Lower-Extremity Venous Ultrasound in DVT-Unlikely Patients with Positive D-Dimer Test
| Autor: | Chinnarat Bua-ngam, Tanapong Panpikoon, Tharintorn Treesit, Songpol Chuntaroj, Orapin Chansanti |
|---|---|
| Rok vydání: | 2022 |
| Předmět: |
medicine.medical_specialty
Deep vein 030218 nuclear medicine & medical imaging Fibrin Fibrinogen Degradation Products 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests D-dimer medicine Humans Radiology Nuclear Medicine and imaging cardiovascular diseases Vein Retrospective Studies Venous Thrombosis business.industry Ultrasound Retrospective cohort study medicine.disease Thrombosis Venous thrombosis medicine.anatomical_structure Lower Extremity 030220 oncology & carcinogenesis Radiology business Lower limbs venous ultrasonography |
| Zdroj: | Academic Radiology. 29:1058-1064 |
| ISSN: | 1076-6332 |
| DOI: | 10.1016/j.acra.2020.06.028 |
| Popis: | Rationale and Objectives To review the clinical data, D-dimer level and the ultrasonographic findings from complete venous ultrasound of the lower extremity in deep venous thrombosis (DVT)-unlikely patients with abnormal D-dimer test were compared to DVT-likely patients to ascertain the appropriate ultrasound examination protocol for patients in this group. Material and methods A retrospective cohort study was conducted of all patients who underwent a complete (whole leg) venous ultrasound in one 13-month period. The medical history, demographic, clinical risk factors, and ultrasonographic findings of the patients with high clinical probability for deep vein thrombosis (Wells score ≥2), along with patients with a low clinical probability of deep vein thrombosis (Wells score ≤1) but with a D-dimer level higher than the threshold (≥500 ng/ml FEU) were evaluated. Results There were 96 patients in the DVT-likely group and 86 patients in the DVT-unlikely group. The indication for ultrasound examination in the DVT-unlikely group was preoperative assessment to avoid the risk of pulmonary thromboembolism. The patients in the DVT-likely group had more positive ultrasound results for DVT (15.63% vs. 5.18%, p value = 0.03) than the patients in the DVT-unlikely group. In the DVT-unlikely group, the median D-dimer level in the patients with positive ultrasound for DVT showed statistically significantly higher levels than the patients with negative ultrasound for DVT did (2208 vs. 921 ng/ml FEU, p value = 0.02). The optimal D-dimer cut-off from the receiver operating characteristics analysis shows the maximized summation of sensitivity and specificity (80% and 66.67%) at 1251 ng/ml FEU. The prevalence of acute thrombus in a thigh vein in DVT-unlikely, preoperative patients is low (1.2%). Conclusion To minimize the number of unnecessary complete venous ultrasound lower-extremity examinations, the use of a higher D-dimer cut-off level and limiting proximal or thigh vein ultrasound examinations in the preoperative patient is considered. |
| Databáze: | OpenAIRE |
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