Circulation, Vol 79, 810-814, Copyright © 1989 by American Heart Association
LA Killewich, GR Bedford, KW Beach and DE Strandness Jr
Duplex scanning has been proposed as a safe alternative to contrast
venography for diagnosing deep venous thrombosis, but its accuracy has not
been proved. In this prospective, double-blind study of 47 patients, the
sensitivity and specificity of duplex scan criteria were determined
relative to contrast venography for lower extremity deep venous thrombosis.
Criteria considered to show the presence of deep venous thrombosis included
visualization of thrombus (T), absence of spontaneous flow by Doppler
ultrasonography (F), absence of phasicity of flow with respiration (P), and
incompressibility of the vein with probe pressure (VC). When analyzed
individually, the variables T and F had low sensitivities (50% and 76%) but
high specificities (92% and 100%). VC had low values for both (79% and 67%,
respectively). The best single variable was P (sensitivity and specificity
= 92%). The best combinations of variables were T+P (sensitivity = 95%,
specificity = 83%), T+F+P (sensitivity = 95%, specificity = 83%), F+P
(sensitivity and specificity = 92%), and F+T (sensitivity = 92%,
specificity = 87%). The low specificity of vein incompressibility was
secondary to cases in which normal veins were difficult to compress in the
thigh. All false- negative cases were from isolated calf vein thrombi. We
conclude that isolated criteria from duplex scanning should not be used to
diagnose deep venous thrombosis. In cases of suspected calf vein
thrombosis, repeat duplex examination should be obtained in 3-4 days to
determine the most appropriate therapy. In equivocal cases of proximal vein
thrombosis, a contrast venogram should be obtained.
ARTICLES
Diagnosis of deep venous thrombosis. A prospective study comparing duplex scanning to contrast venography
Department of Surgery, University of Washington School of Medicine, Seattle 98195.
This article has been cited by other articles:
 |
|
 |
|
  S. Dhupar, R. Iorio, W. L. Healy, and K. Dhimitri A Comparison of Discharge and Two-Week Duplex Ultrasound Screening Protocols for Deep Venous Thrombosis Detection Following Primary Total Joint Arthroplasty J. Bone Joint Surg. Am., November 1, 2006; 88(11): 2380 - 2385. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Kluge, C. Mueller, J. Strunk, U. Lange, and G. Bachmann Experience in 207 combined MRI examinations for acute pulmonary embolism and deep vein thrombosis. Am. J. Roentgenol., June 1, 2006; 186(6): 1686 - 1696. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M Mantoni, L Larsen, J O Lund, L Henriksen, T Karlsmark, C Strandberg, J Ogstrup, S Ribel-Madsen, F Gottrup, and L Danielsen Evaluation of chronic venous disease in the lower limbs: comparison of five diagnostic methods Br. J. Radiol., July 1, 2002; 75(895): 578 - 583. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Schwarz, B. Schmidt, B. Schmidt,, and S. M. Schellong Interobserver Agreement of Complete Compression Ultrasound for Clinically Suspected Deep Vein Thrombosis Clinical and Applied Thrombosis/Hemostasis, January 1, 2002; 8(1): 45 - 49. [Abstract] [PDF]
|
|
|
|
 |
|
 Guidelines on diagnosis and management of acute pulmonary embolism Eur. Heart J., August 2, 2000; 21(16): 1301 - 1336. [PDF]
|
|
|
|
 |
|
 T. Sugimoto, M. Okada, T. Mukai, and Y. Morimoto Clinical Assessment of Vascular Thrombosis Using Indium-111 Platelet Scintigraphy Angiology, January 1, 2000; 51(1): 61 - 68. [Abstract] [PDF]
|
|
|
|
 |
|
 M. T Caps, M. H Meissner, M. J Tullis, N. L Polissar, R. A Manzo, B. K Zierler, W. L Chandler, and D E. Strandness Jr Venous thrombus stability during acute phase of therapy Vascular Medicine, February 1, 1999; 4(1): 9 - 14. [Abstract] [PDF]
|
|
|
|
|
|
F. Pasquariello, M. Kurol, S. Wiberg, M. Krekmanova, and J. Leppert Diagnosis of Deep Venous Thrombosis of the Lower Limbs: It Is Premature to Introduce Ultrasound as a Routine Method Angiology, January 1, 1999; 50(1): 31 - 36. [Abstract] [PDF]
|
|
|
|
 |
|
 D. E. Strandness JR Duplex Scanning in Reflux Vascular and Endovascular Surgery, May 1, 1997; 31(3): 240 - 242. [PDF]
|
|
|
|
 |
|
 W. R. Flinn, G. P. Sandager, M. B. Silva Jr, M. E. Benjamin, L. J. Cerullo, and M. Taylor Prospective Surveillance for Perioperative Venous Thrombosis: Experience in 2643 Patients Arch Surg, May 1, 1996; 131(5): 472 - 480. [Abstract] [PDF]
|
|
|
|
|
|
A. Markel, Y. Weich, and D. Gaitini Doppler Ultrasound in the Diagnosis of Venous Thrombosis Angiology, January 1, 1995; 46(1): 65 - 73. [Abstract] [PDF]
|
|
|
|
|
|
D. L. Keefe, N. Roistacher, and M. K. Pierri Evaluation of Suspected Deep Venous Thrombosis in Oncologic Patients Angiology, September 1, 1994; 45(9): 771 - 775. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Markel, R. A. Manzo, and D. E. Strandness Jr The Potential Role of Thrombolytic Therapy in Venous Thrombosis Arch Intern Med, June 1, 1992; 152(6): 1265 - 1267. [Abstract] [PDF]
|
|
|
|
|
|
A. Markel, R. A. Manzo, R. O. Bergelin, and D. E. Strandness Jr Pattern and Distribution of Thrombi in Acute Venous Thrombosis Arch Surg, March 1, 1992; 127(3): 305 - 309. [Abstract] [PDF]
|
|
|
|
 |
|
 S. J. Arkfeld, G. A. Rouse, and M. de Lange Deep Venous Thrombosis of the Lower Extremity: Current Sonographic Concepts and Techniques Journal of Diagnostic Medical Sonography, January 1, 1991; 7(1): 2 - 6. [Abstract] [PDF]
|
|
|
|
|
|
P. C. Smith Noninvasive venous investigation Vascular Medicine, September 1, 1990; 1(2): 139 - 166. [PDF]
|
|