• Lana K Hirai, Jayme M Takahashi, and Hyo-Chun Yoon.
• John A. Burns School of Medicine, Kaiser Foundation Hospital, 3288 Moanalua Road, Honolulu, Hawaii 96819, USA.
• J Vasc Interv Radiol. 2007 Aug 1;18(8):970-4.

PurposeA prospective study was designed to determine if a screening quantitative serum D-dimer measurement of 1.0 microg/mL or less precludes pulmonary computed tomographic (CT) angiography in patients with possible acute pulmonary embolism (PE).Materials And MethodsOver a period of 16 months, every patient seen in the emergency department in whom there was clinical suspicion of PE sufficient to warrant pulmonary CT angiography was also requested to have a quantitative serum D-dimer level measurement taken. All pulmonary CT angiography procedures were performed on a four-slice scanner and every examination was overread by a radiologist who was blinded to the D-dimer assay results. Three-month medical record and telephone follow-up was carried out for all participants who had a serum D-dimer level of 1.0 microg/mL or less to verify no new diagnosis or death from PE.ResultsIn this prospective study, 361 consecutive patients who received pulmonary CT angiography had a D-dimer level of 1.0 microg/mL or less. There were 310 patients who had negative pulmonary CT angiography results and 50 patients who had indeterminate CT angiography results. Only one patient had positive pulmonary CT angiography findings. Minimum 3-month follow-up information was available for 349 patients, none of whom reported subsequent PE, including those with indeterminate pulmonary CT angiography results.ConclusionThe use of a screening D-dimer measurement of 1.0 microg/mL or less precludes pulmonary CT angiography in patients with possible acute PE. The use of this quantitative D-dimer assay would decrease radiation exposure, contrast medium toxicity, cost, and time for patients seen in the emergency medicine department.

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