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[Diagnosis of floating venous thrombi by spiral CT phlebography]
M Gartenschläger1, K J Klose, J A Schmidt
1Medizinisches Zentrum für Radiologie, Philipps Universität Marburg.
Insights
Spiral CT accurately identifies deep vein thrombosis (DVT) adherence, unlike conventional venography which may overestimate free-floating thrombi. This imaging technique improves DVT assessment.
Area of Science:
- Vascular imaging
- Radiology
- Thrombosis diagnostics
Background:
- Deep venous thrombosis (DVT) diagnosis relies on imaging modalities to differentiate between free-floating and adherent thrombi.
- Accurate characterization of thrombus attachment is crucial for guiding treatment decisions in DVT management.
Observation:
- This study evaluated spiral computed tomography (CT) against conventional venography and color Doppler flow imaging for assessing thrombus adherence in proximal deep leg veins.
- 16 patients with confirmed DVT underwent spiral CT and color Doppler imaging after conventional venography.
Findings:
- Spiral CT identified 15 out of 16 thrombi as adherent to the vessel wall, closely matching conventional venography findings for adherence.
- Conventional venography suggested 8 thrombi were free-floating, whereas spiral CT found only one such case, indicating a significant discordance (p=0.0002).
- Color Doppler imaging showed 3 free-floating thrombi, with one discordant finding compared to conventional venography.
Implications:
- Computed tomography (CT) demonstrates high agreement with conventional venography for detecting thrombus adherence.
- Conventional venography may overestimate the incidence of free-floating thrombi, potentially impacting clinical management strategies.
- Spiral CT offers a more reliable assessment of thrombus adherence in deep venous thrombosis.
Purpose:
Evaluation by means of spiral CT as to whether or not a thrombus in a proximal deep vein of the leg is floating or adherent to the vessel wall.
Methods:
Local application of contrast agent into an ipsilateral dorsal foot vein and spiral CT were used to examine 16 consecutive cases with deep venous thrombosis proven at conventional venography; in addition, colour Doppler flow imaging was performed.
Results:
At conventional venography, 8/16 thrombi appeared to be floating and the remaining 8/16 were adherent to the vessel wall. Spiral-CT showed 15/16 thrombi to be adherent to the vessel wall; the floating thrombus correlated with findings in conventional venography. At colour Doppler flow imaging 3/16 thrombi were considered floating, one of them was discordant to conventional venography. The comparison of conventional venography to spiral-CT demonstrates complete agreement for adherence to vessel wall seen in conventional venography (p = 1,0) and significant discordance in cases with free-floating appearance in conventional venography (p = 0,0002).
Conclusion:
Adherence of thrombi to the wall of the vessel at conventional venography is in agreement with computed tomography. Conventional venography probably overestimates the prevalence of free floating thrombi.