Diagnosis of lower-limb deep venous thrombosis: A prospective blinded study of magnetic resonance direct thrombus imaging
Diagnosis of lower-limb deep venous thrombosis: A prospective blinded study of magnetic resonance direct thrombus imaging
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DOI：
10.7326/0003-4819-136-2-200201150-00006
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发表时间：
2002-01-15
影响因子：
39.2
通讯作者：
Davidson, I
中科院分区：
文献类型：
--
作者：
Fraser, DGW;Moody, AR;Davidson, I
背景：当前的磁共振技术从静脉血产生高信号，并将血栓显示为充盈缺陷。磁共振直接血栓成像 (MRDTI) 可以直接显示急性血栓。目的：确定 MRDTI 诊断膝盖以下和以上的急性症状性深静脉血栓 (DVT) 的准确性。设计：前瞻性、双盲研究。地点：拥有 1355 个床位的大学医院。患者：101 名疑似 DVT 且接受过常规静脉造影的患者。参与者是从疑似 DVT 患者队列中招募的。使用随机序列选择所有静脉造影呈阳性的患者和四分之一静脉造影呈阴性的患者。干预：在静脉造影后 48 小时内进行 MRDTI，并由两名评审员进行解读。测量：DVT 总体诊断；孤立的小腿、股腘动脉和回股动脉 DVT；以及小腿、股腘和髂段的血栓。结果：两位读者的报告灵敏度分别为96%和94%，特异性强； DVT 诊断率分别为 90% 和 92%。孤立性小腿 DVT 的敏感性为 92% 和 83%，股腘静脉 DVT 的敏感性为 97% 和 97%，回股 DVT 的敏感性为 100% 和 100%。孤立小腿 DVT 的特异性分别为 94% 和 96%，股腘静脉和回股 DVT 的特异性分别为 100% 和 100%。同样，每个静脉段的敏感性和特异性范围为 91% 至 100%。对于这些测量，使用加权 kappa 统计量测量的观察者间变异性范围为 0.89 至 0.98。结论：磁共振直接血栓成像是诊断 DVT 的一种准确的无创测试，其准确性保持在膝盖以下。各个静脉段的比较表明，MRDTI 结果与静脉造影结果非常一致。扫描耐受性良好，判读具有高度可重复性。
Background: current magnetic resonance techniques generate high signal from venous blood and show thrombi as filling defects. Magnetic resonance direct thrombus imaging (MRDTI) directly visualizes acute thrombus.Objective: To determine the accuracy of MRDTI for diagnosis of acute symptomatic deep venous thrombosis (DVT) below and above the knee.Design: Prospective, blinded study.Setting: A 1355-bed university hospital.Patients: 101 patients with suspected DVT who had had routine venography. Participants were recruited from a cohort of patients with suspected DVT. All patients with a positive venogram and one quarter of patients with a negative venogram were selected by using a random sequence.Intervention: MRDTI was performed within 48 hours of venography and was interpreted by two reviewers.Measurements: Diagnosis of DVT overall; isolated calf, femoropopliteal, and ileofemoral DVT; and thrombus in the calf, femoropopliteal, and iliac segments. Results: The reports from two readers had sensitivities of 96% and 94% and specificities; of 90% and 92% for diagnosis of DVT. Sensitivities were 92% and 83% for isolated calf DVT, 97% and 97% for femoropopiliteal DVT, and 100% and 100% for ileofemoral DVT. Specificities were 94% and 96% for isolated calf DVT and 100% and 100% for both femoropopliteal and ileofemoral DVT. Similarly, sensitivity and specificity within each of the venous segments ranged from 91% to 100%. Interobserver variability measured by using a weighted kappa statistic ranged from 0.89 to 0.98 for these measures.Conclusion: Magnetic resonance direct thrombus imaging is an accurate noninvasive test for diagnosis of DVT, and its accuracy is maintained below the knee. Comparison of individual venous segments showed that results of MRDTI agreed strongly with findings on venography. Scanning was well tolerated, and interpretation was highly reproducible.