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ABSTRACT |
Thursday, May 4, 10:00 AM-12:00 PM
Abstracts 227-238
Moderators: Kitt Shaffer, MD and Narinder S. Paul, MD
10:00 AM
227. Characteristics of Superior Diaphragmatic Lymph Nodes by Computed Tomography in Patients with or without Malignancy
Santosa A.C.1*; Hazany S.2; Levin D.L.1; Stark P.S.1; 1. Radiology, University of California, San Diego, San Diego, CA; 2. School of Medicine, University of California, San Diego, La Jolla, CA.
Address correspondence to A.C. Santosa (acsantosa{at}ucsd.edu)
Objective: The presence of superior diaphragmatic lymph nodes has previously been considered abnormal. The purpose of this study is to assess the frequency of superior diaphragmatic lymph nodes using helical computed tomography (CT) in individuals free of disease and those with malignancy.
Materials and Methods: We retrospectively reviewed electronic radiology reports from a single Veterans Affairs Hospital of all CT scans of the chest or abdomen from July 2000 through May 2005 for the presence of superior diaphragmatic lymph nodes (SDLN) using keyword recognition. Two radiologists reviewed all SDLN-positive CT images in consensus. The number and size of superior diaphragmatic lymph nodes were recorded. Medical records from patients with SDLN-positive CT scans were correlated with radiologic findings.
Results: Of the greater than 35,000 reports reviewed, we identified 30 cases with SDLN: 17 (57%) in disease-free individuals and 13 (43%) in individuals with malignancy. The average age of those without disease is 55.9 years (95% CI: 51.0 - 60.7) and those with malignancy is 64.4 years (95% CI: 58.8 - 69.9); p = 0.025. The average size of SDLN in individuals without disease (mean = 0.71 cm; 95% CI: 0.47 - 0.94) and those with malignancy (mean = 1.26 cm; 95% CI: 0.99 - 1.53) was significantly different (p = 0.003). There was also a statistically significant difference (p = 0.015) in the number of SDLN between those without disease (mean = 3.13; 95% CI: 2.39 - 3.68) and those with malignancy (mean = 5.23; 95% CI: 3.57 - 6.89).
Conclusion: Superior diaphragmatic lymph nodes are not only seen in individuals with malignancy as once believed and can be found with equal frequency in individuals without disease. However, SDLN in individuals without disease are significantly fewer and smaller compared to SDLN found in individuals with malignancy. This study on SDLN confirms the general rule that lymph nodes less than 1 cm in size are likely to be benign.
228. Short-Term Follow-up CT in Patients with Non-Small-Cell Lung Cancer
Bruzzi J.F.1*; Zinner R.; Truong M.1; Sabloff B.1; Gladish G.1; Munden R.1; 1. Dept of Diagnostic Imaging, MD Anderson Cancer Center, Houston, TX.
Address correspondence to J.F. Bruzzi (jbruzzi{at}mdanderson.org)
Objective: To determine whether short-term follow-up CT in patients with non-small cell lung cancer can detect significant changes in tumor size due to disease progression or response to therapy.
Materials and Methods: All consecutive patients receiving chemotherapy for non-small cell lung cancer who underwent short-term CT restaging scans between January 2003 and March 2005 were enrolled into the study. Short-term restaging scans in each patient comprised at least 2 serial CT studies performed within a 31-day time period. All scans were performed using single-slice or multislice CT technology (GE Lightspeed Plus), with reconstructed slice thicknesses of 7mm or less. All images were reviewed using a PACs workstation (Stentor iSite). Unidimensional tumor measurements were performed with an electronic caliper according to RECIST criteria.
Results: A total of 41 patients were included in the study (22 men, 19 women; mean age, 61 years; age range, 26 - 85 years). A significant change in tumor size was observed in 7 (17%) patients, 4 of whom had poorly-differentiated tumors. In 1 patient with a poorly-differentiated adenocarcinoma, there was a significant decrease in tumor size (by 33%) in response to chemotherapy. In 5 patients, tumors increased significantly in size (by 20% - 48%) over a period of 31 days or less, and prompted either a change or a discontinuation of chemotherapy in all 5 patients.
