D-dimer assay to exclude pulmonary embolism in high-risk oncologic population: Correlation with CT pulmonary angiography in an urgent care setting Journal Article

  

Authors:	King, V.; Vaze, A. A.; Moskowitz, C. S.; Smith, L. J.; Ginsberg, M. S.
Article Title:	D-dimer assay to exclude pulmonary embolism in high-risk oncologic population: Correlation with CT pulmonary angiography in an urgent care setting
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. © RSNA, 2008.
Keywords:	adult; clinical article; middle aged; methodology; diagnostic accuracy; prospective study; sensitivity and specificity; prospective studies; neoplasm; neoplasms; computer assisted tomography; tomography, x-ray computed; lung embolism; pulmonary embolism; blood; diagnostic agent; diagnostic value; prediction and forecasting; predictive value of tests; iohexol; contrast medium; contrast media; radiography; angiography; d dimer; lung angiography; emergency; fibrin degradation product; fibrin fragment d; emergencies; fibrin fibrinogen degradation products
Journal Title:	Radiology
Volume:	247
Issue:	3
ISSN:	0033-8419
Publisher:	Radiological Society of North America, Inc.
Date Published:	2008-06-01
Start Page:	854
End Page:	861
Language:	English
DOI:	10.1148/radiol.2473070939
PUBMED:	18487539
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-45149097105&partnerID=40&md5=eb972795ef9ac98107c72de8255cb127
Notes:	--- - "Cited By (since 1996): 8" - "Export Date: 17 November 2011" - "CODEN: RADLA" - "Source: Scopus"

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