Leila Rezai Gharai, Presenter: Nothing to Disclose

Suhny Abbara MD, Abstract Co-Author: Speaker, Siemens AG Medical Advisory Board, Partners Imaging Consultant, Perceptive Informatics, Inc Stock options, Amirsys, Inc Consultant, Magellan Health Services, Inc

Stephan Wicky MD, Abstract Co-Author: Consultant, Johnson & Johnson

Sanjeeva Prasad Kalva MD, Abstract Co-Author: Research grant, AngioDynamics, Inc Speakers Bureau, Johnson & Johnson

To study the clinical utility of imaging the deep veins of the pelvis and legs in patients suspected of paradoxical embolism and cryptogenic brain ischemia

Out of 220 consecutive patients with brain ischemia (TIA/stroke) and contrast echocardiography confirmed patent foramen ovale (PFO), 95 (61% Male, Mean age: 53 y, Range 19-88 y) had further investigatigations including compression ultrasonography of the lower extremities and contrast-enhanced MR venography of the abdomen and pelvis. The presence and location of DVT, the presence of venous anomalies and associated risk factors for stroke and DVT were determined.

Risk factors for DVT were present in 34 (hypercoagulability [n=12]; smoking [n=11]; OCP [n=9]; confinement [n=8]; cancer [n=6]; surgery [n=4]; trauma [n=1]) patients. On MRV, one patient (1/95; 1.05%) had chronic pelvic and femoral vein DVT associated with May Thurner’s syndrome and previous history of venous thrombosis. MRV demonstrated venous anomalies in 7/95 (7%) including May-Thurner’s syndrome in 3. 74 patients had closure of the PFO and 1 had recurrent stroke because of residual shunt in the occluder device.

The prevalence of DVT in patients suspected of paradoxical embolism and brain ischemia is very low. Although Imaging is relevant to exclude DVT as this can alter the management, MR venography was also useful to demonstrate pelvic venous anomalies and exclude DVT prior to catheter based intervnetion.

The role of magnetic resonance venography and lower extremity compression ultrasound in acute stroke work up and PFO closure pre-procedural investigations is elucidated.

Rezai Gharai, L, Abbara, S, Wicky, S, Kalva, S, Prevalence of Pelvic Deep Venous Thrombosis (DVT) on MR Venography in Patients with Suspected Paradoxical Embolism and Stroke.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6021144.html