Diagnosis of deep venous thrombosis using a Doppler ultrasonic technique.
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Abstract:
A consecutive series of 118 patients was studied postoperatively by Doppler ultrasonic techniques and by either venography or radioiodinated fibrinogen. When using the latter diagnostic measures, 22 patients were shown to have deep venous thrombosis, an incidence of 18.6 per cent. The Doppler ultrasonic technique showed that 21 patients had deep venous thrombosis, an incidence of 17.7 per cent. When the patients diagnosed as having deep venous thrombosis by two separate methods were compared, it was shown that the Doppler technique gave two false-positive results and three false-negative results. It is concluded that this technique is accurate, and because of its convenience, lack of complications and ability to be repeated frequently, it should be the preferred screening technique for the diagnosis of postoperative deep venous thrombosis.Keywords:
Venography
Doppler sonography
Doppler ultrasound
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Venography
Gold standard (test)
Doppler ultrasound
Power doppler
Positive predicative value
Femoral vein
Popliteal vein
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Summary In a prospective study, we compared real-time B-mode ultrasonography, using the simple criteria of common femoral and popliteal vein compressibility (Compression US), and Doppler ultrasound, using a standardized technique (Doppler US), with contrast venography in 158 consecutive outpatients symptomatic for deep-vein thrombosis of the lower limbs (DVT). For proximal vein thrombosis, the sensitivities documented for Compression US and Doppler US were 100% (95% CI: 90% to 100%) and 89% (95% CI: 76% to 96%), respectively. This difference is not statistically significant (p = 0.056). For all thrombi (including isolated calf-vein thrombosis), however, the sensitivity of Compression US was significantly higher than that of Doppler US (95% and 76%, respectively; p <0.04). Compression US was normal in all patients with normal venogram (specificity, 100%; 95% CI: 95% to 100%), while Doppler US was abnormal in two patients with normal venogram (specificity, 98%; 95% CI: 92% to 100%). The specificities of the two tests did not differ significantly. The results of our comparison suggest that Compression US is superior to Doppler US in the detection of DVT in symptomatic outpatients.
Venography
Doppler ultrasound
Popliteal vein
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Venography
Duplex ultrasonography
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A total of 244 patients were examined using both ultrasonic Doppler technique and conventional venography for deep venous thrombosis. The Doppler examination was 93.8% accurate overall in detecting the condition, with a specificity of 96% and sensitivity of 85.7%. Indications for venography after Doppler evaluation include: (1) a positive or equivocal Doppler examination; and (2) critically ill patients with negative Doppler results where absolute diagnostic accuracy is essential. Had these criteria been followed in this study, 174 normal examinations would have been avoided and only six large vein thrombi (ileofemoral or popliteal) in 244 examinations would have been misdiagnosed.
Venography
Doppler ultrasound
Doppler sonography
Popliteal vein
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Seventy-one patients with 80 lower limbs clinically suspected of deep venous thrombosis (DVT) were investigated by both Doppler ultrasound and venography. Sixty-seven lower limbs demonstrated by venography to have DVT, in 5 the thrombus was confined to the calf, and all were detected by the Doppler ultrasound. In 62 limbs thrombus extended into the popliteal and more proximal veins, the Doppler ultrasound detected 61 of them, a sensitivity of 98%. Venography showed a deep venous system without any evidence of thrombosis in 13, the Doppler findings were normal in all of the 13 lower limbs, a specificity of 100%. We found that the examination of the popliteal vein with patient in a semi-lateral prone position was important in detecting the presence of thrombosis in popliteal and more proximal vein.
Venography
Popliteal vein
Doppler ultrasound
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In this study, eighty limbs (71 patients) with clinically suspected deep venous thrombosis (DVT) were investigated by both venography and Doppler ultrasonography. Diagnosis was confirmed by venography in 67 limbs and Doppler ultrasonography was positive in 66 of them with the Doppler sensitivity of 98%. In the remaining 13 limbs clinically suspected to have DVT, neither venography nor Doppler ultrasonography found any abnormality in the venous system of the lower limbs.
Venography
Doppler ultrasound
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Venography
Popliteal vein
Doppler ultrasound
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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.
Venography
Doppler ultrasound
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The accuracy of Doppler examination for lower extremity deep venous thrombosis in a community hospital vascular laboratory was determined by comparing the Doppler results with venograms of 97 limbs in 90 patients. There were 47 limbs with a normal Doppler study, 46 abnormal (consistent with deep venous thrombosis) and 4 with an equivocal study. The overall accuracy was 95%. Both the sensitivity and specificity were 94% when equivocal studies were considered abnormal. Based on these results, we recommend venography or repeat Doppler examination for patients with a normal Doppler study only if the clinical findings are strongly suggestive of deep venous thrombosis. Patients with an abnormal Doppler examination and clinical findings consistent with deep venous thrombosis can be treated for deep venous thrombosis, with a high degree of confidence in the diagnosis, without venography. Patients with equivocal Doppler examinations are advised to have a venogram. While our results are equal to the best reports from research-oriented university vascular laboratories it should not be assumed that they can be readily reproduced in other settings. The technologists performing these studies should be highly skilled, experienced and preferably board certified. Internal quality control of any testing facility is necessary to assure accurate and reliable Doppler ultrasonic results prior to recommending treatment of deep venous thrombosis based on Doppler ultrasound without venography.
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Doppler ultrasound
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Venography
Doppler ultrasound
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