Detection of upper extremity deep vein thrombosis by magnetic resonance non‐contrast thrombus imaging

Dam, Lisette F. van; Dronkers, C.E.A.; Gautam, Gargi; Eckerbom, Åsa; Ghanima, Waleed; Gleditsch, Jostein; Haren, Guido R. van; Heijne, Anders von; Huisman, Menno V.; Stöger, J. Lauran; Westerlund, Eli; Kroft, Lucia J.M.; Klok, Frederikus A.

doi:10.1111/jth.15394

Cited by 10 publications

(21 citation statements)

References 25 publications

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“…Computed tomography (CT) and magnetic resonance (MR) venography are alternatives, although they typically also involve injection of contrast media and therefore share similar disadvantages with conventional venography. MR non-contrast thrombus imaging (MR-NCTI) is one imaging modality with the potential to replace venography as second-line diagnostic test 1005,1006 . This technique involves visualizing the acute thrombus, which appears as a high signal due to red cell methemoglobin in the clot, against a suppressed background 1007,1008 .…”

Section: - What Is the Optimal Imaging Modality For Detection Of Uppe...mentioning

confidence: 99%

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Recommendations from the ICM-VTE: General

2022

Journal of Bone and Joint Surgery

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Section: - What Is the Optimal Imaging Modality For Detection Of Uppe...mentioning

confidence: 99%

“…Moreover, due to the infrequent use of venography, radiologists may have a limited experience diagnosing UEDVT using this imaging modality 1024 . CT venography and MR-NCTI are alternatives, although studies assessing its diagnostic accuracy in UEDVT are scarce 1006,1025 .…”

Section: Sofienementioning

confidence: 99%

Recommendations from the ICM-VTE: General

2022

Journal of Bone and Joint Surgery

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“…19 A positive MRDTI, indicating acute DVT, was defined as a high signal in the location of a deep vein segment against the suppressed background greater than that observed in the contiguous segments of the ipsilateral vein. 6 9 21 Major bleeding and clinically relevant nonmajor bleeding were defined according to the criteria of the International Society on Thrombosis and Haemostasis. 22 23…”

Section: Methodsmentioning

confidence: 99%

“…As a result, nondiagnostic inconclusive CUS has been reported in up to 32% of patients with suspected recurrent ipsilateral DVT, which likely leads to overdiagnosis and overtreatment. 5 6 The application of reference compression ultrasound in daily clinical practice has the potential to improve the diagnostic work-up in patients with suspected recurrent ipsilateral DVT. 5 A reference compression ultrasound is an additional CUS performed directly prior or after discontinuation of anticoagulants in patients diagnosed with and treated for DVT, providing a baseline evaluation at the time of anticoagulant cessation.…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Performing Reference Ultrasonography in Patients with Deep Vein Thrombosis

de Jong,

van den Hout,

van Dijk

et al. 2023

Thromb Haemost

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Background The diagnosis of recurrent ipsilateral deep vein thrombosis (DVT) with compression ultrasonography (CUS) may be hindered by residual intravascular obstruction after previous DVT. A reference CUS, an additional ultrasound performed at anticoagulant discontinuation, may improve the diagnostic work-up of suspected recurrent ipsilateral DVT by providing baseline images for future comparison. Objectives To evaluate the cost-effectiveness of routinely performing reference CUS in DVT patients. Methods Patient-level data (n = 96) from a prospective management study (Theia study; NCT02262052) and claims data were used in a decision analytic model to compare 12 scenarios for diagnostic management of suspected recurrent ipsilateral DVT. Estimated health care costs and mortality due to misdiagnosis, recurrent venous thromboembolism, and bleeding during the first year of follow-up after presentation with suspected recurrence were compared. Results All six scenarios including reference CUS had higher estimated 1-year costs (€1,763–€1,913) than the six without reference CUS (€1,192–€1,474). Costs were higher because reference CUS results often remained unused, as 20% of patients (according to claims data) would return with suspected recurrent DVT. Estimated mortality was comparable in scenarios with (14.8–17.9 per 10,000 patients) and without reference CUS (14.0–18.5 per 10,000). None of the four potentially most desirable scenarios included reference CUS. Conclusion One-year health care costs of diagnostic strategies for suspected recurrent ipsilateral DVT including reference CUS are higher compared to strategies without reference CUS, without mortality benefit. These results can inform policy-makers regarding use of health care resources during follow-up after DVT. From a cost-effectiveness perspective, the findings do not support the routine application of reference CUS.

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“…Magnetic resonance (MR) examination techniques such as MR direct thrombus imaging can also be used to differentiate between acute ipsilateral recurrent thrombosis and residuals of a previous DVT. 23 However, this method has not yet been widely used.…”

Section: Diagnostic Approach In Suspected Recurrent Dvtmentioning

confidence: 99%

Management of Deep Vein Thrombosis: An Update Based on the Revised AWMF S2k Guideline

Linnemann,

Beyer-Westendorf,

Espinola-Klein

et al. 2024

Hamostaseologie

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Deep vein thrombosis (DVT) and pulmonary embolism (PE) are the most common manifestations of venous thromboembolism (VTE). Most DVTs affect the lower-extremity veins. Since the symptoms of DVT are non-specific, a prompt and standardised diagnostic work-up is essential to minimise the risk of PE in the acute phase and to prevent thrombosis progression, post-thrombotic syndrome and VTE recurrence in the long-term. Only recently, the AWMF S2k guidelines on Diagnostics and Therapy of Venous Thrombosis and Pulmonary Embolism have been revised. In the present article, we summarize current evidence and guideline recommendations focusing on lower-extremity DVT (LEDVT). Depending on whether the diagnostic work-up is performed by a specialist in vascular medicine or by a primary care physician, different diagnostic algorithms are presented that combine clinical probability, D-dimer testing and diagnostic imaging. The diagnosis of ipsilateral recurrent DVT poses a particular challenge and is presented in a separate algorithm. Anticoagulant therapy is an essential part of therapy, with current guidelines clearly favouring regimens based on direct oral anticoagulants over the traditional sequential therapy of parenteral anticoagulants and vitamin K antagonists. For most DVTs, a duration of therapeutic-dose anticoagulation of at least 3 to 6 months is considered sufficient, and this raises the question of the risk of VTE recurrence after discontinuation of anticoagulation and the need for secondary prophylaxis in the long-term. Depending on the circumstances and trigger factors that have contributed to the occurrence of DVT, management strategies are presented that allow decision-making taking into account the individual bleeding risk and patient's preferences.

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Detection of upper extremity deep vein thrombosis by magnetic resonance non‐contrast thrombus imaging

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 10 publications

References 25 publications

Recommendations from the ICM-VTE: General

Recommendations from the ICM-VTE: General

Cost-Effectiveness of Performing Reference Ultrasonography in Patients with Deep Vein Thrombosis

Management of Deep Vein Thrombosis: An Update Based on the Revised AWMF S2k Guideline

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