Conclusion: Short interval follow-up CT in patients receiving chemotherapy for non-small cell lung cancer can detect significant changes in tumor growth that may have important clinical implications in the management of patients, enabling early discontinuation of potentially toxic chemotherapy drugs.
229. Computer-aided Volumetric Assessment in Solid Pulmonary Nodules Compared with Conventional Method on Thin Section Multidetector CT Screening Exams
Cestaro K.K.*; O'Donnell C.; Gamito E.; Salganicoff M.; Bronner T.; Garg K.; Department of Radiology, University of Colorado Health Sciences Center, Denver, CO.
Address correspondence to K.K. Cestaro (Kirsten.Cestaro{at}UCHSC.edu)
Objective: To compare a computerized method to the conventional method of estimating lung nodule volume on thin section multidetector computed tomography (CT) scans.
Materials and Methods: 44 low-dose CT studies from 32 men and women participating in the National Lung Screening Trial were retrospectively analyzed by two board-certified radiologists. Scans were done with a 4-slice or 16-slice scanner (120 kVp, 30 effective mAs, collimation 4 x 1 mm, slice thickness = 2 mm). At least two consecutive annual CT studies for each participant were analyzed. Thirty-four solid nodules were identified in 32 participants (18 men and 14 women). Nodules were classified as round if the ratio of the longest and shortest cross sectional diameter was < 1.5. Nodules with a ratio 1.5 or with spiculated or lobulated margins were classified as irregular. Ground glass and mixed-density nodules were excluded. The conventional nodule volume estimates were based on hand measurements and calculated using the ellipsoid formula (4/3 pi * width axis radius * length axis radius * height axis radius). A third observer independently estimated the nodule volumes using the computerized Nodule Enhanced Viewing (NEV) system (Siemens LungCare®) six months after the last conventional reading. Wilcoxon Signed Rank tests were used to first test for a difference in volume estimates between conventional and NEV methods for all nodules and then for a difference between methods in calculated percent relative change of nodule size between years. McNemar's test was used to test a null hypothesis of no difference between methods in identifying clinically significant change (= 20%). All statistical analyses were performed in SAS® 9.1.3.
Results: The nodules ranged in diameter from 3 to 11 mm (mean = 6.0 mm). Four nodules (12%) were irregular, while 30 (88%) were round with smooth contours. Signed rank testing failed to detect a significant difference between volume estimates (S = 1.0, p = 0.94), or percent relative change in nodule size (S = 1.5, p = 0.84). Exact calculations for McNemar's test failed to detect a statistically significant difference between methods to identify nodules with clinically significant change (S = 0.53, p = 0.63).
Conclusion: The results indicate that nodule volume estimates obtained by the computerized NEV system were comparable to those obtained by the conventional method. Therefore, the time and tedium of the conventional method may be avoided utilizing the computerized system without sacrificing volume estimate accuracy.
230. Do Motion Artifacts Affect CAD for Lung Nodule Detection?
Fleiter T.R.*; Waite S.; White C.; Diagnostic Imaging, University of Maryland, Baltimore, MD.
Address correspondence to T.R. Fleiter (tfleiter{at}umm.edu)
Objective: The objective of the study was to determine the influence of the heart-motion on the false positive detected nodules using a commercial available CAD system for lung nodule detection and ECG gated MDCT.
Materials and Methods: Retrospective analysis was made from ECG gated MDCT chest scans originally obtained to exclude pulmonary embolism. Images were reconstructed at 10 phases (0-90%) of the R-R interval. Scans were evaluated for the presence of lung nodules in each phase using a commercial available CAD program (Philips Medical Systems) and data was collected regarding the number and distribution of CAD detected nodules.
