Accuracy Of Compression Ultrasonography Research Articles

General Practitioner–Performed Compression Ultrasonography for Diagnosis of Deep Vein Thrombosis of the Leg: A Multicenter, Prospective Cohort Study

Patients with suspected deep vein thrombosis (DVT) of the lower limb represent a diagnostic dilemma for general practitioners. Compression ultrasonography (US) is universally recognized as the best test of choice. We assessed the diagnostic accuracy of compression US performed by general practitioners given short training in the management of symptomatic proximal DVT. From May 2014 to May 2016, we evaluated in a multicenter, prospective cohort study all consecutive outpatients with suspected DVT; bilateral proximal lower limb compression US was performed by general practitioners and by physicians expert in vascular US, each group blinded to the other's findings. In all examinations with a negative or nondiagnostic result, compression US was repeated by the same operator after 5 to 7 days. Inter-observer agreement and accuracy were calculated. We enrolled a total of 1,107 patients. The expert physicians diagnosed DVT in 200 patients, corresponding to an overall prevalence of 18.1% (95% CI, 15.8%-20.3%). The agreement between the trained general practitioners and the experts was excellent (Cohen κ = 0.86; 95% CI, 0.84-0.88). Compression US performed by general practitioners had a sensitivity of 90.0% (95% CI, 88.2%-91.8%) and a specificity of 97.1% (95% CI, 96.2%-98.1%) with a diagnostic accuracy for DVT of 95.8% (95% CI, 94.7%-97.0%). Our results suggest that, even in hands of physicians not expert in vascular US, compression US can be a reliable tool in the diagnosis of DVT. We found that the sensitivity achieved by general practitioners appeared suboptimal, however, so future studies should evaluate the implementation of proper training strategies to maximize skill.

Optimal management strategy for use of compression US for deep venous thrombosis in symptomatic patients: A cost-effectiveness analysis

The authors' purpose was to identify the optimal strategy for using compression ultrasonography (US) in patients suspected of having deep venous thrombosis (DVT). The authors developed a decision-analytic model representing the natural history of DVT and the benefits and risks of anticoagulation therapy. They evaluated six initial imaging strategies: (a) unilateral examination of the common femoral and popliteal veins; (b) unilateral examination of the common femoral, popliteal, and femoral veins; (c) bilateral examination of the common femoral and popliteal veins; (d) bilateral examination of the common femoral, popliteal, and femoral veins; (e) complete unilateral examination of the symptomatic leg (including calf veins); and (f) complete bilateral examination of both legs. For 65-year-old men with unilateral symptoms of DVT, the most effective strategy was bilateral examination of the common femoral and popliteal veins with anticoagulation therapy in patients with proximal DVT and follow-up bilateral examination of the common femoral and popliteal veins in patients without an initial diagnosis of DVT with an incremental cost-effectiveness ratio of $39,000 per quality-adjusted life year gained. These results suggest that bilateral examination limited to the common femoral and popliteal veins, with follow-up bilateral examination limited to the common femoral and popliteal veins, was as cost-effective as other well-accepted medical interventions. The results were sensitive to the distribution of clot, diagnostic accuracy of compression US, and probability of bleeding with long-term morbidity.

Non-invasive detection of deep venous thrombosis: Ultrasonography versus duplex scanning

In a prospective study the diagnostic value of compression ultrasonography (CUS) versus Duplex scanning (DS) in the non-invasive detection of acute femoropopliteal deep venous thrombosis (DVT) was determined. In 114 eligible patients clinically suspected of DVT of the lower extremity, compression ultrasonography and Duplex scanning were performed within 24 hours by different assessors unaware of the outcome of the other test. In 109 patients concordant results of combined compression ultrasonography and Duplex scanning were obtained and considered as a proof of the absence or presence of deep venous thrombosis and no subsequent invasive investigations were performed. In five patients compression ultrasonography and Duplex scanning were discordant and contrast venography was performed. Femoropopliteal thrombosis was present in 47 legs (41%). The sensitivity, specificity and accuracy of compression ultrasonography were 93.6, 97.0 and 95.6%, respectively, and of Duplex scanning 100, 98.5 and 99.1%, respectively. We conclude that compression ultrasonography and Duplex scanning are methods with comparably high accuracy. Because of its availability, accuracy, cost-effectiveness and simplicity we recommend compression ultrasonography as the primary diagnostic test in the detection of deep venous thrombosis.