title: Update on techniques for the diagnosis of pulmonary embolism.
abstract: BACKGROUND
  The clinical suspicion of acute pulmonary embolism (PE) is frequently raised. However, the diagnosis of PE is confirmed in only 20 - 30% of these patients. The high incidence in addition to the potential harm from false-positive or false-negative diagnostic decisions underline the importance of a standardised diagnostic algorithm with high sensitivity as well as specificity.
  
  
  METHODS
  This article reviews the diagnostic tests for the diagnosis of PE.
  
  
  RESULTS
  This review provides an overview of the different clinical decision rules (CDRs), D-dimer tests and imaging techniques in patients suspected of PE. Furthermore, the diagnostic process in patients with clinically suspected recurrent PE, suspicion during pregnancy and new research areas are discussed.
  
  
  CONCLUSIONS
  Various diagnostic tests are available to detect or exclude PE with good accuracy. CDRs and D-dimer tests play an important role in the exclusion of PE. Neither is sufficient as a single test, but the combination of an 'unlikely' clinical prediction and a normal D-dimer test result safely excludes PE. In case of a high CDR score and/or an elevated D-dimer concentration, extra imaging is necessary with multi-slice computed tomography pulmonary angiography as first choice modality.
authors.affiliation: Leiden University Medical Centre, Section of Vascular Medicine, Department of General Internal Medicine - Endocrinology, Albinusdreef 2, Postbus 9600, 2300 RC Leiden, the Netherlands +003171 5262085 ; +003171 5248140 ; I.C.M.Mos@LUMC.nl.
authors.forename: Inge Cm
authors.initials: IC
authors.lastname: Mos
authors.forename: Frederikus A
authors.initials: FA
authors.lastname: Klok
authors.forename: Lucia Jm
authors.initials: LJ
authors.lastname: Kroft
authors.forename: Menno V
authors.initials: MV
authors.lastname: Huisman