Results: Preliminary analysis of 10 patients with a total of 2,199 detected nodules demonstrated significant less false positives at 30% and 70% of the RR interval. Furthermore in general, fewer false positive nodules were detected during diastole than systole. No difference in the location of false positive detected nodules was identified.
Conclusion: The study demonstrates that heart-motion and the depending motion artifacts in both lungs are influencing the number of false positive findings using CAD and MDCT. The diastolic phase was identified to produce the least false positives. Performance of CAD can be improved by using ECG gated MDCT chest studies.
231. Reducing the Radiation Dose to the Female Breast during Chest CT: Use of a Tungsten-Antimony Composite Breast Shield
Parker M.S.*; Kelleher N.M.; Hoots J.A.; Chung J.K.; Fatouros P.P.; Benedict S.H.; Thoracic Radiology, Medical College of Virginia Hospitals VCU Health System, Richmond, VA.
Address correspondence to M.S. Parker (markcindyparker{at}comcast.net)
Objective: To reduce the radiation dose to the female breast during chest CT by the application of a custom-designed tungsten-antimony composite breast shield.
Materials and Methods: Bilateral attachable tissue equivalent breast phantoms containing 20-5mm wide, and up to 20 mm deep cavities, for thermoluminescent dosimetry (TLD), were used in combination with a tissue equivalent thorax phantom. The latter, 30 cm long x 30 cm wide x 20 cm thick, represents an average human torso in proportion, density, and two-dimensional structure. 48 calibrated, energy specific TLDs were placed in each breast phantom, at different locations and depths. Each TLD position was mapped and recorded. The combined breast-torso phantom was scanned on our 16-head multi-detector CT with parameters simulating our pulmonary embolus protocol. TLDs were removed, and a second set was placed in a similar manner, and the phantom rescanned with identical imaging parameters, employing a 0.25 lead equivalent tungsten-antimony composite breast shield containing an internal buffer pad to reduce beam hardening artifact.
Results: Our breast shield effectively reduced the breast dose 53-63% for both the left and right breast phantoms. The dose reduction was 55% at the skin surface; 54% at the areola; 60% at the upper inner quadrant; 60% at the lower inner quadrant; 58% at the upper outer quadrant; 59% at the lower outer quadrant; and 58% 10-12 mm below the skin surface. Beam-hardening artifact was negligible.
Conclusion: Our custom-designed breast shield reduces the breast dose between 53-63%, without substantial beam hardening artifact. The shield is lightweight, easily applied, reusable, and could be employed during chest CT exams.
232. CT-Guided Lung Biopsy: Is Minimum Dose CT Helpful in Patient Management?
Pereira A.M.1,2; Paul N.S.1,2; Doyle D.1,2*; Benamore R.1,2; Chung T.1,2; Roberts H.C.1,2; 1. Medical Imaging, University Health Network / Mount Sinai Hospital, Toronto, ON, Canada; 2. Medical Imaging, Mount Sinai Hospital, Toronto, ON, Canada.
Address correspondence to D. Doyle (Deirdre.Doyle{at}uhn.on.ca)
Objective: Pneumothorax (PTx) is the most common complication of percutaneous lung biopsy occurring in 0-61% of cases of which 3.3-15% require chest drain insertion. Post biopsy management is variable with some institutions only performing chest x-ray at 30 minutes and others imaging up to 4 hours. The aim of this study is to evaluate whether minimum dose CT (MnDCT) can safely facilitate patient discharge at one-hour post procedure.
Materials and Methods: A prospective non-randomized study commenced in July 2005. Two hundred patients referred for CT-guided percutaneous fine needle aspiration lung biopsy (FNAB) will be enrolled. MnDCT is performed on all patients immediately post lung biopsy and evaluated for a PTx. A chest x-ray is performed at 1 hour. Patients with no PTx on the 1-hour film are discharged. Any patient with a PTx detected at one hour, patients 70 years and those living 2 hours travel from the hospital have a chest x-ray performed at 2 hours. All patients are contacted by telephone, one-week post biopsy to check for delayed complications.
