title: Contrast sonovenography - Is this the answer to complex deep vein thrombosis imaging?
abstract: BACKGROUND
  Deep vein thrombosis (DVT) is a potentially fatal condition causing significant morbidity and mortality in the patient population. Ultrasound (USS) is the mainstay for detecting DVT. This can sometimes be difficult in hostile limbs due to factors such as large body habitus and oedema. This pilot study investigated contrast-enhanced ultrasound (CEUS) as a viable method to improve visualisation of the venous system of the lower limb.
  
  
  METHODS
  Patients at high risk for DVT were selected after an initial negative USS. A follow-up scan was performed 1 week later utilising standard B-mode imaging with a curvilinear 3-5 MHz transducer array. After the fundamental scan, intravenous Sonovue™ contrast was administered and visualisation of the proximal limb veins and visualisation gains in distance were mapped onto a proforma.
  
  
  RESULTS
  Twelve patients were selected. Visualisation was not improved in the common femoral vein (CFV) but increases in full visualisation were demonstrated in the femoral vein (FV) and popliteal vein (Pop V) from (n = 8) 67% and (n = 10) 83-100% in both veins, respectively. Significant gains in visualisation distance were observed in the posterior tibial vein (PTV) (p = 0.0005) and peroneal vein (Per V) (p = 0.02) with increased full visualisation of the Per V from (n = 3) 25% to (n = 7) 58%.
  
  
  CONCLUSIONS
  CEUS is a viable and clinically safe method for increasing visualisation of the deep venous system. It has the potential to improve visualisation of the lower limb venous system, reducing follow-up costs and diagnostic uncertainty for patients and the clinician.
authors.affiliation: Department of Academic Radiology, Hull Royal Infirmary, Hull, UK.
authors.forename: Agw
authors.initials: A
authors.lastname: Smith
authors.affiliation: Department of Academic Radiology, Hull Royal Infirmary, Hull, UK.
authors.forename: P
authors.initials: P
authors.lastname: Parker
authors.affiliation: Department of Academic Radiology, Hull Royal Infirmary, Hull, UK.
authors.forename: O
authors.initials: O
authors.lastname: Byass
authors.affiliation: Department of Academic Radiology, Hull Royal Infirmary, Hull, UK.
authors.forename: K
authors.initials: K
authors.lastname: Chiu
keywords: Contrast enhanced ultrasound (CEUS); Doppler ultrasound; deep vein thrombosis; microbubble contrast agents