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Observer variation in lower limb venography

E Sauerbrei, J G Thomson, M S McLachlan

    Journal of the Canadian Association of Radiologists
    |March 1, 1981
    PubMed
    Summary
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    Venography performed without fluoroscopy often results in uncertain findings for deep vein thrombosis. Fluoroscopic guidance in a semi-erect position improves diagnostic accuracy for venograms.

    Area of Science:

    • Radiology
    • Vascular Imaging
    • Diagnostic Accuracy

    Background:

    • Venography is a key diagnostic tool for deep vein thrombosis (DVT).
    • Previous studies suggest fluoroscopic control improves diagnostic reliability.
    • The current study evaluates venography performed without fluoroscopy.

    Purpose of the Study:

    • To assess the diagnostic reliability of venography performed without fluoroscopic guidance.
    • To compare observer agreement in supine venography versus fluoroscopically-controlled venography.
    • To determine the impact of patient positioning on venographic interpretation.

    Main Methods:

    • Three radiologists interpreted 34 venograms (68 limbs) performed in a supine position without fluoroscopy.
    • Observers assessed 11 major veins per limb for thrombus presence (absent, doubtful, presumed, definite, or no opinion).

    Related Experiment Videos

  • Data were analyzed using the kappa statistic and compared to a prior study using fluoroscopic control.

    • Main Results:

    • Observers frequently expressed "no opinion," particularly for anterior tibial and iliac veins.
    • Excluding these examinations, observer variation was similar to the previous study (approx. 10% disagreement).
    • The high rate of "no opinion" significantly limits the diagnostic value of non-fluoroscopic, supine venography.

    Conclusions:

    • Venography performed supine without fluoroscopy has limited diagnostic value due to frequent indeterminate results.
    • Fluoroscopically-controlled venography with patients in a semi-erect position is the preferred method.
    • Improving diagnostic certainty in DVT imaging is crucial for patient management.