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Thromb Haemost 2004; 91(01): 187-195
DOI: 10.1160/TH03-05-0278
New Technologies and Diagnostic Tools
Schattauer GmbH

Diagnostic performance of complete lower limb venous ultrasound in patients with clinically suspected acute pulmonary embolism

Antoine Elias
1   Departments of Vascular Medicine, Rangueil University Hospital Centre,Toulouse, France
,
Daniel Colombier
2   Departments of Radiology, Rangueil University Hospital Centre,Toulouse, France
,
Gérard Victor
3   Departments of Nuclear Medicine, Rangueil University Hospital Centre,Toulouse, France
,
Marie Elias
1   Departments of Vascular Medicine, Rangueil University Hospital Centre,Toulouse, France
,
Catherine Arnaud
4   Faculty of Medicine, Department of Epidemiology and Health Economics, Community Health,Toulouse, France
,
Henri Juchet
5   Departments of Emergency, Rangueil University Hospital Centre,Toulouse, France
,
Jean-Louis Ducassé
5   Departments of Emergency, Rangueil University Hospital Centre,Toulouse, France
,
Alain Didier
6   Departments of Pulmonology, Rangueil University Hospital Centre,Toulouse, France
,
Cyrille Colin
7   Department of Medical Information of the Hospices Civils de Lyon, Lyons, France
,
Hervé Rousseau
2   Departments of Radiology, Rangueil University Hospital Centre,Toulouse, France
,
Françoise Nguyen
8   Haemostasis, Rangueil University Hospital Centre,Toulouse, France
,
Francis Joffre
2   Departments of Radiology, Rangueil University Hospital Centre,Toulouse, France
› Author AffiliationsGrant support: Financial support was provided by the Regional Delegation for Clinical Research (DRRC: Délégation Régionale à la Recherche Clinique) and by Pharmacia Upjohn.
Further Information

Publication History

Received 09 May 2003

Accepted after resubmission 26 September 2003

Publication Date:
30 November 2017 (online)

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Summary

A limited ultrasound (US) confined to the popliteal and femoral veins is usually performed to detect deep vein thrombosis (DVT) in patients with clinically suspected acute pulmonary embolism (PE). Our objective was to assess the diagnostic accuracy of complete lower limb US examining both the proximal and distal veins in this setting. In this prospective study, 210 consecutive patients were included. Complete US was performed by independent operators and compared blindly with a reference strategy combining clinical probability, ventilation perfusion scan and pulmonary angiography to a three-month clinical follow-up. Simultaneously,VIDAS D-dimer (DD) assay and helical computed tomography (HCT) of the lungs were assessed independently and blindly. PE was present in 74 patients (35%). Complete US detected DVT in 91 patients (43%), proximal in 51 and distal in 40. Sensitivity and specificity with a 0.95 confidence interval were respectively 0.93 [0.85 – 0.97] and 0.84 [0.77 – 0.89]. Limited US detected DVT in only 46 patients (22%). Sensitivity and specificity were respectively 0.55 [0.44 – 0.66] and 0.96 [0.92 – 0.98]. For DD they were 0.92 [0.83 – 0.96] and 0.24 [0.17 – 0.32] and for HCT 0.84 [0.73 – 0.90] and 0.87 [0.80 – 0.92]. Complete lower limb US has higher sensitivity and capacity to exclude PE than limited US, but a slightly lower specificity. Complete US results also compared favourably with those of HCT and DD.The utility of including this method in diagnostic strategies for PE needs to be assessed in cost-effectiveness analysis and in outcome studies.

Keywords

Pulmonary embolism - deep vein thrombosis - ultrasound/diagnosis
 

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