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Magnetic resonance imaging for diagnosis of recurrent ipsilateral deep vein thrombosis.

Abstract：

:The diagnosis of recurrent ipsilateral deep vein thrombosis (DVT) is challenging, because persistent intravascular abnormalities after previous DVT often hinder a diagnosis by compression ultrasonography. Magnetic resonance direct thrombus imaging (MRDTI), a technique without intravenous contrast and with a 10-minute acquisition time, has been shown to accurately distinguish acute recurrent DVT from chronic thrombotic remains. We have evaluated the safety of MRDTI as the sole test for excluding recurrent ipsilateral DVT. The Theia Study was a prospective, international, multicenter, diagnostic management study involving patients with clinically suspected acute recurrent ipsilateral DVT. Treatment of the patients was managed according to the result of the MRDTI, performed within 24 hours of study inclusion. The primary outcome was the 3-month incidence of venous thromboembolism (VTE) after a MRDTI negative for DVT. The secondary outcome was the interobserver agreement on the MRDTI readings. An independent committee adjudicated all end points. Three hundred five patients were included. The baseline prevalence of recurrent DVT was 38%; superficial thrombophlebitis was diagnosed in 4.6%. The primary outcome occurred in 2 of 119 (1.7%; 95% confidence interval [CI], 0.20-5.9) patients with MRDTI negative for DVT and thrombophlebitis, who were not treated with any anticoagulant during follow-up; neither of these recurrences was fatal. The incidence of recurrent VTE in all patients with MRDTI negative for DVT was 1.1% (95% CI, 0.13%-3.8%). The agreement between initial local and post hoc central reading of the MRDTI images was excellent (κ statistic, 0.91). The incidence of VTE recurrence after negative MRDTI was low, and MRDTI proved to be a feasible and reproducible diagnostic test. This trial was registered at www.clinicaltrials.gov as #NCT02262052.

journal_name

Blood

journal_title

Blood

authors

van Dam LF,Dronkers CEA,Gautam G,Eckerbom Å,Ghanima W,Gleditsch J,von Heijne A,Hofstee HMA,Hovens MMC,Huisman MV,Kolman S,Mairuhu ATA,Nijkeuter M,van de Ree MA,van Rooden CJ,Westerbeek RE,Westerink J,Westerlund E,Krof

doi

10.1182/blood.2019004114

subject

Has Abstract

pub_date

2020-04-16 00:00:00

pages

1377-1385

issue

eissn

0006-4971

issn

1528-0020

pii

440989

journal_volume

135

pub_type

临床试验,杂志文章,多中心研究

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Magnetic resonance imaging for diagnosis of recurrent ipsilateral deep vein thrombosis.