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Differentiation of deep venous thrombosis from femoral vein mixing artifact on routine abdominopelvic CT

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Abstract

Purpose

The objective of this study is to assess the performance of qualitative and quantitative imaging features for the differentiation of deep venous thrombosis (DVT) from mixing artifact on routine portal venous phase abdominopelvic CT.

Methods

This retrospective study included 40 adult patients with a femoral vein filling defect on portal venous phase CT and a Duplex ultrasound (n = 36) or catheter venogram (n = 4) to confirm presence or absence of DVT. Two radiologists (R1, R2) assessed the femoral veins for various qualitative and quantitative features.

Results

60% of patients were confirmed to have DVT and 40% had mixing artifact. Features with significantly greater frequency in DVT than mixing artifact (all p ≤ 0.006) were central location (R1 90% vs. 28%; R2 96% vs. 31%), sharp margin (R1 83% vs. 28%; R2 96% vs. 31%), venous expansion (R1 48% vs. 6%, R2 56% vs. 6%), and venous wall enhancement (R1 62% vs. 0%; R2 48% vs. 0%). DVT exhibited significantly lower mean attenuation than mixing artifact (R1 42.1 ± 20.2 vs. 57.1 ± 23.6 HU; R2 43.6 ± 19.4 vs. 58.8 ± 23.4 HU, p ≤ 0.031) and a significantly larger difference in vein diameter compared to the contralateral vein (R1 0.4 ± 0.4 vs. 0.1 ± 0.2 cm; R2 0.3 ± 0.4 vs. 0.0 ± 0.1 cm, p ≤ 0.026). At multivariable analysis, central location and sharp margin were significant independent predictors of DVT for both readers (p ≤ 0.013).

Conclusion

Awareness of these qualitative and quantitative imaging features may improve radiologists’ confidence for differentiating femoral vein DVT and mixing artifact on routine portal venous phase CT. However, given overlap with mixing artifact, larger studies remain warranted.

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Authors and Affiliations

  1. Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016, USA

    Ankur M. Doshi, David Hoffman, Justin M. Ream & Andrew B. Rosenkrantz

  2. Department of Radiology, New York-Presbyterian Hospital / Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10021, USA

    Andrea S. Kierans

Authors
  1. Ankur M. Doshi
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  2. David Hoffman
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  3. Andrea S. Kierans
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  4. Justin M. Ream
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  5. Andrew B. Rosenkrantz
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Correspondence to Ankur M. Doshi.

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Doshi, A.M., Hoffman, D., Kierans, A.S. et al. Differentiation of deep venous thrombosis from femoral vein mixing artifact on routine abdominopelvic CT. Abdom Imaging 40, 3191–3195 (2015). https://doi.org/10.1007/s00261-015-0525-6

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  • DOI: https://doi.org/10.1007/s00261-015-0525-6

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