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Diagnosis of Deep-Vein Thrombosis Using an Objective Doppler Method
- Anthonie W.A. Lensing, MD;
- Marcel M. Levi, MD;
- Harry R. Büller, MD, PhD;
- Paolo Prandoni, MD;
- Mario Vigo, MD;
- Giancarlo Agnelli, MD;
- Luciano Lupatelli, MD;
- Menno V. Huisman, MD, PhD; and
- Jan Wouter ten Cate, MD, PhD
Abstract
Study Objective: To determine the diagnostic criteria (phase I) and to assess the accuracy (phase II) of an objective Doppler-Valsalva pressure method as compared with contrast venography for the diagnosis of acute deep-leg-vein thrombosis in symptomatic outpatients.
Design: A two-phase prospective study in consecutive patients. Doppler ultrasound strip-chart recordings and venograms were independently analyzed by experienced observers.
Setting: Referral-based medical clinics at university medical centers.
Patients: One hundred and ten (phase I) and one hundred and fifty-five (phase II) patients who had clinically suspected venous thrombosis and were referred by their general practitioners were included.
Methods and Measurements: A normal Doppler test result was defined as a cyclic spontaneous signal (S-signal), a continuous S-signal with a Valsalva pressure of less than 6.5 mm Hg, or an absent S-signal with flow after cessation of the Valsalva maneuver. A continuous S-signal with a Valsalva pressure of 6.5 mm Hg or more or an absent S-signal without flow after cessation of the Valsalva maneuver were defined as abnormal test results. The accuracy indices for proximal vein thrombosis in phase II (155 patients; prevalence, 31%) were sensitivity, 91% (95% CI, 79% to 98%), and specificity, 99% (CI, 97% to 100%). All 3 patients with isolated calf-vein thrombosis had normal Doppler test results.
Conclusions: The objective Doppler method is an accurate, reproducible, and simple method for detection of venous thrombosis in symptomatic outpatients.
Article and Author Information
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From the Academic Medical Center, Amsterdam, the Netherlands; the Institute of Internal Medicine, University of Padua, Padua, Italy; and the Institute of Internal Medicine, University of Perugia, Perugia, Italy.
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Grant Support: By fellowship grant 86.073 from the Netherlands Heart Foundation (A.W.A.L.), a grant from the "Drie Lichten," the Netherlands, and a fellowship of the Royal Netherlands Academy of Art and Sciences (H.R.B.).
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Requests for Reprints: Anthonie W. A. Lensing, MD, Center for Thrombosis, Haemostasis and Atherosclerosis Research, F4 Room 237, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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Current Author Addresses: Drs. Lensing, Levi, Büller, Huisman, and ten Cate: Center for Thrombosis, Haemostasis and Atherosclerosis Research, F4, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
Drs. Prandoni and Vigo: Institute of Internal Medicine, University of Padua, via Augustini, 3500 Padua, Italy.
Drs. Agnelli and Lupatelli: Institute of Internal Medicine, University of Perugia, Perugia, Italy.
- © 1990 American College of Physicians
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