SearchPublisher and Institutes
You are here: Home :: Area NEM :: Medical science :: Human medicine
Antoine Elias, Daniel Colombier, Grard Victor, Marie Elias, Catherine Arnaud, Henri Juchet, Jean-Louis Ducass, Alain Didier, Cyrille Colin, Herv Rousseau, Franoise Nguyen, Francis Joffre
Diagnostic performance of complete lower limb venous ultrasound in patients with clinically suspected acute pulmonary embolism
A limited ultrasound (US) confined to the popliteal and femoral veins is usually performed to detect deep vein thrombosis (DVT) in patients with clinically suspected acute pulmonary embolism (PE). Our objective was to assess the diagnostic accuracy of complete lower limb US examining both the proximal and distal veins in this setting. In this prospective study, 210 consecutive patients were included. Complete US was performed by independent operators and compared blindly with a reference strategy combining clinical probability, ventilation perfusion scan and pulmonary angiography to a three-month clinical follow-up. Simultaneously, VIDAS D-dimer (DD) assay and helical computed tomography (HCT) of the lungs were assessed independently and blindly. PE was present in 74 patients (35%). Complete US detected DVT in 91 patients (43%), proximal in 51 and distal in 40. Sensitivity and specificity with a 0.95 confidence interval were respectively 0.93 [0.85 0.97] and 0.84 [0.77 0.89]. Limited US detected DVT in only 46 patients (22%). Sensitivity and specificity were respectively 0.55 [0.44 0.66] and 0.96 [0.92 0.98]. For DD they were 0.92 [0.83 0.96] and 0.24 [0.17 0.32] and for HCT 0.84 [0.73 0.90] and 0.87 [0.80 0.92]. Complete lower limb US has higher sensitivity and capacity to exclude PE than limited US, but a slightly lower specificity. Complete US results also compared favourably with those of HCT and DD. The utility of including this method in diagnostic strategies for PE needs to be assessed in cost-effectiveness analysis and in outcome studies.
Thrombosis and Haemostasis, Schattauer
Print ISSN: 0340-6245
Volume: 91, 01/2004
Pages: 187 - 195