Deep Venous Thrombosis with Suspected Pulmonary Embolism: Detection with Combined CT Venography and Pulmonary Angiography

Loud, Peter A.; Katz, Douglas S.; Bruce, Dennis; Klippenstein, Donald; Grossman, Zachary D.

doi:10.1148/radiology.219.2.r01ma26498

Cited by 254 publications

(153 citation statements)

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“…[4][5][6] Recently, some centers have begun using computed tomography (CT) venography, with comparable results. [7][8][9] Although most emergency departments (EDs) are able to obtain VDUS during business hours, this often requires patients' being gone from the ED for several hours. 10 Furthermore, some EDs do not have access to such studies ''around the clock,'' leading to either admission for subsequent testing or presumptive anticoagulation and outpatient follow-up.…”

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confidence: 99%

Resident-performed Compression Ultrasonography for the Detection of Proximal Deep Vein Thrombosis: Fast and Accurate

et al. 2004

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Objectives: To assess whether emergency medicine residents (EMRs) could quickly perform accurate compression ultrasonography (CUS) for the detection of proximal lower extremity deep vein thromboses (PLEDVTs) with minimal training. Methods: A prospective, observational study using a convenience sample of patients presenting with signs and/or symptoms for PLEDVT. Vascular laboratory and department of radiology studies were considered the criterion standard. CUS of the femoral vessels was performed. Incompressibility or visualized thrombus was considered ''positive.'' Results: Eight residents with limited ultrasound (US) experience and no prior experience with deep vein thrombosis (DVT) US volunteered to participate in this study, enrolling 72 patients. Their average scan time was 11.7 minutes (95% CI ¼ 9.4 to 14). There were 23 true positives, 4 false positives, 45 true negatives, and 0 false negatives. The test characteristics for PLEDVT gave a sensitivity of 100% (95% CI ¼ 82.2 to 100) and a specificity of 91.8% (95% CI ¼ 79.5 to 97.4). Conclusion: Emergency medicine residents with limited US experience were able to quickly perform CUS after minimal training for the detection of PLEDVT in a select group of patients.

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Resident-performed Compression Ultrasonography for the Detection of Proximal Deep Vein Thrombosis: Fast and Accurate

et al. 2004

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“…60 -62 In one of the largest series, CTV was 97% sensitive and 100% specific for femoropopliteal DVT. 63 A more recent study using multislice CT showed a sensitivity of 100% and specificity of 97% and positive and negative predictive values of 92% and 100%, respectively. 64 There are several drawbacks to combining CTV with CTPA as a single comprehensive imaging modality for VTE.…”

Section: Ct Venography For Diagnosis Of Dvtmentioning

confidence: 96%

“…64 There are several drawbacks to combining CTV with CTPA as a single comprehensive imaging modality for VTE. In a number of published studies of combined CTPA and CTV, Ϸ150 mL of iodinated contrast was required to produce adequate opacification of the pulmonary arteries and pelvic and lower extremity veins, 61,[63][64][65][66][67][68] more than the amount usually required for adequate opacification of the pulmonary arteries alone. Given that the nephrotoxicity of iodinated radiocontrast is dose related, 69 minimizing the dose is important, especially in critically ill patients with underlying renal Exposure to ionizing radiation is also greater with combined CTRA/CTV over either test alone, and this is particularly pertinent to radiosensitive tissues such as the ovaries and testes.…”

Section: Ct Venography For Diagnosis Of Dvtmentioning

confidence: 99%

“…Protocols using spaced sections rather than helical acquisition help reduce radiation doses but risk missing smaller venous thrombi. 63 Although concern about exposure need not preclude clinically indicated examinations, physicians should be aware of the deleterious effects, particularly in younger patients, and remember that CT imaging contributes to the bulk of medical radiation exposure. In part because of these issues, the value of combining CTV with CTPA is still debated, and in many institutions, including our own, CTV is not routinely included in the CTPA protocol.…”

Section: Ct Venography For Diagnosis Of Dvtmentioning

confidence: 99%

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Role of Computed Tomography and Magnetic Resonance Imaging for Deep Venous Thrombosis and Pulmonary Embolism

2004

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Abstract-During the 1990s, computed tomography (CT) and magnetic resonance (MR) imaging underwent extensive technological advancement and expanded clinical use in patients with venous thromboembolic disease, particularly with regard to evaluation of the pulmonary vasculature. In many institutions, helical (spiral) CT pulmonary angiography has become the initial imaging study of choice to evaluate patients with suspected pulmonary embolism, supplanting ventilation/perfusion scintigraphy. In addition, CT venography of the pelvis and lower extremities is often incorporated into the CT angiography protocol to identify or exclude concurrent deep venous thrombosis. MR pulmonary angiography and MR venography are second-line diagnostic tools because of their higher cost, limited availability, and other logistical constraints. As the technology improves and becomes more widely available, MR imaging may play a greater role in the evaluation of patients with venous thromboembolic disease. Key Words: thrombosis Ⅲ pulmonary heart disease Ⅲ imaging Ⅲ MRI D uring the 1990s, technological advances in computed tomography (CT) and magnetic resonance (MR) imaging made these techniques applicable to the diagnosis of venous thromboembolic disease, particularly for the pulmonary vasculature in patients with suspected pulmonary embolism (PE). At the opening of the third millennium, in many institutions, helical (spiral) CT pulmonary angiography (CTPA) has become the initial imaging study of choice for evaluating patients with suspected PE, supplanting ventilation/perfusion (V/Q) scintigraphy by reducing indeterminate examinations. 1-4 CT venography (CTV) of the pelvic and lower extremity veins after CTPA of the pulmonary arteries has been advocated by some as an adjunct to helical CT for detection of concurrent deep venous thrombosis (DVT) using a single imaging technique for detection of venous thromboembolic disease.Although MR imaging produces high tissue contrast without ionizing radiation, currently, this technique is less popular than CT for evaluation of acute venous thromboembolism (VTE) because of technical limitations, higher costs, limited availability, and other logistical considerations. As technology improves, however, MR pulmonary angiography (MRPA) and MR venography (MRV) may play a greater role in the evaluation of patients with venous thromboembolic disease.This article reviews applications of CT and MR imaging in the clinical evaluation of patients with suspected venous thromboembolic disease. CT Pulmonary AngiographyCTPA has gained acceptance as a first-line imaging study in cases of suspected acute PE, replacing traditional V/Q scintigraphy at many institutions. In general, V/Q scanning is reserved for patients in whom motion artifact or poor right heart function limit the quality of CT examination and those with contraindications to intravenous radiographic contrast.After contrast administration, CTPA provides visualization of the pulmonary arterial system in the axial plane, and multiplanar and three-dimensional...

