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Evaluation of deep vein thrombosis with multidetector row CT after orthopedic arthroplasty: a prospective study for comparison with Doppler sonography.

Byun SS, Kim JH, Kim YJ, Jeon YS, Chun YS, Park CH, Kim WH - Korean J Radiol (2008 Jan-Feb)

Bottom Line: Sixty-two patients had undergone orthopedic replacement surgery on a total of 30 hip joints and 54 knee joints.The incidence and location of deep vein thrombosis was analyzed.The z-axis length (mean +/- standard deviation) of the beam hardening artifact was 4.5 +/- 0.8 cm in the arthroplastic knees and 3.9 +/- 2.9 cm in the arthroplastic hips.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Inha University, College of Medicine, Incheon, Korea.

ABSTRACT

Objective: This prospective study evaluated the ability of indirect 16-row multidetector CT venography, in comparison with Doppler sonography, to detect deep vein thrombosis after total hip or knee replacement.

Materials and methods: Sixty-two patients had undergone orthopedic replacement surgery on a total of 30 hip joints and 54 knee joints. The CT venography (scan delay time: 180 seconds; slice thickness/increment: 2/1.5 mm) and Doppler sonography were performed 8 to 40 days after surgery. We measured the z-axis length of the beam hardening artifact that degraded the image quality so that the presence of deep vein thrombosis couldn't be evaluated on the axial CT images. The incidence and location of deep vein thrombosis was analyzed. The diagnostic performance of the CT venograms was evaluated and compared with that of Doppler sonography as a standard of reference.

Results: The z-axis length (mean +/- standard deviation) of the beam hardening artifact was 4.5 +/- 0.8 cm in the arthroplastic knees and 3.9 +/- 2.9 cm in the arthroplastic hips. Deep vein thrombosis (DVT) was found in the popliteal or calf veins on Doppler sonography in 30 (48%) of the 62 patients. The CT venography has a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 90%, 97%, 96%, 91% and 94%, respectively.

Conclusion: The ability of CT venography to detect DVT was comparable to that of Doppler sonography despite of beam hardening artifact. Therefore, CT venography is feasible to use as an alternative modality for evaluating post-arthroplasty patients.

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Related in: MedlinePlus

A 32-year-old female underwent right total hip arthroplasty. An axial CT image showed non-enhancing, low-attenuated lesions surrounded by high-attenuated tissue in the right calf (arrows). However, there was no definite evidence of deep vein thrombosis in the right calf vein despite the repeated sonographic examinations. This was a false-positive case.
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Figure 4: A 32-year-old female underwent right total hip arthroplasty. An axial CT image showed non-enhancing, low-attenuated lesions surrounded by high-attenuated tissue in the right calf (arrows). However, there was no definite evidence of deep vein thrombosis in the right calf vein despite the repeated sonographic examinations. This was a false-positive case.

Mentions: Discrepancies between the CT venograms and Doppler sonography were present in four patients. In three patients, CT venography did not initially detect the DVT despite the presence of DVT as detected by Doppler sonography. However, in these three patients, the DVT was retrospectively found on the CT venography (Fig. 3). In one patient, the CT venography showed a suspicious focal DVT in the calf veins (Fig. 4), but there was also no DVT noted in the calf veins on the repeated sonographic examinations. Based on the results of Doppler sonography, the CT venography has a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 90%, 97%, 96%, 91% and 94%, respectively, for the diagnosis of DVT after major orthopedic arthroplasty (Table 2).


Evaluation of deep vein thrombosis with multidetector row CT after orthopedic arthroplasty: a prospective study for comparison with Doppler sonography.

Byun SS, Kim JH, Kim YJ, Jeon YS, Chun YS, Park CH, Kim WH - Korean J Radiol (2008 Jan-Feb)

A 32-year-old female underwent right total hip arthroplasty. An axial CT image showed non-enhancing, low-attenuated lesions surrounded by high-attenuated tissue in the right calf (arrows). However, there was no definite evidence of deep vein thrombosis in the right calf vein despite the repeated sonographic examinations. This was a false-positive case.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627179&req=5

Figure 4: A 32-year-old female underwent right total hip arthroplasty. An axial CT image showed non-enhancing, low-attenuated lesions surrounded by high-attenuated tissue in the right calf (arrows). However, there was no definite evidence of deep vein thrombosis in the right calf vein despite the repeated sonographic examinations. This was a false-positive case.
Mentions: Discrepancies between the CT venograms and Doppler sonography were present in four patients. In three patients, CT venography did not initially detect the DVT despite the presence of DVT as detected by Doppler sonography. However, in these three patients, the DVT was retrospectively found on the CT venography (Fig. 3). In one patient, the CT venography showed a suspicious focal DVT in the calf veins (Fig. 4), but there was also no DVT noted in the calf veins on the repeated sonographic examinations. Based on the results of Doppler sonography, the CT venography has a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 90%, 97%, 96%, 91% and 94%, respectively, for the diagnosis of DVT after major orthopedic arthroplasty (Table 2).

Bottom Line: Sixty-two patients had undergone orthopedic replacement surgery on a total of 30 hip joints and 54 knee joints.The incidence and location of deep vein thrombosis was analyzed.The z-axis length (mean +/- standard deviation) of the beam hardening artifact was 4.5 +/- 0.8 cm in the arthroplastic knees and 3.9 +/- 2.9 cm in the arthroplastic hips.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Inha University, College of Medicine, Incheon, Korea.

ABSTRACT

Objective: This prospective study evaluated the ability of indirect 16-row multidetector CT venography, in comparison with Doppler sonography, to detect deep vein thrombosis after total hip or knee replacement.

Materials and methods: Sixty-two patients had undergone orthopedic replacement surgery on a total of 30 hip joints and 54 knee joints. The CT venography (scan delay time: 180 seconds; slice thickness/increment: 2/1.5 mm) and Doppler sonography were performed 8 to 40 days after surgery. We measured the z-axis length of the beam hardening artifact that degraded the image quality so that the presence of deep vein thrombosis couldn't be evaluated on the axial CT images. The incidence and location of deep vein thrombosis was analyzed. The diagnostic performance of the CT venograms was evaluated and compared with that of Doppler sonography as a standard of reference.

Results: The z-axis length (mean +/- standard deviation) of the beam hardening artifact was 4.5 +/- 0.8 cm in the arthroplastic knees and 3.9 +/- 2.9 cm in the arthroplastic hips. Deep vein thrombosis (DVT) was found in the popliteal or calf veins on Doppler sonography in 30 (48%) of the 62 patients. The CT venography has a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 90%, 97%, 96%, 91% and 94%, respectively.

Conclusion: The ability of CT venography to detect DVT was comparable to that of Doppler sonography despite of beam hardening artifact. Therefore, CT venography is feasible to use as an alternative modality for evaluating post-arthroplasty patients.

Show MeSH
Related in: MedlinePlus