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Deep Venous Thrombosis: Diagnosis by Using Venous Enhanced Subtracted Peak Arterial MR Venography versus Conventional Venography¹

¹ From the Departments of Academic Radiology (D.G.W.F., A.R.M., P.S.M.), Radiology (I.R.D.), and Medical Physics (A.L.M.), Queen’s Medical Centre, Nottingham, England. Received January 28, 2002; revision requested March 13; revision received June 12; accepted July 25. Supported by grant RB2305 from the British Heart Foundation. Address correspondence to A.R.M., Department of Medical Imaging, Sunnybrook and Women’s Health Sciences Centre, 2075 Bayview Ave, Toronto M4N 3M5, Ontario, Canada (e-mail: alan.moody@swchsc.on.ca).

PURPOSE: To assess diagnostic accuracy and interobserver variability at venous enhanced subtracted peak arterial (VESPA) magnetic resonance (MR) venography compared with those at conventional venography for the diagnosis of femoral and iliac deep venous thrombosis (DVT).

MATERIALS AND METHODS: A single anteroposterior maximum intensity projection (MIP) venogram of the femoral and iliac veins was constructed by using VESPA MR venography in 55 symptomatic patients suspected of having lower limb DVT. All patients also underwent conventional venography, results of which were used as the standard of reference. VESPA MR venograms were interpreted by two independent reviewers (reviewers A and B) who were unaware of other results. Sensitivity and specificity of VESPA MR venography for the diagnosis of thrombus in the femoral and iliac veins were calculated. Interobserver variability was calculated for these observations by using weighted with equally spaced weights for positive, nondiagnostic, and negative studies. Nondiagnostic studies were reinterpreted separately by reviewer A on the basis of source data.

RESULTS: Sensitivity of VESPA MR venography for the femoral veins (20 of 20) and iliac veins (seven of seven) was 100% for both reviewers. Specificity was 100% (39 of 39 for reviewer A, 40 of 40 for reviewer B) for the iliac veins and 97% (31 of 32) for the femoral veins for both reviewers. Segments in which the VESPA MR venograms were nondiagnostic were excluded from this analysis. Interobserver variability as calculated by using weighted for positive, negative, and nondiagnostic studies was 0.85 for femoral veins and 0.97 for iliac veins. Interpretation of the source data led to correct diagnosis in six of six cases in which the VESPA MR venograms were nondiagnostic.

CONCLUSION: VESPA MR venography yielded MIP venograms that were highly accurate for the diagnosis of DVT in femoral and iliac veins. Interpretation of the studies was also highly reproducible.

© RSNA, 2003

Index terms: Magnetic resonance (MR), image processing • Veins, extremities, 938.751, 988.751 • Veins, MR, 938.12942, 988.12942 • Veins, thrombosis, 938.751, 988.751

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