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Updated: Aug 5, 2026
Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
Ultrafast shear-wave elastography for pediatric deep vein thrombosis: a prospective feasibility study
Julien Aguet1,2, Nikan Fakhari3,4, Luc Mertens5,6
1Department of Medical Imaging, University of Toronto, Toronto, Canada. julien.aguet@sickkids.ca.
Insights
Ultrafast shear-wave elastography (SWE) is feasible for measuring pediatric deep vein thrombosis (DVT) stiffness. Thrombus stiffness, measured by shear-wave velocity (SWV), increases over time in children with DVT.
Area of Science:
- Pediatric radiology
- Vascular imaging
- Biomaterials science
Background:
- Deep vein thrombosis (DVT) in children is a significant clinical concern.
- Accurate assessment of thrombus characteristics is crucial for effective management.
- Current methods for evaluating thrombus stiffness are limited, especially in pediatric populations.
Purpose of the Study:
- To assess the feasibility of ultrafast shear-wave elastography (SWE) for quantifying thrombus stiffness in pediatric deep vein thrombosis (DVT).
- To explore the changes in thrombus stiffness over time using SWE.
- To establish SWE as a potential non-invasive biomarker for thrombus maturation in children.
Main Methods:
- A prospective, single-center study enrolled pediatric patients (<18 years) with confirmed DVT.
- Bedside ultrafast SWE ultrasound was performed using a research platform and a linear transducer.
- Mean shear-wave velocity (SWV) was calculated using MATLAB, with measurements planned at multiple time points post-diagnosis.
Main Results:
- Ultrafast SWE was feasible in 19 out of 35 pediatric DVT patients, with higher success rates in older children and occlusive DVTs.
- A statistically significant increase in mean SWV (thrombus stiffness) of 0.012 m/s per day was observed over time (P<0.001).
- Older age at DVT diagnosis and female sex were independently associated with increased SWV.
Conclusions:
- Ultrafast SWE is a feasible technique for quantifying thrombus stiffness in pediatric DVT, particularly in older children and those with occlusive thrombi.
- Longitudinal analysis revealed that thrombus stiffness increases over time, suggesting a maturation process.
- Ultrafast SWE shows promise as a non-invasive quantitative biomarker for monitoring thrombus maturation in pediatric DVT.
Objective:
To evaluate the feasibility of ultrafast shear-wave elastography (SWE) for quantifying thrombus stiffness in pediatric deep vein thrombosis (DVT), and to explore changes over time.
Materials And Methods:
In this single-center prospective study, pediatric patients (<18 years) with ultrasound-confirmed DVT were prospectively enrolled. Bedside SWE ultrasound was performed using a research platform (Vantage-256, Verasonics, Kirkland, Washington, USA) with a 6.9-MHz linear transducer. Mean shear-wave velocity was computed using MATLAB software. To assess shear-wave velocity (SWV) changes over time (exploratory analysis), SWE was planned at three timepoints (0-5 days, 6 days-6 weeks, and 6-16 weeks from DVT diagnosis). Feasibility was defined as the ability to obtain SWV measures. Changes in SWV over time in patients with ≥2 successful SWE were estimated using generalized estimating equations. The model was adjusted for patient age at DVT and sex.
Results:
In total, 35 patients (median age 1.4 years [range, 0.0-17.6], 63% male) were enrolled. SWE was successful in 19 patients, with a higher frequency of success in older patients and in occlusive DVTs. Fifteen of the 19 patients had ≥2 SWE. We documented an increase in SWV over time, with an increase in mean velocity of 0.012 m/s per day (P<0.001). Older age at DVT and female sex were associated with increased SWV, independent of time from index DVT.
Conclusions:
Ultrafast SWE was feasible in pediatric DVT, particularly in older patients and in those with occlusive DVT. In exploratory longitudinal analyses, SWV increased over time, supporting further investigation of ultrafast SWE as a non-invasive quantitative biomarker of thrombus maturation in children.
