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Color Doppler sonographic imaging in the assessment of upper-extremity deep venous thrombosis
G J Knudson1, D A Wiedmeyer, S J Erickson
1Radiology Associates of Appleton, WI 54912.
Insights
Color Doppler flow imaging accurately detects upper-extremity deep venous thrombosis (DVT). While sensitive and specific, further imaging may be needed for suspected central venous obstruction.
Area of Science:
- Vascular Imaging
- Medical Diagnostics
Background:
- Deep venous thrombosis (DVT) in the upper extremities poses diagnostic challenges.
- Accurate and noninvasive diagnostic tools are crucial for timely DVT management.
Purpose of the Study:
- To evaluate the diagnostic accuracy of Color Doppler flow imaging (CDFI) for upper-extremity DVT.
- To determine the sensitivity and specificity of CDFI compared to other imaging modalities and clinical follow-up.
Main Methods:
- Color Doppler flow imaging was performed on 130 extremities in 91 patients with suspected upper-extremity DVT.
- Correlation was established using venography, CT, MR imaging, and clinical follow-up in 84 patients.
- Sensitivity and specificity of CDFI were calculated based on imaging correlation.
Main Results:
- CDFI detected thrombi in 30% of studies.
- Imaging correlation showed a sensitivity of 78% and specificity of 92% for CDFI.
- False negatives occurred with subclavian vein imaging difficulties; false positives with extrinsic compression; central venous obstructions were missed.
Conclusions:
- Color Doppler flow imaging is an accurate, noninvasive method for evaluating upper-extremity deep venous thrombosis.
- Additional imaging may be necessary when CDFI is negative and central venous thrombosis is suspected.
Abstract:
Color Doppler flow imaging with linear-array transducers was performed in 130 extremities in 91 patients with suspected upper-extremity deep venous thrombosis. Thrombi were detected in 39 studies (30%). Eighty-four patients had either imaging examinations (22 studies comprising venography in 20 patients, CT in one, and MR imaging in one) or clinical follow-up (99 studies) for correlation. In studies with imaging correlation, the sensitivity of the Doppler studies was 78% and the specificity was 92%. There were two false-negative examinations in which the proximal subclavian vein either could not be imaged or the anatomy was distorted. There was one false-positive color Doppler diagnosis of deep venous thrombosis in a case of partial obstruction of the subclavian vein caused by extrinsic compression. There were no known additional errors in color Doppler imaging in patients who had clinical follow-up. Four cases of isolated superior vena cava or proximal innominate vein obstruction were missed by color Doppler imaging. Color Doppler flow imaging is an accurate, noninvasive method for the evaluation of upper-extremity deep venous thrombosis. Other imaging tests may be required when the color Doppler study is negative and central venous thrombosis is suspected.