Sinan ŞAHİN, Hakan BARUTCA, İsmail MİHMANLI, Fatih KANTARCI

A comparison of multidetector computed tomography direct venography with color Doppler ultrasound in the diagnosis of lower limb and inferior vena cava deep venous thrombosis

Amaç: Bu çalışmada direkt multidedektör bilgisayarlı tomografi (MDBT) venografi ile renkli Doppler ultrasonografinin (RDUS) alt ekstremite derin ven trombozunun (DVT) saptanmasındaki tanısal değerinin kıyaslanması amaçlandı. Çalışma planı: Klinik DVT şüphesi bulunan 30 olguda (21 erkek, 9 kadın; ort. yaş 48 yıl; dağılım 21-80 yıl) RDUS ve MDBT direkt venografi incelemeleri yapıldı. Multidedektör bilgisayarlı tomografi direkt venografi, RDUSnin ardından 24 saat içerisinde gerçekleştirildi. Bulgular: Renkli Doppler ultrasonografi, tüm alt ekstremite venlerinde tanı koydurabilirken (240 ven segmenti), pelvik bölgedeki 150 ven segmentinin 68inde tanı koydurucu bulgu sağlayamadı. Pelvik bölgede RDUS 13 segmentte DVT yakalayabilirken, MDBT direkt venografi ile 21 ven segmentinde DVT tanısı kondu. Renkli Doppler ultrasonografi ile saptanabilen bir olgudaki baldır kas venindeki izole DVT haricinde, alt ekstremite venlerinde her iki yöntem ile DVT gelişmiş venler saptanabildi. Multidedektör bilgisayarlı tomografi direkt venografi ile beş ven segmentinde (4 femoral ven, 1 popliteal ven) yalancı pozitif tromboz bulgusu ve bir ven segmentinde de (ana femoral ven) akım fenomenine bağlı yalancı trombüs görünümü elde edildi. Kronik DVT hastalarında kısmi rekanalize olmuş yavaş dolum da MDBT direkt venografi ile tespit edilebildi. Sonuç: Multidedektör bilgisayarlı tomografi direkt venografi, iliyak ven ve inferior vena kavayı etkileyen DVTlerde RDUSye göre daha güvenilirdir. Ancak, MDBT direkt venografide de, konvansiyonal venografiye benzer şekilde, tıkalı segment sonrasındaki venlerde yalancı pozitif sonuçlar görülebilir.

Alt ekstremite ve inferior vena kava derin venöz trombozunun ta nısında multidedektör bilgisayarlı tomografi direkt venografi ile renkli Doppler ultrasonun kıyaslanması

Background: This study aims to compare the diagnostic value of the multidetector computed tomography (MDCT) direct venography and color Doppler ultrasound (CDUS) in detection of lower limb deep venous thrombosis (DVT). Methods: Color Doppler ultrasound and MDCT direct venography examinations were performed in 30 patients (21 males, 9 females; mean age 48 years; range 21 to 80 years) with clinical suspicion of DVT. The MDCT direct venography was performed within 24 hours, after the CDUS examination. Results: Color Doppler ultrasound was diagnostic in all of the lower limb veins (240 venous segments), while non-diagnostic in 68 out of 150 venous segments at the pelvic region. Color Doppler ultrasound identified DVT in 13 segments, and MDCT direct venography identified DVT in 21 venous segments at the pelvic region. All of the lower limb DVT s were depicted both by CDUS and direct MDCT venography, except for one calf muscular vein thrombosis which was detected by CDUS. Multidetector computed tomography direct venography showed false positive thrombosis in five venous segments (4 femoral vein, 1 popliteal vein) and a pseudotrombosis appearance due to the flow phenomenon in one venous segment (common iliac vein). Partially recanalized low flow in chronic DVT patients could also be demonstrated on MDCT direct venography. Conclusion: Multidetector computed tomography direct venography is more reliable than color Doppler US in diagnosis of DVT of the iliac veins and inferior vena cava. However, false positive thrombosis on MDCT direct venography can be seen distal to an occluded venous segment similar to the conventional venography.

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