A comparative study of ultrasound and multi-slice spiral CT venography on the diagnosis of venous thrombosis of lower limbs
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Objective: To explore the diagnostic value of ultrasound and multi-slice spiral CT venography on the diagnosis of venous thrombosis of lower limbs and make a comparative study between these two modalities. Methods: 43 patients with suspected lower leg venous thrombosis were examined. Each patient underwent Color Doppler sonography and multi-slice spiral CT venography(MSCTV) within 24 hours after ultrasound study,and multiple planar reconstruction technique and curved planar reconstruction technique were made for venography of lower limbs. Results: Among 43 patients,37 patients were diagnosed as venous thrombosis of lower limbs by Ultrasound,83 thrombi in all,57 of them are located in femorapopliteal veins. 41 venous thrombosis patients diagnosed by multi-slice spiral CT venography,88 thrombi in all,59 of them in femorapopliteal veins. Diagnostic results of these two modalities for venous thrombosis had no obvious differenc(eP0.05). Conclusion: Ultrasound and multi-slice spiral CT venography are valuable modalities on the diagnosis of venous thrombosis of lower limbs,and the comination of these two modalities can enhance detecting rate of renous thrombosis.Keywords:
Venography
Doppler ultrasound
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Objective To study the incidence and locations of deep venous thrombosis(DVT) by using 16-slice spiral CT venography in combination with pulmonary angiography(CTVPA).The accuracy of DVT in lower extremities by CT venography(CTV) was compared with color Doppler ultrasound.Methods 147 patinets with clinically suspected pulmonary embolism underwent CTVPA.The interobserver agreement in two doctors were assessed based on a patient as unit in diagnosing DVT.The results of CTV were compared with the ultrasonic results of DVT in lower extremities.Results DVT were diagnosed in 33 patients,among which 27 patients had been combined PTE and 6 patients without PTE.156 thrombi were detected in 33 patients,among which 48 thrombi(31%) were located in abdominal and pelvic veins,58 thrombi(37%) were located in femoropopliteal veins and the other 50 thrombi(32%) were located in the calf veins.The CT value ofDVT was(42±13) HU.Agreement of diagnosis was achieved in 90% patients.The Kappa was 0.86.The sensitivity and specificity were 92.3% and 100% in diagnosis of femoropopliteal venous thrombosis by CTV.Conclusion CTV is an accurate method in the diagnosis of femoropopliteal venous thrombosis and can also reveal the thrombosis in the inferior vena cava,filter and iliac veins.The interobserver agreement is very good.
Venography
Popliteal vein
Pulmonary angiography
Spiral computed tomography
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To evaluate the role of CT venography in the diagnosis and treatment of benign thoracic central venous obstruction.Eighteen patients who had undergone both CT venography and digital subtraction venography were prospectively enrolled in this study. The following features were analyzed by two observers: the cause, degree, and extent of venous obstruction; associated thrombosis; and implications for the planning of treatment. CT venography and digital subtraction venography were compared in defined venous segments, and the degree of obstruction, and correlation was expressed using Spearman's rank correlation coefficient.In all patients, CT venography depicted the causes of obstruction, including extrinsic compression of the left brachiocephalic vein, and mediastinal inflammatory pseudotumor. Interobserver agreement regarding classification of the degree of obstruction was judged as good for CT venography (K=0.864), and in evaluating this, there was significant correlation between CT venography and digital subtraction venography (reader 1: Rs = 0.58, p < 0.01; reader 2: Rs = 0.56, p < 0.01). In evaluating the status of central veins proximal to long segmental obstruction, and associated thrombosis, CT venography was superior to digital subtraction venography. In half of all patients, the findings of CT venography led to changes in the treatment plan.The findings of CT venography correlated closely with those of digital subtraction venography, and the former accurately depicted the degree and extent of benign venous obstruction.
Venography
Subtraction
Digital subtraction angiography
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Venography
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Objective
To investigate and compare the value of dual source CT venography and digital subtraction angiography (DSA) in diagnosis of deep venous thrombosis.
Methods
Forty-nine patients with deep venous thrombosis were selected as the subjects, there were 26 cases of acute thrombosis or chronic phase attack, and 23 cases of old thrombosis; all the patients underwent dual-source CT and DSA for check, and the diagnostic coincidence rates were compared.
Results
Compliance rate of dual-source CT results for the diagnosis of acute deep vein thrombosis was 100%, which was significantly higher than 76.92% of DSA (P<0.05); compliance rate of dual-source CT results in diagnosis of old thrombosis was 90.03%, which was higher than 65.22% of DSA (P<0.05).
Conclusions
Dual source CT venography of lower extremity has higher compliance rate in diagnosis of deep venous thrombosis, and it is worthy of clinical promotion.
