Contrast-enhanced US in the assessment of the ilio-caval axis in deep venous thrombosis.
OBJECTIVE
To assess the feasibility and the accuracy of a new technique in the evaluation of deep venous thrombosis (DVT) in the ilio-caval axis.


METHODS
Thirty-eight patients with suspected DVT were prospectively examined with unenhanced and enhanced colour-Doppler ultrasonography, and ascending contrast venography. Thirty-five out of 38 patients underwent US phlebography, consisting in manual injection of Levovist (Schering Ag, Berlin, Germany) through a 21-G cannula in a suitable dorsal vein of the foot ipsilateral to the suspected DVT. Three patients in whom it was not possible to cannulate a dorsal vein of foot underwent contrast-enhanced US after injection of Levovist through an antecubital vein, but where excluded from the present study. A contrast venogram was nonetheless carried out in all out three patients for comparison with the US-phlebography findings.


RESULTS
US-phlebography allowed better definition of the presence and extension of deep vein thrombosis in all patients, when compared to conventional color-Doppler US. In the evaluation of suspected acute thrombosis, the comparative efficacy of Doppler-US and US phlebography compared with ascending phlebography as the gold standard, was as follows: sensitivity of 85.7% and 90%, specificity of 71.4 and 100%, accuracy of 80.9 and 95.2%, PPV of 85.7, and 100%, and NPV of 71.4, and 75%, respectively. In the assessment of chronic thrombosis, US and US phlebography achieved a sensitivity of 90% and 100%, a specificity of 75% and 100%, an accuracy of 85.7% and 100%, a PPV of 100, 100%, a NPV of 87.5, 100%, respectively. No complications related to US phlebography were observed.


CONCLUSIONS
US-phlebography is a promising tool in the assessment of deep vein thrombosis, being highly accurate and feasible. However, further studies based on larger series are mandatory to confirm our promising results and establish a standardised role for this new technique.
Ricci
Paolo
P
Dipartimento di Scienze Radiologiche, Università degli Studi di Roma La Sapienza, Policlinico Umberto I, Roma, Italy. paolo.ricci@uniroma1.it
Intrieri
Francesco
F
Cantisani
Vito
V
Drudi
Francesco M
FM
Fasoli
Fabrizio
F
Arduini
Federico
F
Pagliara
Elisa
E
Benedetti Valentini
Fabrizio
F
Passariello
Roberto
R
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003287:Contrast Media; D005260:Female; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D011134:Polysaccharides; D011446:Prospective Studies; D018615:Ultrasonography, Doppler, Color; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging*
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508