title: Diagnostic performance of complete lower limb venous ultrasound in patients with clinically suspected acute pulmonary embolism.
abstract: 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.
authors.affiliation: Department of Vascular Medicine, Rangueil University Hospital Centre, 1 Avenue Jean Poulhés 31403, Toulouse Cedex 04, France. elias.a@chu-toulouse.fr
authors.forename: Antoine
authors.initials: A
authors.lastname: Elias
authors.forename: Daniel
authors.initials: D
authors.lastname: Colombier
authors.forename: Gérard
authors.initials: G
authors.lastname: Victor
authors.forename: Marie
authors.initials: M
authors.lastname: Elias
authors.forename: Catherine
authors.initials: C
authors.lastname: Arnaud
authors.forename: Henri
authors.initials: H
authors.lastname: Juchet
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Ducassé
authors.forename: Alain
authors.initials: A
authors.lastname: Didier
authors.forename: Cyrille
authors.initials: C
authors.lastname: Colin
authors.forename: Hervé
authors.initials: H
authors.lastname: Rousseau
authors.forename: Françoise
authors.initials: F
authors.lastname: Nguyen
authors.forename: Francis
authors.initials: F
authors.lastname: Joffre
mesh_terms: D000792:Angiography; D002986:Clinical Trials as Topic; D003937:Diagnosis, Differential; D005338:Fibrin Fibrinogen Degradation Products / Q000096:biosynthesis; D006801:Humans; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014465:Ultrasonics; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000175:diagnosis
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D