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.

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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