Douglas S. Katz MD, Presenter: Nothing to Disclose

1) To overview the clinical and imaging evaluation of suspected deep venous thrombosis (DVT) in the lower and upper extremities. 2) To review the imaging findings of acute and chronic DVT. 3) To explain the role of sonography, MRI, CT/CT venography, and conventional venography, in the diagnosis and management of patients with known or suspected DVT. 4) To briefly explain current controversies in the imaging of DVT.

Ultrasound (US) is the imaging test of choice for suspected lower or upper extremity deep venous thrombosis (DVT).  US has high accuracy in symptomatic patients for the deep thigh veins and in the arms, but is less accurate for the calves and the pelvis, and in asymptomatic patients.  Combined CT pulmonary angiography and CT venography permits comprehensive assessment for PE and DVT, and serves as a roadmap for therapy, although the yield of CTV has decreased substantially in recent years as CTPA has been increasing used/over-utilized.  CTV is not routinely performed at many institutions/practices, although there is still evidence to support its use, especially in high risk patients. MR is a helpful problem-solving test, and can also be combined with MR pulmonary angiography.  Conventional venography is mostly of historical interest when used solely as a diagnostic study for the lower extremities.  Venography via an inguinal approach is still performed at some centers, including ours, as a road-mapping technique immediately prior to inferior vena cava filter placement.  Venography of the lower and upper extremities is routinely performed as part of a variety of therapeutic procedures for DVT – including thrombolysis, percutaneous thrombectomy, angioplasty, and stent placement.   

Katz, D, Multimodality Imaging of Deep Venous Thrombosis.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11001188.html