Detection of Pelvic Vein Thrombosis by Magnetic Resonance Angiography in Patients With Acute Pulmonary Embolism and Normal Lower Limb Compression Ultrasonography

Stern, Jean‐Baptiste; Abehsera, M.; Grenet, Dominique; Friard, S.; Couderc, Louis‐Jean; Scherrer, Antoine; Stern, M.

doi:10.1378/chest.122.1.115

Cited by 63 publications

(38 citation statements)

References 26 publications

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“…5 Several studies have suggested that the deep veins of the lower extremity (LE) could be a source of paradoxical thromboembolism in CS patients with patent foramen ovale (PFO). [6][7][8] Deep pelvic veins have also been shown to harbor thrombi in patients diagnosed with pulmonary emboli 9,10 and CS. 11 The published prevalence of LE and pelvic deep venous thrombosis (DVT) in patients with CS is highly variable, ranging from 3.2% to 65.5%, depending on imaging modality.…”

mentioning

confidence: 99%

Diagnostic Yield of Pelvic Magnetic Resonance Venography in Patients With Cryptogenic Stroke and Patent Foramen Ovale

Liberman

Daruwalla

Collins

et al. 2014

Stroke

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Background and Purpose— Paradoxical embolization is frequently posited as a mechanism of ischemic stroke in patients with patent foramen ovale. Several studies have suggested that the deep lower extremity and pelvic veins might be an embolic source in cryptogenic stroke (CS) patients with patent foramen ovale. Methods— Consecutive adult patients with ischemic stroke or transient ischemic attack and a patent foramen ovale who underwent pelvic magnetic resonance venography as part of an inpatient diagnostic evaluation were included in this single-center retrospective observational study to determine pelvic and lower extremity (LE) deep venous thrombosis (DVT) prevalence in CS versus non-CS stroke subtypes. Results— Of 131 patients who met inclusion criteria, 126 (96.2%) also had LE duplex ultrasound data. DVT prevalence overall was 7.6% (95% confidence interval, 4.1–13.6), pelvic DVT 1.5% (95% confidence interval, 0.1–5.8), and LE DVT 7.1% (95% confidence interval, 3.6–13.2). One patient with a pelvic DVT also had a LE DVT. Comparing patients with CS (n=98) with non-CS subtypes (n=33), there was no significant difference in the prevalence of pelvic DVT (2.1% versus 0%, P =1), LE DVT (6.2% versus 10.3%, P =0.43), or any DVT (7.2% versus 9.1%, P =0.71). Conclusions— Among patients with ischemic stroke/transient ischemic attack and patent foramen ovale, the majority of detected DVTs were in LE veins rather than the pelvic veins and did not differ by stroke subtype. The routine inclusion of pelvic magnetic resonance venography in the diagnostic evaluation of CS warrants further prospective investigation.

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mentioning

confidence: 99%

Diagnostic Yield of Pelvic Magnetic Resonance Venography in Patients With Cryptogenic Stroke and Patent Foramen Ovale

Liberman

Daruwalla

Collins

et al. 2014

Stroke

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“…Ultrasound is sometimes not feasible due to obesity, edema, bandages, or plaster casts, and ultrasound of pelvic veins are prone to be problem-ridden (2,3). These difficulties may be overcome using MRI, and several quite different MRI venography techniques have been developed and reported.…”

Section: Discussionmentioning

confidence: 99%

“…Four patients had DVT of the right limb, and mean symptom duration was 8.3 days (range, [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Figure 3 shows examples of patients with DVT and direct and indirect findings of venous thrombosis in calf, knee, and thigh in corresponding images of the two MRI techniques.…”

Section: Dvt Detectionmentioning

confidence: 99%

“…Another problem is diagnostic imaging in patients presenting with recurrent, acute, or chronic DVT. These challenges can be overcome by use of MRI (2)(3)(4). Finally, MRI may provide valuable additional diagnostic information and establish differential diagnoses since this method also visualizes adjacent soft tissues and other vessels; i.e., superficial veins and arteries.…”

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confidence: 99%

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Visualization of deep veins and detection of deep vein thrombosis (DVT) with balanced turbo field echo (b‐TFE) and contrast‐enhanced T1 fast field echo (CE‐FFE) using a blood pool agent (BPA)

Enden¹,

Storås²,

Negård³

et al. 2010

Magnetic Resonance Imaging

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Purpose: To assess image quality, vessel visualization, preliminary diagnostic properties, and interobserver variability of a novel balanced turbo field echo (b-TFE) sequence and contrast-enhanced T1 fast field echo (CE-FFE) sequence with blood pool agent (BPA). Materials and Methods:A total of 15 healthy volunteers and six patients with ultrasound-verified proximal deep vein thrombosis (DVT) were examined from the inferior vena cava (IVC) to the proximal calf veins.Results: The great majority of deep veins were completely visualized on both sequences. In healthy volunteers the IVC was completely visualized in five b-TFE and 11 CE-FFE scans, and partially in seven b-TFE and four CE-FFE scans (P ¼ 0.008). Poorest image quality was in the pelvis. Contrast-to-noise ratio (CNR) was higher on b-TFE compared to CE-FFE, with significant difference in calf images (P ¼ 0.036). Sensitivity was 100% for proximal DVT with both methods. Specificity was 70% (CE-FFE) and 80% (b-TFE) for proximal femoral DVT; 100% in distal femoral. Interobserver reliability was kappa 1.0 (b-TFE), 0.9 (CE-FFE) for proximal, and overall poor for distal DVT.Conclusion: Contrast-enhancement did not add valuable information in visualizing deep veins of the lower limbs compared to b-TFE, though the IVC was slightly better visualized. Diagnostic properties and interobserver reliability of both sequences were good for proximal DVT and poor for distal DVT.

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“…(Figure 2) It is also called venous ultrasonography or ultrasound, which is widely used for evaluation of suspected DVT. (19) It is a safe, non-invasive test that involves compressing and imaging femoral vein down to most proximal calf vein. (20) This test has inability to distinguish between old and fresh thrombus.…”

Section: Clinical Possibility Scorementioning

confidence: 99%

Deep Vein Thrombosis: Review and Update

Pattnaik¹,

Mishra²

2016

jemds

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Detection of Pelvic Vein Thrombosis by Magnetic Resonance Angiography in Patients With Acute Pulmonary Embolism and Normal Lower Limb Compression Ultrasonography

Cited by 63 publications

References 26 publications

Diagnostic Yield of Pelvic Magnetic Resonance Venography in Patients With Cryptogenic Stroke and Patent Foramen Ovale

Diagnostic Yield of Pelvic Magnetic Resonance Venography in Patients With Cryptogenic Stroke and Patent Foramen Ovale

Visualization of deep veins and detection of deep vein thrombosis (DVT) with balanced turbo field echo (b‐TFE) and contrast‐enhanced T1 fast field echo (CE‐FFE) using a blood pool agent (BPA)

Deep Vein Thrombosis: Review and Update

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