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Deep Venous Thrombosis: Detection by Using Indirect CT Venography¹

¹ From the New York Presbyterian Hospital/Weill Medical College of Cornell University, 525 E 68th St, Bldg Starr-8A23, New York, NY 10021 (D.F.Y.). The Department of Radiology, the New York Presbyterian Hospital, Cornell Campus, New York, NY (M.D.C., D.F.Y., A.A.S., H.D.S., C.I.H.); the Department of Radiology, Hadassah University Hospital, Israel (D.S.); the Department of Radiology, the New York Hospital of Queens, New York, NY (L.S., W.W.); the Department of Radiology, St Barnabas Hospital, Bronx, NY (A.L., P.M.P.); the Department of Radiology, Charite, Campus Virchow Hospital, Berlin, Germany (J.R.); the Department of Radiology, the Hannover Medical School, Hannover, Germany (M.G.); the Department of Radiology, the New York Presbyterian Hospital, Columbia Campus, New York, NY (G.P.); and the Department of Radiology, the H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla (J.C., R.A.C.). Received June 11, 1999; revision requested August 3; revision received December 8; accepted December 16. Financial support is listed at the end of this article. Address correspondence to D.F.Y.

PURPOSE: To assess the clinical benefits of performing indirect computed tomographic (CT) venography after pulmonary CT angiography to detect deep venous thrombosis (DVT) in patients suspected of having a pulmonary embolism.

MATERIALS AND METHODS: The authors prospectively enrolled 541 consecutive patients who underwent pulmonary CT angiography for suspected pulmonary embolism at seven institutions. Using a protocol that optimizes venous enhancement without additional contrast material injection, the authors obtained contiguous images from the pelvis to the popliteal fossa. Ultrasonography (US) also was performed in 116 patients.

RESULTS: DVT was found at indirect CT venography in 45 (8%), and pulmonary embolism was found at pulmonary CT angiography in 91 (17%) of 541 patients. Among the 45 patients with DVT, DVT occurred in 16 patients who had no pulmonary embolism at pulmonary CT angiography, which increased the diagnosis of thromboembolic disease by 18%. Among 116 patients who underwent US and indirect CT venography, 15 had DVT at US, and in all 15, DVT also was seen at indirect CT venography. In four additional cases, DVT was seen at only indirect CT venography.

CONCLUSION: Among patients suspected to have pulmonary embolism, a substantial number had DVT in the absence of pulmonary embolism. Combined pulmonary CT angiography–indirect CT venography can depict these cases with accuracy comparable to that of US and thus could have a significant effect on patient care.

Index terms: Computed tomography (CT), angiography, 944.12916 • Embolism, pulmonary, 60.721 • Pulmonary arteries, CT, 944.12915, 944.12916 • Pulmonary arteries, thrombosis, 944.751

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