Results: To date: 116 patients (66 M: 50 F) have been enrolled. Forty-seven patients (40.5%) developed a PTx: 23/47 (49%) were first detected during the procedure, 18/47 (38%) on MnDCT and 6/47 (13%) on the 1-hour chest x-ray. Fourteen symptomatic PTx (12.0%) required drainage: 4/14 (28.6%) were detected during the procedure, 7/14 (50%) on MnDCT and 3/14 (21.4%) on the 1-hour chest x-ray. One of these patients had a small PTx on MnDCT, 1-hour chest X-ray but required chest drainage 6 days post procedure. Considering the role of MnDCT in predicting the need for chest drainage: of 80 patients with a negative MnDCT, 3 (3.8%) required drainage; of 31 patients with a small PTx on MnDCT, 7 (22.6%) required drainage; of 5 patients with a moderate PTx on MnDCT, 4 (80%) required drainage. Of 40 patients (34%), with no PTx or a small PTx on MnDCT and 1 hour chest X-ray, observed for an additional hour post lung biopsy (> 70 years of age), none developed delayed complications.
Conclusion: Preliminary: MnDCT performed immediately post CT guided lung biopsy allows for early detection of PTx and is helpful in predicting the requirement for subsequent insertion of a chest drain. A combination of MnDCT and 1-hour chest X-ray identifies > 90% of patients that require insertion of a chest drain. We conclude that a normal post biopsy MnDCT and chest x-ray at 1 hour allows for safe patient discharge at one-hour post procedure.
233. Chest Radiography versus Computed Tomography for the Diagnosis of Pulmonary Infection in the Late Phase after Bone Marrow Transplantation
Schueller G.*; Matzek W.; Schaefer-Prokop C.; Radiology, Medical University of Vienna, Vienna, Austria.
Address correspondence to G. Schueller (gerd.schueller{at}meduniwien.ac.at)
Objective: To evaluate the diagnostic accuracy of chest radiography (CXR) and computed tomography (CT) in the detection of pulmonary infection in the late phase (> 100 days) after bone marrow transplantation (BMT).
Materials and Methods: Between 1997 and 2001, 72 patients (mean age 39.8 years) underwent allogeneic BMT at our institution. 73 matched CXR and CT examinations, obtained within 48 hours, were available for retrospective analysis. All examinations had been performed for clinical suspicion of infectious disease. Results of diagnostic broncho-alveolar lavage (BAL) were available for 23 imaging studies. For 50 examinations, imaging findings were correlated with the patients' clinical course. An unremarkable clinical course over subsequent seven days after imaging served as evidence of excluding infectious complications. Positive microbiological culture and/or improvement of symptoms after antibiotic therapy were considered as evidence of infectious disease.
Results: With CXR, infectious lung disease was suspected in 41.1%. CXR was unremarkable in 32.9%, and showed non-infectious pathologies in 26%. With CT, pulmonary opacifications compatible with infectious infiltrations were seen in 57.5%, and was unremarkable in 19.2%. Correlation with the clinical course and/or the results of the BAL revealed sensitivity, specificity and accuracy values of 59%, 92% and 71% for CXR and of 87% (p < 0.0001), 93% (p > 0.05) and 89% (p < 0.0001) for CT, respectively. McNemar-test showed that CT significantly (p < 0.05) improved the accuracy for diagnosing pulmonary infections in BMT-recipients.
Conclusion: CT is significantly superior to CXR for the diagnosis of pulmonary infections also in the late phase after bone marrow transplantation and should be performed early on clinical suspicion in these patients.
