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Updated: Aug 8, 2026
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A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis
Published on: June 2, 2015
How should we diagnose suspected deep-vein thrombosis?
S Goodacre1, M Stevenson, A Wailoo
1Medical Care Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA. s.goodacre@sheffield.ac.uk
Summary
For diagnosing deep-vein thrombosis (DVT), selectively using ultrasound in high-risk patients or those with a positive D-dimer test is most cost-effective. Routine radiological testing for all patients is not recommended for the NHS.
Area of Science:
- Medical diagnostics
- Health economics
- Evidence-based medicine
Background:
- Multiple diagnostic approaches exist for suspected deep-vein thrombosis (DVT).
- Formal comparisons of these diagnostic strategies are limited.
- Optimizing diagnostic pathways is crucial for efficient healthcare delivery.
Purpose of the Study:
- To identify the most cost-effective strategy for diagnosing DVT within the UK National Health Service (NHS).
- To compare the economic and clinical value of various DVT diagnostic pathways.
Main Methods:
- Systematic review and meta-analysis of diagnostic test performance.
- Cost-effectiveness analysis using a decision-analysis model.
- Estimation of costs, accuracy, and quality-adjusted life-years (QALYs) for 18 different strategies.
Main Results:
- The optimal strategy involves discharging patients with low/intermediate Wells score and negative D-dimer.
- Ultrasound should be limited to patients with high Wells score or positive D-dimer.
- Strategies involving universal radiological testing were only cost-effective at higher willingness-to-pay thresholds (£40,000/QALY).
Conclusions:
- Selective ultrasound use based on clinical risk and D-dimer status is the preferred DVT diagnostic strategy.
- Widespread radiological testing for all patients is not a cost-effective allocation of NHS resources.
- This finding supports evidence-based, resource-conscious diagnostic practices.
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