The rate of missed diagnosis of lower-limb DVT by ultrasound amounts to 50% or so in patients without symptoms of DVT

Abstract

Background:To assess whether the ultrasound (US) is a reliable approach in detecting lower-limb deep-vein thrombosis (DVT) in patients without symptoms of DVT.Methods:The research team performed a systematic search in PubMed, Ovid, Cochrane, and Web of Science without language or date restrictions. Full-text reports on prospective diagnostic studies involve the detection of lower-limb proximal and distal DVT in patients without symptoms of DVT using US and venography. A meta-analysis was performed using Meta-DiSc (version 1.4), providing the pooled sensitivity, specificity, positive (LR+) and negative (LR–) likelihood ratios of the detection accuracy of US. There were 4 different classes of subgroup analysis—the class of patients stratified by location of US exam (proximal, distal, whole leg), the class stratified by technique (color/doppler, compression, both modalities), the class stratified by kind of surgery (orthopedic, otherwise hospitalized) and the class stratified by era of publishing (1980s, 1990s, 2000s). The study quality and the risk of bias were evaluated using QUADAS-2, with heterogeneity was assessed and quantified by the Q score and I2 statistics, respectively.Results:The meta-analysis included 26 articles containing 41 individual studies with a total of 3951 patients without symptoms of DVT. Using venography as the gold standard, US for proximal DVT had a pooled sensitivity of 59% (95% confidence interval (CI) = 51%–66%) and a pooled specificity of 98% (95% CI = 97%–98%), US for distal DVT had a poor sensitivity of 43% (95% CI = 38%–48%) and a pooled specificity of 95% (95% CI = 94%–96%), US for whole-leg DVT had a pooled sensitivity of 59% (95% CI = 54%–64%) and a pooled specificity of 95% (95% CI = 94%–96%), US for post-major orthopedic surgery patients had a pooled sensitivity of 52% (95% CI = 49%–55%), and US for other types of patients had a pooled sensitivity of 58% (95% CI = 43%–72%). Pure compression technique for DVT had a poor sensitivity of 43% (95% CI = 39%–48%), pure color/doppler technique for DVT had a pooled sensitivity of 58% (95% CI = 53%–63%), compression and color/doppler technique for DVT had a pooled sensitivity of 61% (95% CI = 48%–74%).Conclusion:US could be a useful tool for diagnosing DVT, but it has a lower positive rate and a higher false negative rate. The rate of missed diagnosis of lower-limb DVT by US amounts to 50% or so in the patients without symptoms of DVT. The negative results do not preclude the possibility of DVT and if appropriate heightened surveillance and continued monitoring or try a more accurate inspection method is warranted. The whole leg evaluation and color/doppler technique should be the preferred approach.

Evaluation of stability of deep venous thrombosis of the lower extremities using Doppler ultrasound

“…However, the rate of missed diagnosis of lower limb DVT by ultrasound is approximately 50% in patients without symptoms of DVT. 19 Combined D-dimer and ultrasound screening in patients with acute spinal cord injuries improves the detection of venous thromboembolism. 20 , 21 Therefore, the related risk factors need to be identified to provide evidence for early detection and treatment of DVT.…”

Point‐of‐care ultrasound for deep venous thrombosis of the lower limb

“…The greater saphenous vein is a superficial vein, which receives venous blood from the anterior medial calf and the foot and runs up along the medial aspect of the thigh. It also usually has a valve in its terminal portion (terminal valve) . The femoral vein is a deep vein, which drains most of the lower limb and may contain a valve either proximal and/or distal to the junction with the greater saphenous vein.…”

“…The conventional venous duplex examination performed includes ultrasound of the entire venous system of the lower leg. However, the sensitivity of detection of DVT below the knee with ultrasound has been reported as low as 38% . In addition, the management of below‐knee DVT is controversial, as the proximal propagation rate may be low, with some guidelines recommending serial ultrasound examinations to detect proximal propagation of thrombus before commencement of treatment .…”

Photoacoustic Imaging of Human Vasculature Using LED versus Laser Illumination: A Comparison Study on Tissue Phantoms and In Vivo Humans

“…Many of these vascular diseases need point-of-care (POC) diagnosis and monitoring using nonionizing, noninvasive and cost-effective approaches. Although Doppler ultrasound meets all these requirements, it only maps blood flow, which is operator dependent and influenced by motion artifacts, resulting in limited sensitivity and specificity to detect the disease in its early stage [ 4 ]. A POC technique that provides direct label-free molecular and functional information of vasculature is needed to reliably detect and monitor vascular diseases [ 5 , 6 ].…”