234. Nonspecific Interstitial Pneumonia: Histologic Correlation with High-Resolution CT
Sumikawa H.1*; Johkoh T.2,1; Noriyuki T.1; Ichikado K.3; Nakamura H.1; 1. Department of Diagnostic and Interventional Radiology, Osaka University Medical School, Suita, Japan; 2. Department of Medical Physics, Osaka University Medical School, Suita, Japan; 3. the First Department of Internal medicine, Kumamoto University School of Medicine, Kumamoto, Japan.
Address correspondence to H. Sumikawa (h-sumikawa{at}nifty.com)
Objective: The aim of this study was to find out pathological backgrounds of various high-resolution CT (HRCT) findings in the cases with nonspecific interstitial pneumonia (NSIP) paying special attention to pathological subgroups.
Materials and Methods: The study included 29 patients with NSIP who were compatible with the criteria of ATS-ERS consensus report clinically and histologically. Surgical biopsy was performed in all cases. More than two specimens were obtained in 20 cases and 53 specimens were obtained and divided with Katzenstein's classification for NSIP. Two observers evaluated HRCT findings on every biopsy site. Main CT pattern of each biopsy site was classified into the following 5 patterns; A. ground-glass attenuation and fine reticulation, B. ground-glass and coarse reticulation, C. ground-glass attenuation and consolidation, D. consolidation.
Results: Pathological subgroup was NSIP group 1 in 6, group 2 in 22 and group 3 in 25. Histological diagnoses of specimens in one case were discordant in 11 cases. Main HRCT pattern was pattern A in 15 corresponding images to specimens, B in 8, C in 21, D in 9. HRCT patterns except pattern E were seen in all histological subgroups and there was no significant correlation between HRCT pattern and histological subgroup (chi-square test, p = 0.07). HRCT pattern A pathologically corresponded to areas of thickened alveolar septa caused by inflammation and/or fibrosis with temporal uniformity. Pattern B were correlated with the areas with thickened alveolar septa accompanied by emphysema or dilation of small air ways. Areas of airspace consolidation were pathologically reflected to areas including severe septal fibrosis with loss of alveolar structures (n = 9), mucin stasis in the small air way (n = 6) or intraluminal organization (n = 4).
Conclusion: Various CT findings in the patients with NSIP were correlated with pathologic findings. Pathological findings that were correlated with CT findings were not much different among subgroup of NSIP.
235. Novel Approach for Quantitative Thymic Volume Analysis by MR Imaging
Reiman S.R.*; Fishman J.; Katzen J.; Miguez-Burbano M.; Shor-Posner G.; Radiology, Jackson Memorial Hospital, Miami, FL.
Address correspondence to S.R. Reiman (stevenreiman{at}hotmail.com)
Objective: The volume and activity of the thymus changes in response to HIV disease status and antiretroviral therapy. However, the adult thymus is generally fatty involuted, and calculations of true glandular volume may be inaccurate if fatty elements are not excluded. We developed a novel quantitative method for determining thymic volume by MR imaging, and correlated our findings with both qualitative thymic volumes and the status of immune suppression in HIV-positive individuals.
Materials and Methods: Twenty three HIV-infected adults underwent MR imaging both before and 6 months after initiation of antiretroviral therapy. T1 and T2 weighted MR sequences were obtained. Quantitative calculation of thymic volume was performed by correcting total prevascular mediastinal volume by mean signal intensity, using pure fat and muscle signal intensities to delimit the range of percent glandular composition (0-100%). Independently, qualitative region of-interest analysis was used to measure thymic volumes as the sum of observed glandular areas on each slice for both T1 and T2 sequences. Data from two observers was used to measure interobserver variation.
Results: The subjects ranged in age from 23 to 55 years. Quantitative T1 thymus volumes (18.2±12.4 cm3) were larger than either qualitative T1 (6.3±7.5 cm3) or qualitative T2 (7.2±10.3 cm3) methods. As a percentage of average thymus volume, interobserver differences were smallest for quantitative T1 (55%) and largest for qualitative T2 (90%) methods. Both quantitative and qualitative T1 methods demonstrated an increase in thymus volume with therapy (20.9% and 17.6% respectively) but qualitative T2 methods did not. There was a positive correlation between thymic volume and baseline CD4 cell count, using both quantitative (p = 0.012) and qualitative (p = 0.009) T1 methods.
