Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Dutch Thrombosis Network, Leiden, the Netherlands.
Département de médecine interne, vasculaire et Pneumologie, CHU Brest, Univ Brest, INSERM U1304-GETBO, Brest, France.
Presse Med. 2024 Sep;53(3):104241. doi: 10.1016/j.lpm.2024.104241. Epub 2024 Aug 23.
Straightforward, accurate diagnostic management in patients presenting with clinically suspected pulmonary embolism (PE) is essential, since starting anticoagulant treatment may give important adverse effects of bleeding, while false exclusion of the disease may lead to recurrent VTE, with associated morbidity and mortality. In the past three decades, considerable improvement in the diagnostic management of PE has been made. Computed tomography pulmonary angiography (CTPA) has largely replaced conventional pulmonary angiography and ventilation-perfusion lung scanning as the imaging methods of choice. Several diagnostic algorithms, all able to minimize the need for radiological imaging have been developed and validated. Lastly, within the diagnostic algorithms, varying d-dimer cut-off levels have successfully been introduced to further downsize the need for radiological imaging.
在临床上怀疑患有肺栓塞（PE）的患者中，进行直接、准确的诊断管理至关重要，因为开始抗凝治疗可能会产生重要的出血不良反应，而错误排除该疾病可能会导致复发性静脉血栓栓塞症，进而导致相关发病率和死亡率。在过去的三十年中，PE 的诊断管理得到了相当大的改善。计算机断层扫描肺动脉造影（CTPA）已在很大程度上取代了传统的肺动脉造影和通气灌注肺扫描，成为首选的影像学方法。已经开发和验证了几种诊断算法，这些算法都能够最大限度地减少对影像学检查的需求。最后，在诊断算法中，成功引入了不同的 D-二聚体截断值，以进一步减少对影像学检查的需求。
