Pierre-Yves Salaun1, Francis Couturaud2, Alexandra Le Duc-Pennec1, Karine Lacut2, Pierre-Yves Le Roux1, Philippe Guillo1, Pierre-Yves Pennec3, Jean-Christophe Cornily3, Christophe Leroyer2, Grégoire Le Gal4. 1. Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; Université de Brest, CHU de la Cavale Blanche, Brest, France; Service de médecine nucléaire, CHU de la Cavale Blanche, Brest, France. 2. Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; Université de Brest, CHU de la Cavale Blanche, Brest, France; Département de médecine interne et de pneumologie, CHU de la Cavale Blanche, Brest, France. 3. Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; Université de Brest, CHU de la Cavale Blanche, Brest, France; Département de cardiologie, CHU de la Cavale Blanche, Brest, France. 4. Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; Université de Brest, CHU de la Cavale Blanche, Brest, France; Département de médecine interne et de pneumologie, CHU de la Cavale Blanche, Brest, France. Electronic address: gregoire.legal@chu-brest.fr.
Abstract
BACKGROUND: We designed a simple and integrated diagnostic algorithm for acute pulmonary embolism (PE). Diagnosis was based on clinical probability assessment, plasma D-dimer testing, then sequential testing to include lower limb venous compression ultrasonography, ventilation perfusion lung scan, and chest multidetector CT (MDCT) imaging. METHODS: We included 321 consecutive patients presenting at Brest University Hospital in Brest, France, with clinically suspected PE and positive d-dimer or high clinical probability. Patients in whom VTE was deemed absent were not given anticoagulants and were followed up for 3 months. RESULTS: Detection of DVT by ultrasonography established the diagnosis of PE in 43 (13%). Lung scan associated with clinical probability was diagnostic in 243 (76%) of the remaining patients. MDCT scan was required in only 35 (11%) of the patients. The 3-month thromboembolic risk in patients not given anticoagulants, based on the results of the diagnostic protocol, was 0.53% (95% CI, 0.09-2.94). CONCLUSIONS: A diagnostic strategy combining clinical assessment, d-dimer, ultrasonography, and lung scan gave a noninvasive diagnosis in the majority of outpatients with suspected PE and appeared to be safe.
BACKGROUND: We designed a simple and integrated diagnostic algorithm for acute pulmonary embolism (PE). Diagnosis was based on clinical probability assessment, plasma D-dimer testing, then sequential testing to include lower limb venous compression ultrasonography, ventilation perfusion lung scan, and chest multidetector CT (MDCT) imaging. METHODS: We included 321 consecutive patients presenting at Brest University Hospital in Brest, France, with clinically suspected PE and positive d-dimer or high clinical probability. Patients in whom VTE was deemed absent were not given anticoagulants and were followed up for 3 months. RESULTS: Detection of DVT by ultrasonography established the diagnosis of PE in 43 (13%). Lung scan associated with clinical probability was diagnostic in 243 (76%) of the remaining patients. MDCT scan was required in only 35 (11%) of the patients. The 3-month thromboembolic risk in patients not given anticoagulants, based on the results of the diagnostic protocol, was 0.53% (95% CI, 0.09-2.94). CONCLUSIONS: A diagnostic strategy combining clinical assessment, d-dimer, ultrasonography, and lung scan gave a noninvasive diagnosis in the majority of outpatients with suspected PE and appeared to be safe.
Authors: Pierre-Yves Le Roux; Amir Iravani; Jason Callahan; Kate Burbury; Peter Eu; Daniel P Steinfort; Eddie Lau; Beverly Woon; Pierre-Yves Salaun; Rodney J Hicks; Michael S Hofman Journal: Eur J Nucl Med Mol Imaging Date: 2019-05-01 Impact factor: 9.236
Authors: David Bourhis; Laura Wagner; Julien Rioult; Philippe Robin; Romain Le Pennec; Cécile Tromeur; Pierre Yves Salaün; Pierre Yves Le Roux Journal: EJNMMI Phys Date: 2021-07-05