Deep vein thrombosis MRI: Difference between revisions

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'''Editors-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] '''Associate Editor-In-Chief''': [[User:Ujjwal Rastogi|Ujjwal Rastogi, MBBS]] [mailto:urastogi@perfuse.org]
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| [[File:Siren.gif|30px|link=Deep vein thrombosis resident survival guide]]|| <br> || <br>
| [[Deep vein thrombosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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'''Editor(s)-In-Chief:''' {{ATI}}, [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]; '''Associate Editor(s)-In-Chief:''' {{CZ}} ; [[User:Kashish Goel|Kashish Goel, M.D.]]; '''Assistant Editor(s)-In-Chief:''' [[User:Justine Cadet|Justine Cadet]]


{{Deep vein thrombosis}}
{{Deep vein thrombosis}}


==Overview==
==Overview==
Noninvasive technique like ultrasonography and impedance plethysmography are fairly accurate ways to diagnose deep vein thrombosis (DVT) in the legs. But, both tests miss calf-vein thromboses, repeat testing often is required when initial tests are negative, and ability to assess pelvic veins is limited. Magnetic resonance venography has an important role in diagnosis when contrast venography cannot be performed due to patients allergy to contrast material or in renal insufficiency.
[[Magnetic Resonance Imaging|MRI]] can be used for the diagnosis of deep vein thrombosis (DVT); however, it is not a routine test in [[DVT]] because of cost and inaccessibility. MRI can be used in MR venography or in direct thrombus imaging.<ref name="pmid22315268">{{cite journal| author=Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ et al.| title=Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= e419S-94S | pmid=22315268 | doi=10.1378/chest.11-2301 | pmc=PMC3278049 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315268 }} </ref> MRI may be performed to diagnose DVT if compression ultrasound is not feasible because of the presence of a cast or excessive swelling, or when the the ultrasound results are non-diagnostic.
In a double blinded study, involving 85 patients suspected of having DVT, magnetic resonance venography (MRV) was compared with contrast venography, and was found to have 100% sensitivity and 96% specificity. <ref name="pmid8230557">{{cite journal| author=Carpenter JP, Holland GA, Baum RA, Owen RS, Carpenter JT, Cope C| title=Magnetic resonance venography for the detection of deep venous thrombosis: comparison with contrast venography and duplex Doppler ultrasonography. | journal=J Vasc Surg | year= 1993 | volume= 18 | issue= 5 | pages= 734-41 | pmid=8230557 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8230557 }} </ref> In this study, DVT was documented by contrast venography in 27 (27%) venous systems. Results of MRV and contrast venography were identical in 98 (97%) of 101 venous systems, whereas results of duplex scanning and contrast venography were identical in 40 (98%) of 41 venous systems. All DVTs identified by contrast venography were detected by MRV and duplex scanning. Thus it was concluded that MRV is an accurate noninvasive venographic technique for the detection of DVT.  


{{main|Magnetic resonance angiography}}
==MRI==
MRI can be used in multiple ways:<ref name="pmid22315268">{{cite journal| author=Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ et al.| title=Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= e419S-94S | pmid=22315268 | doi=10.1378/chest.11-2301 | pmc=PMC3278049 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315268  }} </ref>
* MR venography without contrast
* MR venography with IV gadolinium contrast
* Direct thrombus imaging (visualizing thrombus against a suppressed background)
In a double blinded study involving 85 patients suspected of having DVT, magnetic resonance venography (MRV) had a 100% sensitivity and 96% specificity, as compared with contrast venography.<ref name="pmid8230557">{{cite journal| author=Carpenter JP, Holland GA, Baum RA, Owen RS, Carpenter JT, Cope C| title=Magnetic resonance venography for the detection of deep venous thrombosis: comparison with contrast venography and duplex Doppler ultrasonography. | journal=J Vasc Surg | year= 1993 | volume= 18 | issue= 5 | pages= 734-41 | pmid=8230557 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8230557  }} </ref> In this study, DVT was documented by contrast venography in 27 (27%) venous systems. Results of MRV and contrast venography were identical in 98 (97%) of 101 venous systems, whereas results of duplex scanning and contrast venography were identical in 40 (98%) of 41 venous systems. All DVTs identified by contrast venography were detected by MRV and duplex scanning. Thus it was concluded that MRV is an accurate noninvasive venographic technique for the detection of DVT.
 
