King Valencia, Vaze Anjali A, Moskowitz Chaya S, Smith Larry J, Ginsberg Michelle S
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.
Radiology. 2008 Jun;247(3):854-61. doi: 10.1148/radiol.2473070939.
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.
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.
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.
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.
前瞻性评估（a）以计算机断层扫描（CT）肺血管造影作为参考标准时，D - 二聚体检测在肿瘤患者中对肺栓塞（PE）的诊断性能；（b）PE部位与检测敏感性之间的关联；（c）检测结果与引起PE怀疑的临床因素之间的关联。
本符合健康保险流通与责任法案（HIPAA）的研究获得了机构审查委员会的批准；已获得知情同意。连续531例临床怀疑患有PE的患者；201例患者（72例男性，129例女性；中位年龄61岁）纳入研究并接受了CT肺血管造影和D - 二聚体检测。记录相关临床病史、症状和体征。解读CT图像并记录栓子的位置。计算D - 二聚体检测结果的阴性预测值（NPV）、阳性预测值（PPV）、敏感性、特异性和诊断似然比。
43例患者（21%）CT检查发现有肺栓塞。171例患者（85%）D - 二聚体结果为阳性。NPV和敏感性分别为97%和98%。特异性和PPV分别为18%和25%。未显示临床病史、症状或体征与NPV、PPV、敏感性或特异性之间存在关联，也未显示PE部位与敏感性之间存在关联。
D - 二聚体检测结果对肿瘤患者的PE具有较高的NPV和敏感性，若结果为阴性，则可用于排除该人群中的PE。将该检测与临床症状和体征相结合，并未显著改变NPV、PPV、敏感性或特异性。
