title: Magnetic resonance direct thrombus imaging differentiates acute recurrent ipsilateral deep vein thrombosis from residual thrombosis.
abstract: Accurate diagnostic assessment of suspected ipsilateral recurrent deep vein thrombosis (DVT) is a major clinical challenge because differentiating between acute recurrent thrombosis and residual thrombosis is difficult with compression ultrasonography (CUS). We evaluated noninvasive magnetic resonance direct thrombus imaging (MRDTI) in a prospective study of 39 patients with symptomatic recurrent ipsilateral DVT (incompressibility of a different proximal venous segment than at the prior DVT) and 42 asymptomatic patients with at least 6-month-old chronic residual thrombi and normal D-dimer levels. All patients were subjected to MRDTI. MRDTI images were judged by 2 independent radiologists blinded for the presence of acute DVT and a third in case of disagreement. The sensitivity, specificity, and interobserver reliability of MRDTI were determined. MRDTI demonstrated acute recurrent ipsilateral DVT in 37 of 39 patients and was normal in all 42 patients without symptomatic recurrent disease for a sensitivity of 95% (95% CI, 83% to 99%) and a specificity of 100% (95% CI, 92% to 100%). Interobserver agreement was excellent (κ = 0.98). MRDTI images were adequate for interpretation in 95% of the cases. MRDTI is a sensitive and reproducible method for distinguishing acute ipsilateral recurrent DVT from 6-month-old chronic residual thrombi in the leg veins.
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands;
authors.forename: Melanie
authors.initials: M
authors.lastname: Tan
authors.affiliation: Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands;
authors.forename: Gerben C
authors.initials: GC
authors.lastname: Mol
authors.affiliation: Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands;
authors.forename: Cornelis J
authors.initials: CJ
authors.lastname: van Rooden
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands;
authors.forename: Frederikus A
authors.initials: FA
authors.lastname: Klok
authors.affiliation: Department of Radiology, Deventer Hospital, Deventer, The Netherlands;
authors.forename: Robin E
authors.initials: RE
authors.lastname: Westerbeek
authors.affiliation: Department of Internal Medicine, Rijnland Hospital, Leiderdorp, The Netherlands; and.
authors.forename: Antonio
authors.initials: A
authors.lastname: Iglesias Del Sol
authors.affiliation: Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands;
authors.forename: Marcel A
authors.initials: MA
authors.lastname: van de Ree
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands;
authors.forename: Menno V
authors.initials: MV
authors.lastname: Huisman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D013927:Thrombosis / Q000145:classification* / Q000473:pathology*; D014680:Veins / Q000473:pathology*; D055815:Young Adult