Thromb Haemost 1993; 70(03): 404-407
DOI: 10.1055/s-0038-1649594
Original Article
Clinical Studies
Schattauer GmbH Stuttgart

Comparison of Real-Time B-Mode Ultrasonography and Doppler Ultrasound with Contrast Venography in the Diagnosis of Venous Thrombosis in Symptomatic Outpatients

Alberto Cogo
1   The Institute of Medical Semeiotics, Department of Patologia Medica II, University of Padua, Padua, Italy
,
Anthonie W A Lensing
2   The Center for Thrombosis, Haemostasis, Atherosclerosis and Inflammation Research, Academic Medical Centre, Amsterdam, The Netherlands
,
Paolo Prandoni
1   The Institute of Medical Semeiotics, Department of Patologia Medica II, University of Padua, Padua, Italy
,
Harry R Büller
2   The Center for Thrombosis, Haemostasis, Atherosclerosis and Inflammation Research, Academic Medical Centre, Amsterdam, The Netherlands
,
Antonio Girolami
1   The Institute of Medical Semeiotics, Department of Patologia Medica II, University of Padua, Padua, Italy
,
Jan Wouter ten Cate
2   The Center for Thrombosis, Haemostasis, Atherosclerosis and Inflammation Research, Academic Medical Centre, Amsterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

Received 12 January 1993

Accepted after revision 23 April 1993

Publication Date:
05 July 2018 (online)

Summary

In a prospective study, we compared real-time B-mode ultrasonography, using the simple criteria of common femoral and popliteal vein compressibility (Compression US), and Doppler ultrasound, using a standardized technique (Doppler US), with contrast venography in 158 consecutive outpatients symptomatic for deep-vein thrombosis of the lower limbs (DVT). For proximal vein thrombosis, the sensitivities documented for Compression US and Doppler US were 100% (95% CI: 90% to 100%) and 89% (95% CI: 76% to 96%), respectively. This difference is not statistically significant (p = 0.056). For all thrombi (including isolated calf-vein thrombosis), however, the sensitivity of Compression US was significantly higher than that of Doppler US (95% and 76%, respectively; p <0.04). Compression US was normal in all patients with normal venogram (specificity, 100%; 95% CI: 95% to 100%), while Doppler US was abnormal in two patients with normal venogram (specificity, 98%; 95% CI: 92% to 100%). The specificities of the two tests did not differ significantly. The results of our comparison suggest that Compression US is superior to Doppler US in the detection of DVT in symptomatic outpatients.

