Prospective Study of Color Duplex Ultrasonography Compared with Contrast Venography in Patients Suspected of Having Deep Venous Thrombosis of the Upper Extremities

18 June 2002 | Volume 136 Issue 12 | Pages 865-872

Background: The optimal strategy for diagnosis of deep venous thrombosis (DVT) is less well established for the upper extremities than for the lower extremities. Duplex color ultrasonography can be difficult to perform in the upper extremities because of their anatomy, and contrast venography is often indicated. Moreover, limited data exist on the use of duplex color ultrasonography in this setting.

Objective: To determine the accuracy of duplex ultrasonography for diagnosis of DVT of the upper extremities.

Design: Prospective study of duplex ultrasonography compared with venography.

Setting: A teaching hospital in Amsterdam, the Netherlands.

Patients: 126 consecutive inpatients and outpatients with suspected DVT of the upper extremities.

Measurements: Contrast venography was obtained after duplex ultrasonography and was judged independently. A three-step protocol, involving compression ultrasonography, color ultrasonography, and color Doppler ultrasonography, was used. Sensitivity, specificity, and likelihood ratios for ultrasonography as a whole were calculated. The independent value of each step was assessed.

Results: Venography and ultrasonography were not feasible in 23 of 126 patients (18%) and 1 of 126 patients (0.8%), respectively. Results of ultrasonography were inconclusive in 3 patients. Venography demonstrated thrombosis in 44 of 99 patients (44%); in 36 patients (36%), thrombosis was related to intravenous catheters or malignant disease. Sensitivity and specificity of duplex ultrasonography were 82% (95% CI, 70% to 93%) and 82% (CI, 72% to 92%), respectively. Venous incompressibility correlated well with thrombosis, whereas only 50% of isolated flow abnormalities proved to be thrombosis-related.

Conclusions: Duplex ultrasonography may be the method of choice for initial diagnosis of patients with suspected thrombosis of the upper extremities. However, in patients with isolated flow abnormalities, contrast venography should be performed.

Editors' Notes Context Venography is the standard test for diagnosing deep venous thrombosis of the upper extremities. It is not an ideal test because it requires intravenous access and contrast media. Ultrasonography is a widely available alternative test, but how feasible and accurate is it? Contribution In 126 consecutive patients with suspected upper-extremity thrombosis, venography and ultrasonography were not feasible in 18% and fewer than 1%, respectively. When venography was used as the reference standard, the likelihood ratio for a positive result on ultrasonography was 4.5 (95% CI, 2.53 to 8.02). The likelihood ratio for a negative result was 0.2 (CI, 0.12 to 5.57). Implications Positive findings on ultrasonography are reasonably accurate for diagnosing deep venous thrombosis of the upper extremities. –The Editors

 

Author and Article Information

From Academic Medical Center, Amsterdam, the Netherlands; and Royal Hallamshire Hospital, Sheffield, United Kingdom.

Acknowledgment: The authors thank B.A. Hutten of the Clinical Department of Epidemiology, Academic Medical Center, Amsterdam, for statistical support.

Requests for Single Reprints: Henk-Jan Baarslag, MD, Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; e-mail, H.J.Baarslag{at}AMC.UvA.nl.

Current Author Addresses: Drs. Baarslag and Reekers: Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.

Dr. van Beek: Academic Unit of Radiology, Floor C, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom.

Dr. Koopman: Department of Vascular Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.

Author Contributions: Conception and design: H.-J. Baarslag, E.J.R. van Beek, M.M.W. Koopman, J.A. Reekers.

Analysis and interpretation of the data: H.-J. Baarslag, E.J.R. van Beek, M.M.W. Koopman, J.A. Reekers.

Drafting of the article: H.-J. Baarslag, E.J.R. van Beek, M.M.W. Koopman, J.A. Reekers.

Critical revision of the article for important intellectual content: H.-J. Baarslag, E.J.R. van Beek, M.M.W. Koopman, J.A. Reekers.

Final approval of the article: H.-J. Baarslag, E.J.R. van Beek, M.M.W. Koopman, J.A. Reekers.

Provision of study materials or patients: H.-J. Baarslag, M.M.W. Koopman, J.A. Reekers.

Statistical expertise: E.J.R. van Beek.

Collection and assembly of data: H.-J. Baarslag, M.M.W. Koopman, J.A. Reekers.