Tools for the Clinician: The Essentials of Bedside (ED or ICU) Ultrasound for Deep Vein Thrombosis

Zitek, Joseph Anton; Baydoun, Jamie; Baird, Jeremy

doi:10.1007/s40138-013-0016-4

Cited by 8 publications

(8 citation statements)

References 25 publications

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“…They can be used to identify thrombus size and location. US is the currently accepted first-line imaging test for the diagnosis of DVT in the lower extremities (5). Although the US is a noninvasive method that does not involve ionizing radiation or the administration of radiographic contrast agents (6)(7)(8), it tends to be susceptible to generating false-negative venous ultrasonography results, particularly in obese patients or patients with markedly edematous limbs (9).…”

Section: Introductionmentioning

confidence: 99%

Time-efficient and contrast-free magnetic resonance imaging approach to the diagnosis of deep vein thrombosis on black-blood gradient-echo sequence: a pilot study

Mao¹,

Guan²,

Peng³

et al. 2021

Quant Imaging Med Surg

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Background: Black-blood thrombus imaging (BTI) has shown to be advantageous for the diagnosis of deep vein thrombosis (DVT). However, previous techniques using fast spin echo have a high specific absorption rate. As DANTE (delay alternating with nutation for tailored excitation) black-blood preparation can suppress blood flows over a broad range of velocities, we hypothesized that a DANTE black-blood preparation combined with a fast low-angle shot (FLASH) gradient-echo readout-DANTE-FLASH could be used to diagnose DVT.Methods: Eleven healthy volunteers and 30 suspected DVT patients were recruited to undergo DANTE-FLASH and magnetic resonance direct thrombus imaging (MRDTI). The suspected DVT patients were also examined by ultrasound (US). For the segment level, a total of 1,066 venous vessel segments were analyzed.Using US and MRDTI as the references, the sensitivity (SE), specificity (SP), positive and negative predictive values (PPV and NPV), and accuracy (ACC) of DANTE-FLASH were calculated. To quantitatively compare image quality between DANTE-FLASH and MRDTI, image signal-to-noise ratio (SNR), apparent contrastto-noise ratio (CNR) between muscle and the venous lumen, and the apparent CNR between the thrombus and venous lumen were measured. Additionally, diagnostic confidence, image quality, and clot burden were also evaluated.Results: Using the consensus results of US and MRDTI as a standard reference, the diagnostic SE, SP, PPV, NPV, and ACC of DANTE-FLASH for the 2 readers were 97.0% and 93.2%, 99.0% and 98.2%, 93.4% and 87.9%, 99.6% and 99.0%, and 98.8% and 97.6%, respectively. According to the image quantitative analysis results, DANTE-FLASH demonstrated higher image SNR and CNR than MRDTI.The image quality and diagnostic confidence scores of DANTE-FLASH were higher than MRDTI (3.66±0.44 vs. 3.52±0.52, P<0.001, and 3.84±0.36 vs. 3.76±0.41, P<0.001). There was excellent agreement between DANTE-FLASH and MRDTI on clot burden evaluation.Conclusions: DANTE-FLASH provided better image quality than MRDTI and accurately detected thrombi. It may, therefore, serve as a safe and convenient alternative for the diagnosis of DVT.

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Section: Introductionmentioning

confidence: 99%

Time-efficient and contrast-free magnetic resonance imaging approach to the diagnosis of deep vein thrombosis on black-blood gradient-echo sequence: a pilot study

Mao¹,

Guan²,

Peng³

et al. 2021

Quant Imaging Med Surg

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“…Although the ultimate gold standard for diagnosis is contrast venography, 2 ultrasound performed by a technologist and interpreted by a radiologist is the current test of choice for diagnosis of DVT in the emergency department (ED). 3 With the potential to save both time 4 and money, emergency physician (EP)-performed DVT ultrasound offers an attractive alternative to reliance on radiology department-performed ultrasound imaging. Indeed, the American College of Emergency Physicians (ACEP) supports EP-performed DVT ultrasound training, as it now considers DVT ultrasound one of the core emergency ultrasound applications.…”

Section: Introductionmentioning

confidence: 99%

Mistakes and Pitfalls Associated with Two-Point Compression Ultrasound for Deep Vein Thrombosis

