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[Plain CT of venous thromboses of the leg]
E Gmelin1, J Link, S Judaschke
1Institut für Radiologie, Medizinische Universität Lübeck.
Insights
Non-enhanced computed tomography (CT) can help determine deep vein thrombosis (DVT) age. Hyperdense clots suggest fresh DVT, while hypodense clots indicate older thrombi, aiding treatment decisions.
Area of Science:
- Radiology
- Vascular Imaging
- Medical Diagnostics
Background:
- Deep vein thrombosis (DVT) diagnosis relies on imaging.
- Assessing thrombus age is crucial for treatment selection, particularly fibrinolysis.
- Non-enhanced computed tomography (CT) offers a potential non-invasive method for thrombus characterization.
Purpose of the Study:
- To evaluate the utility of non-enhanced CT in differentiating fresh from old deep vein thrombi.
- To correlate CT attenuation values with thrombus age in DVT patients.
Main Methods:
- Non-enhanced CT scans were performed on 41 patients with confirmed DVT.
- CT attenuation values (Hounsfield units) of thrombi were measured.
- Findings were compared with clinical history and phlebography results.
Main Results:
- Fresh thrombi (1-7 days) exhibited hyperdense material (60-80 HU).
- Older thrombi (>7 days) predominantly showed hypodense material (≤50 HU).
- Vein dilatation and edema were common but not specific for thrombus age.
Conclusions:
- Non-enhanced CT can provide a rough estimation of DVT age.
- This imaging modality may assist in selecting appropriate therapies, such as fibrinolysis.
- Further studies can explore these findings in other vascular areas.
Abstract:
In 41 patients with deep vein thrombosis which had been demonstrated by duplex sonography, non-enhanced CT was performed at various levels before phlebography was carried out. Clots judged clinically to be fresh (1-7 days) show predominantly hyperdense thrombus material (60-80 Hu). With longer histories, on the other hand, the majority of thrombi were hypodense (50 Hu or less). Non-enhanced CT provided a rough indication of the age of a thrombus and may aid in deciding whether to use fibrinolysis. Dilatation of veins was found in 80% of the hyperdense early thrombi, but also in the presence of loose and old thrombi. This phenomenon and the presence of perivascular and soft tissue oedema does not indicate the type or age of the thrombus. These findings may be expected to occur also in other vascular areas.