A Detailed Analysis of Equivocal Duplex Findings in Patients With Suspected Deep Venous Thrombosis

Norén, Anders; Ottosson, Eva; Sjunnesson, Maggie; Rosfors, Stefan

doi:10.7863/jum.2002.21.12.1375

Cited by 12 publications

(10 citation statements)

References 27 publications

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“…If a segment shorter than 2 cm could not be seen, but no additional signs of DVT were present (i.e. the flow signals immediately above and below this short segment were normal), the case was still classified as negative [6]. Anterior tibial veins and soleal veins, although readily accessible with CDS, were not included in the study protocol as they, according to our experience, are not consistently shown phlebographically and thus of minor interest for the comparison between these diagnostic modalities.…”

Section: Methodsmentioning

confidence: 99%

High sensitivity with color duplex sonography in thrombosis screening after ankle fracture surgery

Lapidus

Bri

Ponzer

et al. 2006

Journal of Thrombosis and Haemostasis

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To cite this article: Lapidus L, de Bri E, Ponzer S, Elvin A, Noré n A, Rosfors S. High sensitivity with color duplex sonography in thrombosis screening after ankle fracture surgery. J Thromb Haemost 2006; 4: 807-12.Summary. Background: Phlebography is regarded as the reference standard for diagnosing asymptomatic deep vein thrombosis (DVT) in studies of thromboprophylaxis. However, technical advances with noninvasive color duplex sonography (CDS) have made this procedure an interesting alternative. Objectives: The objective of the present prospective study was to compare the sensitivity and specificity of CDS with those of phlebography. Patients: The first 180 consecutive patients included in a larger randomized trial for prolonged thromboprophylaxis were subject to unilateral CDS and to phlebography after ankle fracture surgery. The patients were examined 6 weeks after surgery, all examinations being evaluated blindly. After patient drop outs and exclusions, 144 patients were left for analysis. Results: Phlebography and CDS examinations were inconclusive or were not completed for 19% of these patients (28/144). DVT was diagnosed by phlebography in 21% (24/ 116) of the remaining patients. Most of the thrombi were isolated calf DVTs (18/24). In contrast, DVT was diagnosed by CDS in 31% of these patients (36/116): only one case diagnosed by phlebography was missed by CDS. The specificity of CDS is thus 86% and its sensitivity is 96%. The positive predictive value is 64%, and the negative predictive value is 99%. Conclusions: CDS is a safe method for detecting asymptomatic distal DVT. It has a high sensitivity and high negative predictive value, which means that the method is highly reliable to rule out DVT. Our results indicate that CDS could be considered as an alternative method for DVT screening.

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Section: Methodsmentioning

confidence: 99%

High sensitivity with color duplex sonography in thrombosis screening after ankle fracture surgery

Lapidus

Bri

Ponzer

et al. 2006

Journal of Thrombosis and Haemostasis

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“…Routine spectral Doppler distal augmentation is not necessary to diagnose DVT A color or spectral Doppler evaluation can be used to support the presence or absence of an abnormality . Color Doppler imaging using distal augmentation can be helpful to identify vessels and to distinguish complete versus incomplete occlusion. Recordings For normal examinations, images or cine loops are recorded at selected sites to represent a subset of the images seen during the more comprehensive scanning: Grayscale images (or cine loops) should be recorded without and with compression at each of the following levels when feasible: Common femoral vein. Confluence of the common femoral vein with the great saphenous vein. Deep femoral vein at the confluence with the femoral vein separately or along with the femoral vein. Femoral vein at the upper thigh. Femoral vein at the mid thigh. Femoral vein at the distal thigh. Popliteal vein. Representative images without and with compression (or cine loops) of posterior tibial and peroneal veins with both veins on the images or as separate images for each vein. Color and spectral Doppler waveforms from the long axis should be recorded at each of the following levels: Right common femoral or external iliac vein. Left common femoral or external iliac vein. Popliteal vein on the symptomatic side or on both sides if the examination is bilateral. Abnormal symptoms or findings generally require additional images to document the complete extent of the abnormalities. The extent and location of sites where the veins fail to compress completely should be clearly recorded and generally require additional images.…”

Section: Specification Of the Examinationmentioning

confidence: 99%

Section: Specification Of the Examinationmentioning

confidence: 99%

AIUM Practice Parameter for the Performance of a Peripheral Venous Ultrasound Examination

2020

J of Ultrasound Medicine

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“…Imaging usually begins at the brachial level and continues commonly bidirectional as a reflection of the cardiac cycle (Fig. 6,[55][56][57][58][59][60][61][62] When available, the results of the sonogram should be compared with MR venography, CT venography, or contrast venogram. Spectral waveform evaluation is especially important in the upper extremity evaluation, and, if a unilateral examination is ordered, the contralateral subclavian vein should also be studied.…”

Section: Pathophysiology and Anatomymentioning

confidence: 99%

Sonography for Deep Venous Thrombosis

Andrews

Fleischer²

2005

Ultrasound Quarterly

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Deep venous thrombosis (DVT) is a one of the most common problems facing the clinician in medicine today. It is often asymptomatic and goes undiagnosed with potentially fatal consequences. Ultrasound has become the "gold standard" in the diagnosis of deep venous thrombosis and with proper attention to technique sensitivity of this test is approximately 97%. An understanding of anatomy, pathophysiology, and risk factors is important. Thrombus formation usually begins beneath a valve leaflet below the knee. Approximately 40% will resolve spontaneously, 40% will become organized, and 20% will propagate. Whether or not a calf vein thrombus is identified, a repeat examination in 7 to 10 days is recommended in patients with risk factors or when deep venous thrombosis is suspected. The three main risk factors for thrombus formation are age greater than 75 years, previous history of deep venous thrombosis, and underlying malignancy. Other diagnostic studies include the contrast venogram, CT or MRI venogram, Tc99m Apcitide study, and the laboratory test D-Dimer. The D-Dimer study is being used more frequently as a screening test with 99% sensitivity in detecting thrombus, whether deep venous thrombosis or pulmonary embolism. However, specificity is only approximately 50% with many conditions leading to false-positive exams. Therefore, a negative examination is useful in avoiding other diagnostic studies, but a positive one may be misleading. Conditions that can lead to a false-positive examination include, but are not limited to diabetes, pregnancy, liver disease, heart conditions, recent surgery, and some gastrointestinal diseases. Like the sonogram, two negative D-Dimer studies a week apart exclude the diagnosis of deep venous thrombosis. Compression sonography with color Doppler remains the best overall test for deep venous thrombosis. It is easy to perform, less expensive than most "high tech" studies, can be performed as a portable examination, and is highly reliable when done properly.

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A Detailed Analysis of Equivocal Duplex Findings in Patients With Suspected Deep Venous Thrombosis

Cited by 12 publications

References 27 publications

High sensitivity with color duplex sonography in thrombosis screening after ankle fracture surgery

High sensitivity with color duplex sonography in thrombosis screening after ankle fracture surgery

AIUM Practice Parameter for the Performance of a Peripheral Venous Ultrasound Examination

Sonography for Deep Venous Thrombosis

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