Zitek

Baydoun

Yepez

et al. 2016

WestJEM

Self Cite

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IntroductionTwo-point compression ultrasound is purportedly a simple and accurate means to diagnose proximal lower extremity deep vein thrombosis (DVT), but the pitfalls of this technique have not been fully elucidated. The objective of this study is to determine the accuracy of emergency medicine resident-performed two-point compression ultrasound, and to determine what technical errors are commonly made by novice ultrasonographers using this technique.MethodsThis was a prospective diagnostic test assessment of a convenience sample of adult emergency department (ED) patients suspected of having a lower extremity DVT. After brief training on the technique, residents performed two-point compression ultrasounds on enrolled patients. Subsequently a radiology department ultrasound was performed and used as the gold standard. Residents were instructed to save videos of their ultrasounds for technical analysis.ResultsOverall, 288 two-point compression ultrasound studies were performed. There were 28 cases that were deemed to be positive for DVT by radiology ultrasound. Among these 28, 16 were identified by the residents with two-point compression. Among the 260 cases deemed to be negative for DVT by radiology ultrasound, 10 were thought to be positive by the residents using two-point compression. This led to a sensitivity of 57.1% (95% CI [38.8–75.5]) and a specificity of 96.1% (95% CI [93.8–98.5]) for resident-performed two-point compression ultrasound. This corresponds to a positive predictive value of 61.5% (95% CI [42.8–80.2]) and a negative predictive value of 95.4% (95% CI [92.9–98.0]). The positive likelihood ratio is 14.9 (95% CI [7.5–29.5]) and the negative likelihood ratio is 0.45 (95% CI [0.29–0.68]). Video analysis revealed that in four cases the resident did not identify a DVT because the thrombus was isolated to the superior femoral vein (SFV), which is not evaluated by two-point compression. Moreover, the video analysis revealed that the most common mistake made by the residents was inadequate visualization of the popliteal vein.ConclusionTwo-point compression ultrasound does not identify isolated SFV thrombi, which reduces its sensitivity. Moreover, this technique may be more difficult than previously reported, in part because novice ultrasonographers have difficulty properly assessing the popliteal vein.

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“…The accuracy of doppler ultrasound examination in patients with DVT can reach 94%. 6,7 Kesieme (2011) states the incidence of DVT is very rare in young people. The annual incidence is 0.07 to 0.14 per 10,000 patients.…”

Section: Discussionmentioning

confidence: 99%

Antifospholipid Syndrome with Autoimun Hemolitic Anemia

Zukhrufan

Wahid

2020

J. Berk. Ked

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Antiphospholipid syndrome is a part of systemic autoimmune disease (nonspecific organ), characterized by vascular thrombosis (arterial or venous) with a high antibody titter against a plasma protein that binds to phospholipid anions (antiphospholipid-aPL antibodies). Autoimmune haemolytic anaemia (AIHA) is rare in patients with antiphospholipid antibody syndrome. A sixteen years old female patient has been reported with the main complaint of swelling in the right leg. The patient also complained of increased fatigue. On physical examination found anaemic conjunctiva, swelling in the right limb with a diameter of the right leg greater than the left leg. Homan’s sign positive on the right leg. This patient belongs to the high probability criteria of DVT. Doppler Ultrasonography (USG) examination suggests thrombus in the iliac vein, femoral vein, and right leg popliteal vein, and thrombus in the left leg popliteal vein. In the antibody anticardiolipin (ACA) IgG examination an increase was found. The comb test was positive, and haemolytic anaemia antibody screening was the warm type. Heparinisation and immunosuppressant administration were performed in patients. The incidence of antiphospholipid syndrome with AIHA cannot be ascertained whether there is a direct relationship. Keywords: antiphospholipid syndrome, DVT, AIHA

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Tools for the Clinician: The Essentials of Bedside (ED or ICU) Ultrasound for Deep Vein Thrombosis

Cited by 8 publications

References 25 publications

Time-efficient and contrast-free magnetic resonance imaging approach to the diagnosis of deep vein thrombosis on black-blood gradient-echo sequence: a pilot study

Time-efficient and contrast-free magnetic resonance imaging approach to the diagnosis of deep vein thrombosis on black-blood gradient-echo sequence: a pilot study

Mistakes and Pitfalls Associated with Two-Point Compression Ultrasound for Deep Vein Thrombosis

Antifospholipid Syndrome with Autoimun Hemolitic Anemia

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