The Noninvasive Venous Vascular Laboratory

Expanded Criteria for the Diagnosis of Deep Venous Thrombosis

“…Doppler-PVR venous studies must therefore be interpreted with caution when any of these clinical variables are present. 18 Finally, in a prospective study of 211 limbs at the Massa¬ chusetts General Hospital, Boston, Hanel et al20 found Doppler ultrasonography to be much more accurate in the diagnosis of above-knee thrombi (specificity, 90.7%; sensi¬ tivity, 92.4%) than air displacement plethysmography (spe-cificity, 62.4%; sensitivity, 62.4%); for that reason, they no longer use air displacement plethysmography in the evalua¬ tion of suspected DVT. In our series of 244 patients, examined for suspected DVT using the PVR in combination with Doppler ultra¬ sonography, it is clear that a TVS of less than or equal to 4 using standard criteria is inadequate for the safe exclusion of a diagnosis of DVT. So far, however, use of the composite PVR-Doppler venous evaluation has been reported with varying success.…”