Original articleBenefit of CT venography for the diagnosis of thromboembolic disease
Introduction
Deep venous thrombosis (DVT) is a risk factor for pulmonary embolism (PE). Both are treatable conditions that often remain undiagnosed because of their nonspecific signs and symptoms, resulting in significant morbidity and mortality. As the two entities are considered to be part of the same pathologic process [1], assessment for thromboembolic (TE) disease frequently entails investigation of both the pulmonary arterial system as well as the lower extremity deep venous system.
DVT is most often evaluated using either venous sonography or, more recently, computer-assisted tomography (CT) venography (CTV) [2], [3], [4], [5], [7], [8], [9], [10], [11]. CTV provides the additional ability to image DVT in pelvic veins as well as the lower extremity venous system immediately following CT angiography (CTA) of the pulmonary arterial system. Such a technique may provide diagnostic benefit over ultrasound (US) assessment in addition to expediting patient evaluation. As reported by Cham et al. in a large cohort of patients, CTV performed with contiguous, helically acquired, 10-mm sections, resulting in a 20% increase in the diagnosis of TE disease detection, compared with CTA alone [13]. Recently, the Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) trial reported that the sensitivity of CTA for the diagnosis of pulmonary embolism was 83%, which increased to 90% with CTV in addition to CTA [14]. However, there are conflicting results regarding the role of CTV in the literature, given the option to perform ultrasound of the lower extremities instead of CTV and a concern of increasing radiation exposure to the pelvis [2], [3], [4], [15], [16]. Some reports conclude that CTV is a relatively accurate method for the diagnosis of DVT, compared with US [3], [7], [17], while others recommend that any isolated positive finding on CTV for DVT be confirmed with sonography [4].
Our objective was to assess the benefit of performing CTV with CTA for diagnosing TE disease in an acute tertiary care setting, with the specific intention of also identifying any advantage of combined CTA/CTV, as compared to CTA and duplex ultrasonography of the lower extremities.
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Materials and methods
We reviewed reports in our radiology information system for all inpatients or patients who presented to the emergency department at one of the tertiary care hospitals at our medical center and were assessed by CTA and CTV between January 1, 2001, and November 30, 2003 (Group I). In addition, to assess the role of CTV in altering management in patients undergoing CTA and US, we searched the radiology information and noninvasive vascular laboratory databases for all patients who were referred for
Group 1: CTAs and CTVs performed concurrently during a 3-year period
Over a 3-year interval (Period I), 1716 CTAs were performed on 1618 patients (662 male, 956 female; mean, 57.7 years). There were 229 CTAPs (13.3%), 103 CTAIs (6.0%), and 1384 CTANs (80.6%).
Of the same 1716 studies, 909 CTVs were performed concurrently in 858 patients (360 male, 498 female; mean age, 59 years). There was no significant difference in terms of gender between the subset who had CTA/CTV and the 760 patients studied with CTA alone (chi-square=3.84, degrees of freedom (df)=l, P>.05).
Discussion
In our study, we demonstrated during a 3-year interval that 11.9% of our CTV studies were positive for DVT. This rate is slightly higher than, although not dissimilar to, some previous reports of large series. As reported by Cham et al. [18], for example, CTVs were positive in 8% in their 541 patients. Walsh and Redmond [8] reported 10.4% of their CTVs as positive involving 106 patients. Richman et al. [19] in 800 patients reported CTVs to be positive in 7%, and in a subsequent study of Cham et
Acknowledgments
The authors would like to thank Nanda Kirpekar of information technology in the department of Radiology at New York University for his assistance with database search. Amado Ross Sussman, M.D., is acknowledged for his assistance in data analysis.
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Cited by (17)
Impact of CT venography added to CT pulmonary angiography for the detection of deep venous thrombosis and relevant incidental CT findings
2020, European Journal of RadiologyCitation Excerpt :In particular, we reconstructed our images with a thickness of 1.25 mm, which may have led to better detection of pulmonary emboli, especially distally, compared to Cham et al. and Loud et al., who reconstructed CTPA images with a thickness of 3 - 5 mm [3,11]. After directly comparing the results of CTV with those for lower-extremity US, both simultaneously performed with CTPA, prior literature reported no significant advantage of combined CTPA/CTV, provided that lower-extremity US was regularly available [16–20]. The benefit of adding CTV to CTPA was minimal because the detection of isolated DVT was rare and not worth the cost and neither the additional ionizing radiation [21,22].
Near-miss in focused lower-extremity ultrasound for deep venous thrombosis
2013, Journal of Emergency MedicineCitation Excerpt :There are other imaging options. Contrast-enhanced computed tomography (CT) scanning, specifically CT venography (CTV), has been evaluated in studies that have shown it to be effective and statistically equivalent to ultrasound in the diagnosis of lower-extremity venous thrombosis (7,8). CTV can be combined with CT angiography of the chest to evaluate for pulmonary embolism.
Diagnosis of DVT: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines
2012, ChestCitation Excerpt :Strategies involving CT scan venography and MRI were not included in the decision analysis. The methodology of a meta-analysis of CT scan diagnostic accuracy,125 along with individual accuracy studies,126–143 is summarized in Table S27 (Recommendations 3.2-3.6). Most of the studies were of patients with suspected PE rather than suspected DVT.
Pulmonary Embolism: Third Edition
2016, Pulmonary Embolism: Third EditionA retrospective study of the value of indirect CT venography: A British perspective
2012, British Journal of Radiology