Key words:
Dual-source CT; Digital subtraction angiography; Venography; Deep venous thrombosis
Venography
Digital subtraction angiography
Subtraction
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PURPOSE: To compare the efficacy of spiral computed tomographic (CT) venography with conventional venography in the diagnosis of suspected deep venous thrombosis (DVT). MATERIALS AND METHODS: In a prospective study, 52 consecutive patients with clinically suspected unilateral or bilateral DVT were studied with CT venography and conventional venography. In cases in which conventional venographic findings were inconclusive, color-coded duplex sonography and follow-up examinations were performed to make a final diagnosis. CT venography of both extremities covered a 100-cm section from the ankle to the inferior vena cava (IVC). Contrast material diluted with saline was injected in a dorsal vein of each foot. CT and conventional venography (including color-coded duplex sonography and follow-up findings) were correlated for three venous regions for each patient. RESULTS: Correlation was excellent between CT and conventional venographic findings in the detection of DVT. The sensitivity of CT venography was 100% (confidence interval: 0.92, 1.00), specificity was 96% (confidence interval: 0.84, 0.98), positive predictive value was 91%, and negative predictive value was 100%. CT venography more clearly demonstrated thrombus extension of DVT into the pelvic veins and IVC than conventional venography alone. CONCLUSION: CT venography is a valuable tool in the diagnosis of DVT. Compared with conventional venography, CT requires use of 80% less contrast material.
Venography
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Objective:To evaluate diagnostic value of 16-slice spiral CT venography(MSCTV)in detecting venous thrombosis of the lower extremity.Methods:The imaging diagnosis of patients with venous thrombosis of lower extremity was performed on MSCT and processed the data on ADW4.1 workstation.The data of MSCTV were reconstructed with maximum intensity projection(MIP),multiplanar reformation(MPR),volume rendering(VR).Result:Twenty-six cases suspected of having venous thrombosis of the lower extremity were demonstrated successfully with MSCTV.It could clearly reveal the location and extension of the lesion.The pathological changes in MSCTV included swelling of lower extremity,filling defect of vascular lumen,single and/or multiple stenosis and occlusion,forming of collateralization.Conclusion:MSCTV was valuable to demonstrate venous thrombosis of the lower extremity.MSCTV was better than Doppler ultrasonography and DSA in diagnosing venous thrombosis of the lower extremity.MSCTV may be useed as the first choice technique in diagnosing venous thrombosis of the lower extremity.
Venography
Maximum intensity projection
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Objective To evaluate the diagnostic value of direct 64-slice CT venography(CTV) in the detection of deep venous thrombosis(DVT) of lower extremities.Materials and Methods 19 patients with suspicious DVT of the lower extremities underwent direct CTV using 64-slice CT scanner.Results Direct CTV detected DVT in 15 patients.The DVT detected by CTV were located in 4 iliac veins,7 femoral veins,9 popliteal veins,and 5 calf veins.Conclu-sion Combined with postprocessing techniques,direct CTV has high values in the detection of lower extremities DVT.
Venography
Popliteal vein
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Ascending computed tomographic (CT) venography was compared with conventional contrast venography combined with ultrasound and follow-up in 52 patients with suspected deep venous thrombosis (DVT). Ascending CT venography more clearly demonstrated extension of DVT into the pelvic veins and inferior vena cava than conventional contrast venography. The quality of ascending CT venography was superior to conventional venography in all veins. This chapter reviews the methods for CT venous phase imaging of the veins of the pelvis and lower extremities used in the prospective investigation of pulmonary embolism diagnosis II (PIOPED II). In patients with suspected acute pulmonary embolism (PE), the number of patients with PE on CT pulmonary angiography and the number only with DVT on venous phase CT venography are shown in the chapter. The Fleischner Society recommended the use of CT venography when emphasis must be placed on a complete vascular examination that can be accomplished expeditiously.
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Twelve cases, including varicose veins (7), deep venous thrombosis (3), A-V malformation (1) and skin ulcer (1), were examined by three-dimensional CT venography (3D CTV), and comparison was made with conventional ascending venography. In the "double phase method," the first phase scan (40 seconds) of the femoral region was performed in order to rule out deep venous thrombosis, and the second phase scan (30 seconds) of the lower leg was performed to visualize varicose veins. Veins of the thigh and popliteal space were relatively well visualized. It is thought that 3D-CTV is particularly useful for spatially evaluating deep venous thrombosis and varicose veins.
Venography
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This prospective study evaluated the ability of indirect 16-row multidetector CT venography, in comparison with Doppler sonography, to detect deep vein thrombosis after total hip or knee replacement.Sixty-two patients had undergone orthopedic replacement surgery on a total of 30 hip joints and 54 knee joints. The CT venography (scan delay time: 180 seconds; slice thickness/increment: 2/1.5 mm) and Doppler sonography were performed 8 to 40 days after surgery. We measured the z-axis length of the beam hardening artifact that degraded the image quality so that the presence of deep vein thrombosis couldn't be evaluated on the axial CT images. The incidence and location of deep vein thrombosis was analyzed. The diagnostic performance of the CT venograms was evaluated and compared with that of Doppler sonography as a standard of reference.The z-axis length (mean +/- standard deviation) of the beam hardening artifact was 4.5 +/- 0.8 cm in the arthroplastic knees and 3.9 +/- 2.9 cm in the arthroplastic hips. Deep vein thrombosis (DVT) was found in the popliteal or calf veins on Doppler sonography in 30 (48%) of the 62 patients. The CT venography has a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 90%, 97%, 96%, 91% and 94%, respectively.The ability of CT venography to detect DVT was comparable to that of Doppler sonography despite of beam hardening artifact. Therefore, CT venography is feasible to use as an alternative modality for evaluating post-arthroplasty patients.
Multidetector computed tomography
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