Conclusion: Both quantitative and qualitative T1 MR thymic volume measurements tracked expected patterns with respect to baseline immunity and changes with therapy in HIV-positive patients. However, quantitative measurements demonstrated the lowest relative standard deviations and smallest interobserver differences among the tested methods.
236. Evaluation of Thoracic Abnormalities on 64-row MDCT: Comparison of Coronal Reformations versus Axial Images
Nishino M.*; Kubo T.; Kataoka M.L.; Gautam S.; Raptopoulos V.; Hatabu H.; Radiology, Beth Israel Deaconess Medical Center, Boston, MA.
Address correspondence to M. Nishino (mnishino{at}bidmc.harvard.edu)
Objective: To evaluate the capability of coronal reformations of the chest on 64-row MDCT in demonstrating thoracic abnormalities in comparison with axial images.
Materials and Methods: Consecutive 38 patients who underwent pulmonary CTA on a 64-row CT were retrospectively studied with IRB approval. Contiguous 2 mm axial and coronal images were reviewed independently with one week interval, by consensus reading of two board-certified radiologists. The overall image quality was graded using a five-point scale (1 = non-diagnostic to 5 = excellent). The abnormalities in the mediastinum, hilum, pulmonary vessels, aorta, heart, esophagus, pleura, chest wall, and lung parenchyma (emphysema, nodule, mass, atelectasis, consolidation, and linear scarring) were individually scored: 1 = definitely absent, 2 = probably absent, 3 = equivocal, 4 = probably present, 5 = definitely present. Scores on axial and coronal images were compared using weighted kappa analysis.
Results: Overall image quality was not significantly different between axial and coronal images (mean/median scores; 3.7/4; 3.6/4, respectively, p = 0.286, Wilcoxon signed-rank test). Significant agreement was observed between axial and coronal scores (percentage of concordant interpretation; mean, 85%, range, 67-100%; mean weighted kappa, 0.661; range, 0.362-1). Agreement was almost perfect for pneumothorax, lung and pleural mass, effusion and consolidation (weighted kappa = 1, 1, 0.969, 0.842, 0.833, respectively); substantial for pulmonary embolism (PE), trachea, mediastinal lymphadenopathy and non-skeletal chest wall lesion, heart, esophagus, and emphysema (weighted kappa, 0.618-0.799); moderate for atelectasis, mediastinum, hilar nodes, aorta, other lung lesions, skeletal chest wall lesions, linear scarring, and nodule (> 1 cm), pulmonary artery lesions other than PE, pleural thickening (weighted kappa, 0.405-0.592), and fair for nodules smaller than 1 cm (weighted kappa = 0.362).
Conclusion: Coronal reformations of chest on 64-row MDCT had substantial agreement with axial images in evaluating the majority of thoracic abnormalities. Evaluation of nodule < 1 cm was most influenced by axial versus coronal image planes.
237. Comparison of Cine CT during Coughing with Dynamic Expiratory CT for Eliciting Tracheal Collapse
Lee K.S.*; Kataoka M.L.; Lin S.; Raptopoulos V.D.; Boiselle P.M.; Radiology, Beth Israel Deaconess Medical Center, Boston, MA.
Address correspondence to K.S. Lee (kslee{at}bidmc.harvard.edu)
Objective: Because coughing produces a higher level of intrathoracic-extratracheal pressure than forceful exhalation, it should theoretically elicit a greater degree of tracheal collapse. Our purpose was to compare the degree of tracheal collapse elicited by coughing and forceful exhalation maneuvers using a 64-row MDCT scanner.
