitivity, or specificity. SN - 1527-1315 UR - https://www.unboundmedicine.com/medline/citation/18487539/D_dimer_assay_to_exclude_pulmonary_embolism_in_high_risk_oncologic_population:_correlation_with_CT_pulmonary_angiography_in_an_urgent_care_setting_ L2 - https://pubs.rsna.org/doi/10.1148/radiol.2473070939?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -