Prof Jean-Yves Meuwly
Department of Diagnostic and
Interventional Radiology, University
Hospital, Lausanne
DVT, other
available
diagnostic
techniques
Diagnostic studies for DVT
Compression ultrasonography
D-dimer
Computerised tomography
Magnetic resonance imaging
Phlebography
Plethysmography and rheography
Diagnostic studies for DVT
Compression ultrasonography
D-dimer
Computerised tomography
Magnetic resonance imaging
Phlebography
Plethysmography and rheography
Diagnostic studies for DVT
Compression ultrasonography
D-dimer
Computerised tomography
Magnetic resonance imaging
Phlebography
Plethysmography and rheography
Plethysmography and rheography
Non-invasive techniques
Sensitivity 73-91%
Specificity 71-91%
Inadequate diagnostic performance to act as
a stand-alone test in DVT diagnosis
Locker T, Goodacre S, Sampson F, Webster A, Sutton AJ. Meta-analysis of plethysmography and rheography in the diagnosis of deepvein thrombosis. Emergency medicine journal : EMJ. 2006 Aug;23(8):630-5.
Phlebography
(Original) reference standard technique
Detects isolated distal DVT
Detects thrombosis in the iliac veins and
inferior veina cava
Invasive, exposes to radiation, difficult to
perform, difficult to interpret
Arnoldi, C. C. (1967). "The role of phlebography in deep venous thrombosis." Vasc Dis 4(3): 167-173.Torkzad, M. R., et al. (2004). "[Deep venous thrombosis of the lower extremity. Ultrasonography should replace phlebography as first line diagnostic imaging]." Lakartidningen 101(36): 2716-2718.
“we believe that US with compression technique and Doppler should be considered as a replacement for venography of the lower extremities as the first line of diagnostic imaging modality.”Torkzad, M. R., et al. (2004). "[Deep venous thrombosis of the lower extremity. Ultrasonography should replace phlebography as first line diagnostic imaging]." Lakartidningen 101(36): 2716-2718.
Phlebography
“The results showed that only 4-5
per cent of requested and successful
venograms were able to show signs
of deep vein thrombosis of the lower
extremities (LEDVT) in the calf veins
(distal LEDVT).”
Torkzad, M. R., et al. (2004). "[Deep venous thrombosis of the lowerextremity. Ultrasonography should replace phlebography as first line diagnostic imaging]." Lakartidningen 101(36): 2716-2718.
Computerised tomography
Computerised tomography
Krishan S, Panditaratne N, Verma R, Robertson R. Incremental value of CT venography combined with pulmonary CT angiography for the detection of thromboembolic disease: systematic review and meta-analysis. AJR American journal of roentgenology. 2011 May;196(5):1065-72.
Computerised tomography
Incremental CT venography combined with
pulmonary CT angiography increased
detection rates of DVT by identifying an
additional 3% of cases
CT venography can reveal thrombus in
pelvic veins and inferior veina cava
Lim KE, Hsu WC, Hsu YY, Chu PH, Ng CJ. Deep venous thrombosis: comparison of indirect multidetector CT venography and sonography of lower extremities in 26 patients. Clinical imaging. 2004 Nov-Dec;28(6):439-44.
Computerised tomography
Thomas SM, Goodacre SW, Sampson FC, van Beek EJ. Diagnostic value of CT for deep vein thrombosis: results of a systematicreview and meta-analysis. Clinical radiology. 2008 Mar;63(3):299-304.
Computerised tomography
Thomas SM, Goodacre SW, Sampson FC, van Beek EJ. Diagnostic value of CT for deep vein thrombosis: results of a systematic review and meta-analysis. Clinical radiology. 2008 Mar;63(3):299-304.
Computerised tomographySensitivity 96% (CUS 97%)
Specificity 95% (CUS 96%)
Can visualise the pelvic veins and define the upper limits of thrombus extension
Requires injection of contrast, exposes the patient to radiation
More expensive than ultrasonography
Ho WK. Deep vein thrombosis--risks and diagnosis. Australian family physician. 2010 Jun-Jul;39(6):468-74.
Spectral CT
Wu, H. W., et al. (2012). "Pulmonary embolism detection and characterization through quantitative iodine-based material decomposition images with spectral computed tomography imaging." Invest Radiol 47(1): 85-91.Bae, K., et al. (2018). "Improved Opacification of a Suboptimally Enhanced Pulmonary Artery in Chest CT: Experience Using a Dual-Layer Detector Spectral CT." AJR Am J Roentgenol: 1-8.
Spectral 70 keV Image MD Iodine MD Iodine
Color Map
Magnetic resonance imaging
Magnetic resonance imaging
Magnetic resonance imagingSensitivity 96-100% (CUS 97%)
Specificity 93-100% (CUS 96%)
Sensitivity for distal DVT about 62%
Can visualise the pelvic veins and define the upper limits of thrombus extension
Can be performed without contrast
More expensive than ultrasonography
Sampson FC, Goodacre SW, Thomas SM, van Beek EJ. The accuracy of MRI in diagnosis of suspected deep vein thrombosis: systematic review and meta-analysis. European radiology. 2007 Jan;17(1):175-81.
Thank you for your attention