Evaluation of perforating venous insufficiency with shear wave elastography: a preliminary study

Abstract

Purpose: The aim of this study was to investigate the efficacy of shear wave elastography (SWE) in the diagnosis of perforating vein insufficiency, and to determine the applicability of these measurements.

Methods: A total of 140 symptomatic patients with a total of 280 lower extremities were investigated. All patients presented with venous insufficiency (VI) symptoms, and received Doppler ultrasound assessment to determine VI and SWE measurements. The SWE values were measured in the adjacent perivenous tissue of the largest Cockett's perforating vein (PV) of both lower extremities, at the level where they pass the fascia. The Cockett's PV diameter and the presence of reflux in Cockett's PV and the great saphenous vein were compared with SWE values in perivenous tissue of PVs.

Results: The SWE values of the perforating vein insufficiency group were significantly higher than those of the normal PV without insufficiency group (P < 0.001). A significant and positive relation was seen between increased PV diameter and SWE values (P < 0.001) and there was a significant relationship between the presence of perforating vein insufficiency and increase in PV diameter. A statistically significant increase was detected in SWE values for the PV for those with reflux in the great saphenous vein (P < 0.001). The best cut-off values that can be used to detect perforating vein insufficiency were found 34.600 for kPa and 3.375 for m/s.

Conclusion: SWE may be used effectively in addition to conventional Doppler ultrasound examination in diagnosing and following perforating vein insufficiency.

Keywords: Doppler ultrasound; Perforating venous insufficiency; Shear wave elastography; Venous insufficiency.

Fig. 1

a–e 43-year-old woman with perforating vein insufficiency. The diameter, reflux and SWE measurements were performed in Cockett’s PV. The diameter of Cockett’s PV was 5.3 mm at the level where it passed the fascia (a). There was significant reflux in Cockett’s PV; the volume of reflux was 234 mL/min (b). The images were acquired and saved with three types of imaging options [propagation mode (c), elasticity mode (kPa) (d) speed mode (m/s) (e)]. Quantitative elasticity values were measured in propagation mode on magnified view with round ROI, in the adjacent perivenous tissue of the PV (c). The mean quantitative elasticity values were measured as 84.7 + 56.1/2 = 70.4 kPa (d) and 5.16 + 4.07/2 = 4.615 m/s (e)

Fig. 2

a–c 32-year-old woman without perforating vein insufficiency. The diameter of Cockett’s PV was 2.3 mm at the level where it passed the fascia (a). The mean quantitative elasticity values were measured as 14.8 + 10.6/2 = 12.7 kPa (b) and 2.23 + 1.89/2 = 2.060 m/s (c)

Fig. 3

a–d 38-year-old man with perforating vein insufficiency. The diameter of PV was 3.4 mm, and there were varicose veins related with PV (a). There was significant reflux in PV; the volume of reflux was 18 mL/min. The mean quantitative elasticity values were measured as 65.4 + 56.4/2 = 60.9 kPa (c) and 4.65 + 4.32/2 = 4.485 m/s (d)

Fig. 4

a–g 34-year-old woman with perforating vein insufficiency (a–c). The diameter of PV was 4.5 mm (a). The mean quantitative elasticity values were measured as 47.5 + 31.9/2 = 39.7 kPa (b) and 3.95 + 3.22/2 = 3.585 m/s (c). 39-year-old woman with perforating vein insufficiency (d–g). The diameter of PV was 4.9 mm (d). The mean quantitative elasticity values were measured as 75.5 + 75.1/2 = 75.3 kPa (e) and 5.29 + 4.89/2 = 5.09 m/s (f). SWE numerical values were higher in the PV with the larger diameter

Fig. 5

A ROC curve analysis of the SWE value for kPa (a), for m/s (b) of PV and insufficiency in PV and the best cut-off values. The best cut-off values that can be used to detect perforating vein insufficiency were found to be 34.600 for kPa (a) and 3.375 for m/s (b)