 
  • References

  • 1 Haeger K. Problems of acute deep venous thrombosis. I. The interpretation of signs and symptoms. Angiology 1969; 20: 219-223
  • 2 O’Donnel TF, Abbott WM, Athanasoulis CA, Millan VG, Callow AD. Diagnosis of deep venous thrombosis in the out-patient by venography. Surg Gynecol Obstet 1980; 150: 69-74
  • 3 Cranley JJ, Canos AJ, Sull WJ. The diagnosis of deep-vein thrombosis: fallibility of clinical symptoms and signs. Arch Surg 1976; 111: 34-36
  • 4 Rabinov K, Paulin S. Roentgen diagnosis of venous thrombosis in the leg. Arch Surg 1972; 104: 134-144
  • 5 Bettman MA, Robbins A, Braun SD, Wetzner S, Dunnick NR, Finkeistein J. Contrast venography of the leg: diagnostic efficacy, tolerance and complication rates with ionic and non-ionic contrast media. Radiology 1987; 165: 113-116
  • 6 Lensing AWA, Prandoni P, Büller HR, Cogo A, Casara D, ten Cate JW. Lower extremity venography with iohexol: results and complications. Radiology 1990; 77: 503-505
  • 7 Hull RD, Secker-Walker RH, Hirsh J. Diagnosis of deep vein thrombosis. In: Hemostasis and Thrombosis. Colman RW, Hirsh J, Marder VJ, and Salzman EW. (eds) JB Lippincott Company; Philadelphia, PA: 1987. pp 1220-1239
  • 8 Büller HR, Lensing AWA, Hirsh J, ten Cate JW. Deep vein thrombosis: new noninvasive tests. Thromb Haemostas 1991; 66: 133-137
  • 9 Dosick SM, Blackmore WS. The role of Doppler ultrasound in acute deep-vein thrombosis. Am J Surg 1978; 136: 265-268
  • 10 Hull DR, van Aken WG, Hirsh J, Gallus AG, Hoicka G, Turpie AGG, Walker I, Gent M. Impedance plethysmography using the occlusive cuff technique in the diagnosis of venous thrombosis. Circulation 1976; 53: 696-700
  • 11 Lensing AWA, Levi MM, Büller HR, Prandoni P, Vigo M, Agnelli G, Lupatelli L, Huisman MV, ten Cate JW. An objective Doppler method for the diagnosis of deep-vein thrombosis. Ann Intern Med 1990; 113: 9-13
  • 12 Cronan JJ, Dorfmann GS, Scola FH, Schepps B, Alexander J. Deep venous thrombosis of the lower extremity: US assessment using vein compression. Radiology 1987; 162: 191-194
  • 13 Lensing AWA, Prandoni P, Brandjes D, Huisman PM, Vigo M, Tomasella G, Krekt J, ten Cate JW, Huisman MV, Büller HR. Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med 1989; 320: 342-345
  • 14 Becker MB, Philbrick JT, Abbitt PL. Real-time ultrasonography for the diagnosis of lower extremity deep venous thrombosis. The wave of the future?. Arch Intern Med 1989; 149: 1731-1734
  • 15 Wheeler HB, Anderson Jr. FA. Can noninvasive tests be used as the basis for treatment of deep-vein thrombosis?. Bernstein EF. (ed) C. V. Mosby; St Louis, MO: 1982: 545-559
  • 16 Hull RD, Hirsh J, Carter CJ, Jay RM, Ockelford PA, Büller HR, Turpie AGG, Powers P, Kinch D, Dodd PE, Gill GJ, Ledere JR, Gent M. Diagnostic efficacy of impedance plethysmography for clinical suspected deep-vein thrombosis: a randomized trial. Ann Intern Med 1985; 102: 21-28
  • 17 Huisman MV, Büller HR, ten Cate JW, Vreeken J. Serial impedance plethysmography for suspected deep venous thromosis. The Amsterdam general practitioner study. N Engl J Med 1986; 314: 823-828
  • 18 Moser KM, Lemoine JR. Is embolic risk conditioned by location of deep venous thrombosis?. Ann Intern Med 1981; 94: 439-444
  • 19 Prandoni P, Lensing AWA, Huisman MV, Jonker JJC, Vigo M, Borm JJJ, Büller HR, Sing AK, Carta M, ten Cate JW. A new computerized impedance plethysmography: accuracy in the detection of proximal deep vein thrombosis in symptomatic outpatients. Thromb Haemostas 1991; 65: 229-232
  • 20 Prandoni P, Lensing AWA, Büller HR, Carta M, Vigo M, Cogo A, Cuppini S, ten Cate JW. Failure of computerized impedance plethysmography in the diagnostic management of patients with clinically suspected deep vein thrombosis. Thromb Haemostas 1991; 65: 233-236
  • 21 Hirsh J. Reliability of noninvasive tests for the diagnosis of clinically suspected deep vein thrombosis. Thromb Haemostas 1991; 65: 221-222
  • 22 van Ramshorst B, Legemate DA, Verzijlbergen JF, Hoeneveld H, Eikelboom BC, de Valois JC, Meuwissen OJ. Duplex scanning in the diagnosis of acute deep vein thrombosis of the lower extremities. Eur J Vase Surg 1991; 5 (03) 255-260
  • 23 Lensing AWA, Prandoni P. Distribution of venous thrombi in symptomatic patients. Thromb Haemostas 1991; 65 (s) 1176