Current challenges in diagnostic imaging of venous thromboembolism

Abstract

Because the clinical diagnosis of deep-vein thrombosis and pulmonary embolism is nonspecific, integrated diagnostic approaches for patients with suspected venous thromboembolism have been developed over the years, involving both non-invasive bedside tools (clinical decision rules and D-dimer blood tests) for patients with low pretest probability and diagnostic techniques (compression ultrasound for deep-vein thrombosis and computed tomography pulmonary angiography for pulmonary embolism) for those with a high pretest probability. This combination has led to standardized diagnostic algorithms with proven safety for excluding venous thrombotic disease. At the same time, it has become apparent that, as a result of the natural history of venous thrombosis, there are special patient populations in which the current standard diagnostic algorithms are not sufficient. In this review, we present 3 evidence-based patient cases to underline recent developments in the imaging diagnosis of venous thromboembolism.

Combined ultrasound and photoacoustic imaging of blood clot during microbubble-assisted sonothrombolysis

“…With CT angiography, a contrast dye needs to be injected into the bloodstream, which creates a risk of contrast-induced nephropathy. 13 Other clinical studies 14,15 used transcranial Doppler US to image the restoration of the blood flow. While US is safe, it does not provide any further information regarding the composition and age of the blood clot.…”

“…While US is safe, it does not provide any further information regarding the composition and age of the blood clot. 13 It has been reported that the thrombolysis efficiency is much higher if sonothrombolysis is accompanied by clot-dissolving drugs such as tissue plasminogen activator (tPA) 16,17 and heparin. 18,19 Based on histopathological evaluation, it has been observed that the composition 20 of the thrombus is diverse.…”

Improved detectability of thromboses of the lower limb using low kilovoltage computed tomography

“…Pulmonary embolism (PE) derived from deep vein thrombosis (DVT) can cause severe dyspnea, which increases mortality. [ 1 – 4 ] Detection of DVT using ultrasonography (US) and computed tomographic venography (CTV) is necessary for prevention of critical PE. [ 1 – 3 , 5 ] US is the standard method of screening for DVT, but it has several limitations in terms of detection of thrombi.…”

“…[ 1 – 4 ] Detection of DVT using ultrasonography (US) and computed tomographic venography (CTV) is necessary for prevention of critical PE. [ 1 – 3 , 5 ] US is the standard method of screening for DVT, but it has several limitations in terms of detection of thrombi. [ 3 ] CTV is another powerful method for detecting DVT [ 1 , 3 – 6 ] ; it has several advantages, such as providing objective results more rapidly than US and concurrently revealing additional important organ information, such as pulmonary arterial status.…”

“…[ 1 – 3 , 5 ] US is the standard method of screening for DVT, but it has several limitations in terms of detection of thrombi. [ 3 ] CTV is another powerful method for detecting DVT [ 1 , 3 – 6 ] ; it has several advantages, such as providing objective results more rapidly than US and concurrently revealing additional important organ information, such as pulmonary arterial status. Therefore, CTV is the preferred examination modality, particularly in emergency cases associated with a risk of DVT.…”