title: Calf sonography for detecting deep venous thrombosis in symptomatic patients: experience and review of the literature.
abstract: OBJECTIVE
  We determined the accuracy of sonography in the detection of isolated calf deep venous thrombosis (DVT) and the rate of indeterminate ultrasound examinations in patients with physical signs or symptoms suggestive of DVT.
  
  
  METHODS
  We reviewed the medical literature (MEDLINE) to determine the accuracy of sonography and the frequency of indeterminate studies in detecting isolated calf DVT in patients with physical signs or symptoms suggestive of DVT. A meta-analysis was used to derive summary measures of sensitivity, specificity, and accuracy from studies in which 5 or more isolated calf DVT were identified. Frequencies of indeterminate examinations were recorded for studies in which these data were provided, and we pooled these results with our own data for 196 patients.
  
  
  RESULTS
  The meta-analysis revealed that sonography correctly identified isolated calf DVT in 49 of 53 extremities (sensitivity, 92.5%; 95% confidence interval, 81.8-97.9%) and correctly identified the absence of calf DVT in 157 of 159 extremities (specificity, 98.7%; 95% confidence interval, 95.5-99. 9%), yielding an accuracy of 97.2% (95% confidence interval, 93.9-99. 0%) for ultrasound examinations considered diagnostic. However, when evaluating our patient population and the literature, we found a substantial number of indeterminate studies (overall rate of 54.6% in 463 extremities), with a wide variation in the reported frequency of indeterminate studies (9.3-82.7%).
  
  
  CONCLUSIONS
  Sonography is highly accurate in detecting isolated calf DVT in symptomatic patients, but indeterminate studies occur frequently, with a wide range of reported rates. Each ultrasound laboratory should evaluate its own rate of indeterminate studies.
authors.affiliation: Department of Radiology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 648, Rochester, New York 14642, USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Gottlieb
authors.forename: J
authors.initials: J
authors.lastname: Widjaja
authors.forename: L
authors.initials: L
authors.lastname: Tian
authors.forename: D J
authors.initials: DJ
authors.lastname: Rubens
authors.forename: S L
authors.initials: SL
authors.lastname: Voci
mesh_terms: D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging*