Division of Angiology and Hemostasis, Department of Internal Medicine, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland.
Vasc Med. 2010 Oct;15(5):399-406. doi: 10.1177/1358863X10378788.
Deep vein thrombosis (DVT) and pulmonary embolism (PE) cannot be diagnosed solely on a clinical basis owing to the lack of sensitivity and specificity of clinical signs and symptoms. Phlebography and pulmonary angiography are invasive and resource-demanding imaging modalities. Because the prevalence of DVT and PE is relatively low (typically 20% or less) among clinically suspected individuals, submitting all of them to imaging would not be cost-effective. Therefore, non-invasive diagnostic algorithms have been developed that include clinical probability assessment and D-dimer measurement. These initial steps allow the selection of patients who require non-invasive imaging: compression ultrasonography in cases of suspected DVT and multidetector computed tomography (CT) angiography in cases of suspected PE. This review gives a critical appraisal of the sequential steps of the diagnostic work-up in suspected DVT or PE.
深静脉血栓形成（DVT）和肺栓塞（PE）不能仅凭临床基础进行诊断，因为临床症状和体征缺乏敏感性和特异性。静脉造影和肺动脉造影是具有侵袭性和资源需求的影像学方式。由于临床上疑似的个体中 DVT 和 PE 的患病率相对较低（通常为 20%或更低），因此对所有这些个体进行影像学检查都不会具有成本效益。因此，已经开发了非侵入性诊断算法，包括临床可能性评估和 D-二聚体测量。这些初始步骤允许选择需要进行非侵入性影像学检查的患者：疑似 DVT 时进行压缩超声检查，疑似 PE 时进行多排 CT 血管造影。这篇综述对疑似 DVT 或 PE 的诊断工作流程的各个步骤进行了批判性评估。