===Uses===
* MRI may be performed to diagnose [[DVT]] if [[Deep vein thrombosis ultrasound|compression ultrasound]] is not feasible because of the presence of a cast or excessive swelling, or when the the ultrasound results are non-diagnostic.<ref name="pmid22315268">{{cite journal| author=Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ et al.| title=Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= e419S-94S | pmid=22315268 | doi=10.1378/chest.11-2301 | pmc=PMC3278049 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315268  }} </ref>
* MRI can be used when contrast venography cannot be performed due to a patient being allergic to iodinated contrast or if the patient is in [[acute renal insufficiency]].
 
===Examples===
 
* 2D TOF GRE MRV images: Bilateral deep vein thromboses
 
[http://www.radswiki.net Images courtesy of RadsWiki]
 
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Image:Deep-vein-thrombosis-on-MRV-001.jpg
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==References==
==References==
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[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Hematology]]
[[Category:Hematology]]
[[Category:Pulmonology]]
[[Category:Angiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Mature chapter]]
[[Category:Vascular surgery]]
[[Category:Up-To-Date]]
[[Category:Cardiovascular diseases]]


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Latest revision as of 15:25, 16 January 2015
Resident
Survival
Guide

Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] ; Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet

Deep Vein Thrombosis Microchapters

Home

Patient Information

Overview

Classification

Pathophysiology

Causes

Differentiating Deep vein thrombosis from other Diseases

Epidemiology and Demographics

Risk Factors

Triggers

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Approach

Assessment of Clinical Probability and Risk Scores

Assessment of Probability of Subsequent VTE and Risk Scores

History and Symptoms

Physical Examination

Laboratory Findings

Ultrasound

Venography

CT

MRI

Other Imaging Findings

Treatment

Treatment Approach

Medical Therapy

IVC Filter

Invasive Therapy

Surgery

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Special Scenario

Upper extremity DVT

Recurrence

Pregnancy

Trials

Landmark Trials

Case Studies

Case #1

Deep vein thrombosis MRI On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Deep vein thrombosis MRI

CDC on Deep vein thrombosis MRI

Deep vein thrombosis MRI in the news

Blogs on Deep vein thrombosis MRI

Directions to Hospitals Treating Deep vein thrombosis

Risk calculators and risk factors for Deep vein thrombosis MRI

Overview

MRI can be used for the diagnosis of deep vein thrombosis (DVT); however, it is not a routine test in DVT because of cost and inaccessibility. MRI can be used in MR venography or in direct thrombus imaging.[1] MRI may be performed to diagnose DVT if compression ultrasound is not feasible because of the presence of a cast or excessive swelling, or when the the ultrasound results are non-diagnostic.

MRI

MRI can be used in multiple ways:[1]

  • MR venography without contrast
  • MR venography with IV gadolinium contrast
  • Direct thrombus imaging (visualizing thrombus against a suppressed background)

In a double blinded study involving 85 patients suspected of having DVT, magnetic resonance venography (MRV) had a 100% sensitivity and 96% specificity, as compared with contrast venography.[2] In this study, DVT was documented by contrast venography in 27 (27%) venous systems. Results of MRV and contrast venography were identical in 98 (97%) of 101 venous systems, whereas results of duplex scanning and contrast venography were identical in 40 (98%) of 41 venous systems. All DVTs identified by contrast venography were detected by MRV and duplex scanning. Thus it was concluded that MRV is an accurate noninvasive venographic technique for the detection of DVT.

Uses

  • MRI may be performed to diagnose DVT if compression ultrasound is not feasible because of the presence of a cast or excessive swelling, or when the the ultrasound results are non-diagnostic.[1]
  • MRI can be used when contrast venography cannot be performed due to a patient being allergic to iodinated contrast or if the patient is in acute renal insufficiency.

Examples

  • 2D TOF GRE MRV images: Bilateral deep vein thromboses

Images courtesy of RadsWiki

References

  1. ↑ 1.0 1.1 1.2 Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ; et al. (2012). "Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e419S–94S. doi:10.1378/chest.11-2301. PMC 3278049. PMID 22315268.
  2. ↑ Carpenter JP, Holland GA, Baum RA, Owen RS, Carpenter JT, Cope C (1993). "Magnetic resonance venography for the detection of deep venous thrombosis: comparison with contrast venography and duplex Doppler ultrasonography". J Vasc Surg. 18 (5): 734–41. PMID 8230557.

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