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Updated: May 26, 2026

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis
Published on: June 2, 2015
Dual-energy computed tomography venography parameters as potential indicators for pulmonary embolism in deep vein
Xing-Hua Zhang1, Bei-Bei Ma2, Jin-Xing Zhang2
1Department of Oncology and Vascular Intervention, Jinhua Municipal Central Hospital, Jinhua, China.
Background:
The nonspecific nature of pulmonary embolism (PE) in patients initially diagnosed as symptomatic deep vein thrombosis (DVT) often leads to instances of underdiagnosis. The thrombus density of the DVT could serve as a predictive factor for PE. Dual-energy (DE) computed tomography (CT) obtains extra attenuation measurements to differentiate thrombus composition. Therefore, this retrospective study aimed to investigate whether DE-CT venography (DE-CTV) parameters of the DVT could predict the asymptomatic PE occurrence in a single tertiary institution in China.
Methods:
Between March 2020 and October 2023, patients with DVT diagnosed through DE-CTV were retrospectively identified. Thrombus density ratio, normalized iodine concentration (NIC, %), normalized effective atomic number (NZeff, %), and the slope of the spectral Hounsfield unit curve (λHU) were calculated. Risk factors associated with PE were identified using multivariate logistic regression analysis. Receiver operating characteristic (ROC) analysis was used to assess the value of these parameters for predicting the risk of PE.
Results:
Finally, a total of 49 patients were included in this study, including 24 patients in the DVT-only group and 25 patients in the DVT-PE group. Thrombus density ratio, NIC, NZeff, and λHU were significantly higher in the DVT-PE group than in the DVT-only group (P<0.05). Multivariate analyses revealed that NIC was an independent predictor of PE [odds ratio =1.25, 95% confidence interval (CI): 1.09-1.53; P=0.009]. ROC analysis showed that NIC >24.4% was the optimal cutoff for predicting PE with an area under the curve of 0.920 (95% CI: 0.846-0.994, P<0.001).
Conclusions:
The NIC derived from DE-CTV is independently associated with asymptomatic synchronous PE in patients with lower-extremity DVT. The proposed NIC cutoff value is exploratory and requires further validation.
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