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Diagnosis of Lower-Limb Deep Venous Thrombosis: A Prospective Blinded Study of Magnetic Resonance Direct Thrombus Imaging

Douglas G.W. Fraser, MRCP; Alan R. Moody, FRCR; Paul S. Morgan, PhD; Anne L. Martel, PhD; and Ian Davidson, FRCR
[+] Article, Author, and Disclosure Information

From University Hospital, Nottingham, United Kingdom.

Grant Support: By the British Heart Foundation (grant no. RB2305).

Requests for Single Reprints: Alan Moody, FRCR, Department of Academic Radiology, B Floor, Medical School, University Hospital, Derby Road, Nottingham NG7 2UH, United Kingdom; e-mail, Alan.Moody@nottingham.ac.uk.

Current Author Addresses: Drs. Fraser, Moody, and Morgan: Department of Academic Radiology, University Hospital, Derby Road, Nottingham NG7 2UH, United Kingdom.

Dr. Martel: Department of Medical Physics, University Hospital, Derby Road, Nottingham NG7 2UH, United Kingdom.

Dr. Davidson: Department of Radiology, University Hospital, Derby Road, Nottingham NG7 2UH, United Kingdom.

Author Contributions: Conception and design: A.R. Moody.

Analysis and interpretation of the data: D.G.W. Fraser, A.R. Moody, A.L. Martel,

Drafting of the article: D.G.W. Fraser, A.R. Moody, P.S. Morgan.

Critical revision of the article for important intellectual content: D.G.W. Fraser, A.R. Moody, A.L. Martel, I. Davidson.

Final approval of the article: D.G.W. Fraser, A.R. Moody, A.L. Martel, I. Davidson.

Obtaining of funding: A.R. Moody.

Administrative, technical, or logistic support: A.R. Moody, P.S. Morgan.

Collection and assembly of data: D.G.W. Fraser, P.S. Morgan, I. Davidson.

Ann Intern Med. 2002;136(2):89-98. doi:10.7326/0003-4819-136-2-200201150-00006
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Despite considerable recent advances in diagnostic techniques for lower-limb deep venous thrombosis (DVT), current methods have disadvantages. Ultrasonography, the most accurate noninvasive test, is widely available and cheap. As such, it has largely replaced venography as the test of first choice for symptomatic DVT. In a recent meta-analysis, the sensitivity of ultrasonography was 89% overall for symptomatic DVT and 97% for above-knee thrombosis (1). Large outcome studies have shown that patients may be safely left untreated after a negative result on ultrasonography if they have a low clinical risk score, a low D-dimer level, or a negative result on repeated ultrasonography at 1 week (24). However, these strategies may be complex and still require 3% to 34% of outpatients and most inpatients to undergo repeated ultrasonography at 1 week (24). In practice, retesting after 1 week is inconvenient, and physicians often rely on a single test or request immediate venography (5). Other problems with ultrasonography include poor sensitivity for asymptomatic disease, difficulties in diagnosing DVT recurrence, and limited visualization in the pelvis (1, 67).

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Figure 1.
Outline of the study.

DVT = deep venous thrombosis; MRDTI = magnetic resonance direct thrombus imaging.

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Figure 2.
Magnetic resonance direct thrombus imaging in three patients.

A. Extensive below-knee deep venous thrombosis (DVT) extending into the right popliteal vein (arrows). B. Large above-knee DVT extending up to the right common femoral vein (arrows). Poor fat suppression is seen in the left knee. C. Pelvic thrombosis in the left common and internal and external iliac veins, with extension into the common femoral vein (single arrows) and long saphenous vein (double arrows). FH = femoral head; Kn = knee joint; L/S = lumbosacral joint.

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Figure 3.
Venography, magnetic resonance direct thrombus imaging, and ultrasonography in a patient with gastrocnemius thrombus.

A. Venogram. The gastrocnemius veins have not been visualized (arrow). B. Magnetic resonance direct thrombus imaging. The technique demonstrates high-signal filling paired gastrocnemius veins (arrow). C. Ultrasonographic image. This image under compression shows a gastrocnemius vein filled with thrombus (arrow).

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Summary for Patients

Using Magnetic Resonance Direct Thrombus Imaging To Diagnose Deep-Vein Thrombosis in the Lower Legs

The summary below is from the full report titled “Diagnosis of Lower-Limb Deep Venous Thrombosis: A Prospective Blinded Study of Magnetic Resonance Direct Thrombus Imaging.” It is in the 15 January 2002 issue of Annals of Internal Medicine (volume 136, pages 89-98). The authors are DGW Fraser, AR Moody, PS Morgan, AL Martel, and I Davidson.


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