Ultrasound elastography is useful to distinguish acute and chronic deep vein thrombosis

Abstract

Essentials Ultrasound elastography uses tissue deformation to assess the relative quantification of its elasticity. Compression and duplex ultrasonography may be unable to correctly determine the thrombus age. Ultrasound elastography may be useful to distinguish between acute and chronic deep vein thrombosis. The exact determination of the thrombus age could have both therapeutic and prognostic implications. BACKGROUND: Background Ultrasound elastography (UE) imaging is a novel sonographic technique that is commonly employed for relative quantification of tissue elasticity. Its applicability to venous thromboembolic events has not yet been fully established; in particular, it is unclear whether this technique may be useful in determining the age of deep vein thrombosis (DVT). Thus, the aim of this study was to assess the role of UE in distinguishing acute from chronic DVT. Methods Consecutive patients with a first unprovoked acute and chronic (3 months old) DVT of the lower limbs were analyzed. Patients with recurrent DVT or with a suspected recurrence were excluded. The mean elasticity index (EI) values of acute and chronic popliteal and femoral vein thrombosis were compared. The accuracy of the EI in distinguishing acute from chronic DVT was also assessed by measuring the sensitivity, specificity, positive and negative predictive values, and likelihood ratios. Results One-hundred and forty-nine patients (mean age 63.9 years, standard deviation 13.6; 73 males) with acute and chronic DVT were included. The mean EI of acute femoral DVT was higher than that of chronic femoral DVT (5.09 versus 2.46), and the mean EI of acute popliteal DVT was higher than that of chronic popliteal DVT (4.96 versus 2.48). An EI value of > 4 resulted in a sensitivity of 98.9% (95% confidence interval [CI] 93.3-99.9), a specificity of 99.1% (95% CI 94.8-99.9), a positive predictive value of 91.1% (95% CI 77.9-97.1), a negative predictive value of 98.6% (95% CI 91.3-99.9), a positive likelihood ratio of 13.23 (95% CI 93-653) and a negative likelihood ratio of 0.001 (95% CI 0.008-0.05) for acute DVT. Conclusions UE appears to be a promising technique for distinguishing between acute and chronic DVT. Larger prospective studies are warranted to confirm our preliminary findings.

Assessment of histological characteristics, imaging markers, and rt-PA susceptibility of ex vivo venous thrombi

“…Sample ages examined here ranged from 1 to 30 days, with an average and standard deviation of 12.2 ± 9.8 days. The average elastic modulus may also not be a good metric because of sample inhomogeneity, though similar degrees of inhomogeneity is observed for clinical scans of DVT 77 , 78 . Ultrasound images are inherently two-dimensional, and volumetric assessment of the sample stiffness may provide a more applicable comparison to bulk measurements such as mass loss.…”

D-Dimer and Fibrinogen Values according to the Localization of Deep Venous Thrombosis

“…Paper including both acute and chronic DVT used D-dimer values as a confirmation on the recent onset of acute thrombosis. 42 There is no unique accepted definition for chronic DVT, although there are sonographic characteristics that can help this classification. 43 Further research should be conducted on the usefulness of D-dimer and fibrinogen values to distinguish between acute and chronic DVT.…”

Fat‑suppressed magnetic resonance volume interpolated examination for deep venous thrombosis compared with duplex sonography

“…Compression sonography alone would be an appropriate test when identifying proximal DVT as it can achieve an optimal specificity of 97.8%, while combined color-doppler method is the appropriate technique for identifying distal DVT (12). Ultrasound elastography (UE) can estimate elastic properties of soft tissues such as stiffness, and it has been reported that UE may be a promising technique to distinguish between acute and chronic DVT (34). However the clinical applicability of UE to DVT has not yet been fully investigated (34).…”

“…Ultrasound elastography (UE) can estimate elastic properties of soft tissues such as stiffness, and it has been reported that UE may be a promising technique to distinguish between acute and chronic DVT (34). However the clinical applicability of UE to DVT has not yet been fully investigated (34).…”