Evaluation of Deep Vein Thrombosis with Multidetector Row CT after Orthopedic Arthroplasty: a Prospective Study for Comparison with Doppler Sonography

Abstract

ObjectiveThis prospective study evaluated the ability of indirect 16-row multidetector CT venography, in comparison with Doppler sonography, to detect deep vein thrombosis after total hip or knee replacement.Materials and MethodsSixty-two patients had undergone orthopedic replacement surgery on a total of 30 hip joints and 54 knee joints. The CT venography (scan delay time: 180 seconds; slice thickness/increment: 2/1.5 mm) and Doppler sonography were performed 8 to 40 days after surgery. We measured the z-axis length of the beam hardening artifact that degraded the image quality so that the presence of deep vein thrombosis couldn't be evaluated on the axial CT images. The incidence and location of deep vein thrombosis was analyzed. The diagnostic performance of the CT venograms was evaluated and compared with that of Doppler sonography as a standard of reference.ResultsThe z-axis length (mean±standard deviation) of the beam hardening artifact was 4.5 ± 0.8 cm in the arthroplastic knees and 3.9 ± 2.9 cm in the arthroplastic hips. Deep vein thrombosis (DVT) was found in the popliteal or calf veins on Doppler sonography in 30 (48%) of the 62 patients. The CT venography has a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 90%, 97%, 96%, 91% and 94%, respectively.ConclusionThe ability of CT venography to detect DVT was comparable to that of Doppler sonography despite of beam hardening artifact. Therefore, CT venography is feasible to use as an alternative modality for evaluating postarthroplasty patients.

Advanced imaging in acute and chronic deep vein thrombosis

“…Combined CTPA-CTV can depict cases of unsuspected DVT in patients suspected of having PE with studies claiming indirect CTV to be as accurate as US in diagnosing DVT (35)(36)(37). Combining CTPA with CTV has increased the sensitivity from 83% to 90% but with no change in specificity (38).…”

Diagnosis of DVT

“…Only one compared CT scan venography with contrast venography; 143 the remainder compared CT scan venography to US. [126][127][128][129][130][131][132][133][134][135][136][137][138][139][140][141][142] The results of the meta-analysis 125 and fi ve primary studies that were not included in the meta-analysis (mostly because they were subsequently published) [126][127][128][129]133 are described in Tables S28 and S29, with the Summary of Findings in Table 6 . [144][145][146] S37 and Table 6 , the evidence is of low quality, with only an accuracy study and no management studies to determine the consequences of using MR direct thrombus imaging in practice.…”

“…The methodology of a meta-analysis of CT scan diagnostic accuracy, 125 along with individual accuracy studies, [126][127][128][129][130][131][132][133][134][135][136][137][138][139][140][141][142][143] is summarized in Table S27 (Recommendations 3.2-3.6). Most of the studies were of patients with suspected PE rather than suspected DVT.…”

Comparison of the incidence of venous thromboembolism between epidural and general anesthesia for total knee arthroplasty: a retrospective study

“…In Korea, the risks of developing of DVT and PTE following TKA are reported to be very low compared to those of patients from western countries [1,3,5,14]. The low incidence of VTE in Asians is thought to be due to differences in basic genetic factors, in addition to other risk factors such as low incidence of venous disease, obesity, and hyperlipidemia [15].…”

“…Substantial variation exists in the reported rates of postoperative VTE following TKA in the Asian population, with the general consensus being that the rates are lower in the Asian population than the Western population [1][2][3][4]. Over time, various studies have been published regarding the incidence of VTE following TKA, in the Korean population [3,5].…”