Quinn R J, Nour R, Butler S P, Glenn D W, Travers P L, Wellings G, Kwan Y L
Department of Nuclear Medicine, St George Hospital, Kogarah, New South Wales, Australia.
Radiology. 1994 Feb;190(2):509-11. doi: 10.1148/radiology.190.2.8284407.
To test the usefulness of lower limb Doppler venous compression ultrasound (US) and serum D-dimer measurements in diagnosis of pulmonary embolism in patients in whom ventilation-perfusion (V-P) scans indicate intermediate probability of pulmonary embolism.
V-P scanning, pulmonary angiography, US, and D-dimer measurements were performed in 36 patients without known deep venous thrombosis but with intermediate probability of having a pulmonary embolism.
Pulmonary angiography demonstrated pulmonary embolism in 15 (41%) of 36 patients. US demonstrated deep venous thrombosis in only two patients, both with pulmonary embolism. Sensitivity of US was only 13%, but specificity was 100%. Five (14%) of the 36 patients had normal (< 220 micrograms/L) D-dimer levels; none of the five had pulmonary embolism. Sensitivity and specificity of D-dimer values were 100% and 16%, respectively, with a negative predictive value of 100%.
Combined D-dimer measurement and US were helpful in correctly diagnosing pulmonary embolism in only seven (20%) of 36 patients. Pulmonary angiography is still required to diagnose pulmonary embolism in the majority of patients.
对于通气-灌注（V-P）扫描提示肺栓塞可能性为中等的患者，检测下肢多普勒静脉加压超声（US）及血清D-二聚体检测在诊断肺栓塞中的作用。
对36例无已知深静脉血栓形成但有肺栓塞中等可能性的患者进行V-P扫描、肺血管造影、超声及D-二聚体检测。
36例患者中，15例（41%）肺血管造影显示有肺栓塞。超声仅在2例有肺栓塞的患者中显示有深静脉血栓形成。超声的敏感性仅为13%，但特异性为100%。36例患者中有5例（14%）D-二聚体水平正常（<220μg/L）；这5例均无肺栓塞。D-二聚体值的敏感性和特异性分别为100%和16%，阴性预测值为100%。
D-二聚体检测与超声联合应用仅有助于正确诊断36例患者中的7例（20%）肺栓塞。大多数患者仍需肺血管造影来诊断肺栓塞。
