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Open Access
CC BY 4.0 · TH Open 2019; 03(01): e37-e44
DOI: 10.1055/s-0039-1678683
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Diagnosing Recurrent DVT of the Leg by Two Different Non–Contrast-Enhanced Magnetic Resonance Direct Thrombus Imaging Techniques: A Pilot Study

Authors

  • Charlotte E. A. Dronkers

    1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

  • Frederikus A. Klok

    1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

  • Kirsten van Langevelde

    2   Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
    3   Department of Radiology, HAGA Teaching Hospital, The Hague, The Netherlands

  • Alexandr Šrámek

    2   Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

  • Guido R. van Haren

    2   Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

  • Menno V. Huisman

    1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

  • Albert de Roos

    2   Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

  • Lucia J. M. Kroft

    2   Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
Further Information

Publication History

14 October 2018

02 January 2019

Publication Date:
06 February 2019 (online)

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Abstract

Introduction Magnetic resonance direct thrombus imaging (MRDTI) is a promising technique to improve the diagnostic management of patients with a suspected ipsilateral recurrent deep vein thrombosis (DVT) by direct visualization of a thrombus. Another magnetic resonance imaging (MRI) technique, T1-weighted turbo spin-echo spectral attenuated inversion recovery (TSE-SPAIR), has the potential to image a thrombus directly with a high spatial resolution as well. The main aim of this pilot study was to investigate if adding the TSE-SPAIR sequence to an MRDTI sequence performed in patients with suspected recurrent DVT may increase the diagnostic confidence of expert MRDTI readers.

Methods Fifteen patients with suspected acute recurrent DVT were included in this study. The TSE-SPAIR sequence was scanned directly after the MRDTI scan but not used to guide clinical decision making, and both scans were adjudicated post hoc two times separately by three independent expert MRDTI readers. Diagnostic confidence was scored on a 4-point Likert scale: (1) poor (definite diagnosis impossible), (2) fair (evaluation of major findings possible), (3) good (definite diagnosis possible), and (4) excellent (exact diagnosis possible).

Results The diagnostic confidence of expert readers increased when adding the TSE-SPAIR sequence on top of the MRDTI sequence from “good” (median, 3.0; interquartile range [IQR], 2.66–3.0) to “excellent” (median, 3.67; IQR 3.33–3.67; p = 0.001). Evaluation of the scans in the reversed order 5 months after initial reading showed similar results. Diagnostic accuracy for proximal DVT of both scan techniques was good.

Conclusion The extra TSE-SPAIR sequence may help increase diagnostic confidence of radiologists in cases of uncertain diagnosis in patients with suspected ipsilateral recurrent DVT.

Keywords

magnetic resonance imaging - venous thrombosis - diagnosis

Authors' Contributions

C.E.A.D., F.A.K., M.V.H., and L.J.M.K. designed the research. G.R.v.H. designed the MRI scan sequences. K.v.L., A.S., and A.d.R. analyzed the MRI scans. C.E.A.D. collected the data. C.E.A.D., F.A.K., and L.J.M.K. analyzed the data and wrote the manuscript. K.v.L., A.S., G.R.v.H., M.V.H, and A.d.R. critically revised the paper for important intellectual content.