Materials and Methods: A computerized hospital information system was used to retrospectively identify all patients with benign airway disease referred for CT airway imaging at our institution during a 3-month period. All patients were scanned on a 64-detector MDCT scanner using a standard protocol with 3 different sequences: helical CT at end inspiration, helical CT at dynamic expiration (imaging during a forceful exhalation), and cine CT during coughing. Inclusion criteria consisted of patient cooperation with all 3 phases of imaging and absence of fixed tracheal stenosis or airway stent. Two radiologists reviewed the CT images by consensus agreement and measured the cross-sectional area of the tracheal lumen at the same anatomic level on all 3 phases of imaging using an electronic tracing tool. The percentage of tracheal luminal area collapse was then calculated for the dynamic expiration and coughing sequences. Statistical analysis was performed using the paired t test.
Results: 15 patients, including 5 men and 10 women, with mean age of 63 years (range, 45-82 years) comprised the study cohort. Mean tracheal lumen diameters (± standard deviations) for each sequence were: end inspiration, 209 mm2 (± 55); dynamic expiration, 124 mm2 (± 66); and coughing, 57 mm2 (± 47). The mean percentage collapse of the trachea was 73% with coughing versus 41% with dynamic expiration (p < 0.001).
Conclusion: Coughing elicits a significantly greater degree of tracheal collapse than forceful exhalation. Thus, cine CT imaging during coughing may be a more sensitive tool for assessing for airway malacia than dynamic expiratory CT imaging.
238. Utility of Venous Compression in DVT Evaluation Revisited
Kocakoc E.1; Bhatt S.2*; Dogra V.S.2; 1. Radiology, Firat University, Faculty of Medicine, Elazig, Turkey; 2. Radiology, University of Rochester School of Medicine, Rochester, NY.
Address correspondence to S. Bhatt (shweta_bhatt{at}urmc.rochester.edu)
Objective: Venous compression is considered the gold standard for confirmation of deep venous thrombosis (DVT). The objective of this study is to assess the contribution and significance of venous compression in comparison to color flow Doppler alone in the diagnosis of DVT. We also aimed to assess the number of patients diagnosed with DVT by venous compression alone.
Materials and Methods: Retrospective review of all DVT studies performed between January 2004 to February 2005 was performed. DVT examinations were performed using a 5.8-7.6 MHz (PLT604AT) linear broadband transducer (Toshiba Aplio). The images were reviewed independently by two radiologists who were blinded to the ini-tial results; they were categorized as normal, partial thrombus or complete thrombus. All patients with diagnostic quality images were included in the study.
Results: A total (n) of 428 patients comprised the study group. There were 135/428 males and 293/428 females with a mean age of 56.3 and 57.1 years, respectively. In total, 467 DVT exams were performed (39 patients had bilateral lower extremity exams). 198/428 exams were on the right side, and 191/428 were on the left side. 347/467 had normal lower extremity examinations. In total, 120/467 exams were abnormal. 49/120 had complete thrombus (Right-29 and left-20). 71/120 had partial thrombus (right-44 and left-27). The femoral vein was the vein most commonly involved (49/120) followed by the popliteal vein (37/120) and the common femoral vein (34/120). DVT was more common in the right lower extremity. We observed the thrombus on gray scale imaging in all 120 positive patients. No patient had absence of venous color flow Doppler (positive for thrombus) with negative venous compression (negative for thrombus). There was one patient with visualization of thrombus on grey scale imaging and positive venous compression (positive for thrombus) but was negative for thrombus on color flow Doppler examination. 60 lower extremity examinations for DVT also had associated additional findings; Bakers cyst was the commonest (24 /60).
Conclusion: Venous compression did not provide any additional information for diagnosis of DVT. If color flow Doppler demonstrates the presence of DVT, venous compression is not necessary, although it can further confirm the presence of DVT. No additional DVTs were diagnosed by using venous compression alone.
* Will present paper
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