1992 ARRS Executive Council Award. Detection of deep venous thrombosis: prospective comparison of MR imaging with contrast venography.

Diagnosis of deep vein thrombosis, an overview

“…If adequately performed, CV outlines the entire deep venous system of the leg, including the common iliac vein and inferior caval vein. In this way it establishes Table 1 Positive predictive value of several "classical" signs of DVT, when the result of physical examination is compared to venography 1990 [12] (%) Spontaneous pain 44 38 61 63 Palpatory pain 49 22 68 65 Increased circumference 40 63 61 Oedema 54 32 45 32 62 72 Warmth 50 71 68 32 Erythema 55 13 65 28 Homans' sign 58 72 15 62 21 Fever 17 68 59 Venous dilatation 60 79 75 17 93 48 (1996) [109][110][111][112][113][114][115][116][117][118][119][120][121] i l l the presence, precise location, extent and occlusiveness of venous thrombi. O f a number of methods for performing CV, ascending venography according to the technique of Rabinov [21] and Thomas [31] is most com monly used.…”

“…The method is 112 Medicine 48 (1996) [109][110][111][112][113][114][115][116][117][118][119][120][121] based on measurements of changes in blood vol ume in the leg produced by temporary venous obstruction. During a period of venous outflow occlusion by a thigh cuff the increase in volume is measured.…”

“…48 (1996) 109-121 113 hypothesis that calf-vein thrombi that are unde tected by repeated IPG during a 10-day period, thus without proximal extension, are not clinically relevant and thus should not be treated with anticoagulants. This is based on the observation that the frequency of recurrent venous thrombo embolism in studies using serial IPG during the 6-month study period was very low (03-1.9%), which is not higher than the figures obtained in a follow-up study in symptomatic patients with a normal venogram [33].…”

“…Second, isolated thrombi in the iliac vein and in the superficial femoral vein within the adductor canal are difficult to detect. 4H (1996) [109][110][111][112][113][114][115][116][117][118][119][120][121] Criteria associated with DVT are respectively absence of flow, continuous flow without phasicity with respiration, and absence or diminished augmentation of flow with distal compression or proximal decompression. The results for proximal DVT are presented in Table 2.…”

“…The disad vantages of this procedure have led to the devel opment of a wide array of less invasive tests like Medicine 48 (1996) [109][110][111][112][113][114][115][116][117][118][119][120][121] impedance-and strain-gauge plethysmography, Doppler ultrasound investigations, ultrasonogra phy, duplex scanning, scintigraphic methods and blood tests to confirm or exclude venous throm bosis. In this paper the experience with these tests in two different situations is discussed: (1) patients showing signs and symptoms of DVT for the first time, (2) patients with previous DVT showing recurrence of signs and symptoms in the same limb.…”