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“…Clot is identified as a filling defect within a deep vein. Acute DVT often expands the vein, and has associated perivenous edema and enhancement of the venous wall [19,20].…”

Section: Computed Tomography Venographymentioning

confidence: 99%

Modern Methods of Deep Vein Thrombosis Diagnosis: Literature Review

Zostautiene

Žvinienė

Kiudelis

2016

Medicinos Teorija Ir Praktika

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SANTRAUKAReikšminiai žodžiai: giliųjų venų trombozė, kompresinis ultragarsinis tyrimas, daugiasluoksnė kompiuterinė tomografija, magnetinis rezonansas, venografija. Venų tromboembolija (VTE) -tai dvi tarpusavyje susijusios patologijos: plaučių embolija (PE) ir giliųjų venų trombozė (GVT). Giliųjų venų trombozė išlieka svarbi sveikatos sistemos problema, kadangi yra susijusi su komplikacijomis, turinčiomis aukštą sergamumo ir mirtingumo rodiklį: ūminė ir lėtinė plaučių embolijos, plautinė hipertenzija ir potrombozinis sindromas. Paprastai GVT prasideda blauzdos venose, bet gali tęstis proksimaliau ir sąlygoti gyvybei pavojingą plaučių emboliją. Klinikinėje praktikoje labai svarbi šios ligos profilaktika ir gydymas, tad aktuali yra ankstyva ir tiksli diagnozė, įvertintant tikslią GVT vietą ir apimtį. Apibendrinus literatūros duomenis, straipsnyje apžvelgiami radiologinės diagnostikos metodai kojų giliųjų venų trombozei nustatyti, radiologinių tyrimų privalumai ir trūkumai. ABSTRACTKey words: deep vein thrombosis, compression ultrasound, multidetector computed tomography, magnetic resonance, venography. Venous thromboembolism consists of two related conditions: deep vein thrombosis and pulmonary embolism. One-third venous thromboembolism cases are manifested as pulmonary embolism and two-third present with deep vein thrombosis alone. Deep venous thrombosis remains an important health care problem as it is related with the complications having a high morbidity and mortality rate: acute and chronic pulmonary embolism, pulmonary hypertension and post-thrombotic syndrome. It is considered the third most common acute cardiovascular disease after ischemic heart disease and stroke and effects millions of people worldwide. Conventional venography was the gold standard in deep vein thrombosis diagnosis and the only imaging test for a long time in order to specify the suspected deep vein thrombosis in legs, pelvis or inferior vena cava [1,2]. Presently contrast x-ray venography is applied very seldom in conventional medical practice. Contrast x-ray venography is particularly helpful for assessing recurrent acute deep vein thrombosis in patients with a prior history of deep vein thrombosis in whom venous anatomy is often complex and difficult to evaluate using other methods [3] or when to remove an inferior vena cava filter. Conventional venography is presently replaced with non-invasive or less invasive radiological examination methods: the firstchoice method is ultrasound, but there are also other ones -computed tomography venography and magnetic resonance venography. Ultrasound is the imaging examination of choice for suspected lower extremity deep venous thrombosis. Ultrasound has high sensitivity (range, 93.2 %-95.0 %; pooled sensitivity, 94.2 %) and high specificity (range, 93.1 %-94.4 %; pooled specificity, 93.8 %) for diagnosing proximal (thigh) deep vein thrombosis and much lower sensitivity (range, 59.8 %-67.0 %; pooled sensitivity, 63.5 %) for diagnosing distal (calf ) and pelvic veins thrombosis. Compression ultra...

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Deep Venous Thrombosis with Suspected Pulmonary Embolism: Detection with Combined CT Venography and Pulmonary Angiography

Cited by 254 publications

References 18 publications

Resident-performed Compression Ultrasonography for the Detection of Proximal Deep Vein Thrombosis: Fast and Accurate

Resident-performed Compression Ultrasonography for the Detection of Proximal Deep Vein Thrombosis: Fast and Accurate

Role of Computed Tomography and Magnetic Resonance Imaging for Deep Venous Thrombosis and Pulmonary Embolism

Modern Methods of Deep Vein Thrombosis Diagnosis: Literature Review

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