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Multicenter Study
. 2021 Aug;19(8):1973-1980.
doi: 10.1111/jth.15394. Epub 2021 Jun 16.

Detection of upper extremity deep vein thrombosis by magnetic resonance non-contrast thrombus imaging

Lisette F van Dam  1 , Charlotte E A Dronkers  1   2 , Gargi Gautam  3 , Åsa Eckerbom  3 , Waleed Ghanima  4   5 , Jostein Gleditsch  6 , Guido R van Haren  7 , Anders von Heijne  3 , Menno V Huisman  1 , J Lauran Stöger  7 , Eli Westerlund  3 , Lucia J M Kroft  7 , Frederikus A Klok  1
Affiliations
Multicenter Study

Detection of upper extremity deep vein thrombosis by magnetic resonance non-contrast thrombus imaging

Lisette F van Dam et al. J Thromb Haemost. 2021 Aug.

Abstract

Background: Compression ultrasonography (CUS) is the first-line imaging test for diagnosing upper extremity deep vein thrombosis (UEDVT), but often yields inconclusive test results. Contrast venography is still considered the diagnostic standard but is an invasive technique.

Objectives: We aimed to determine the diagnostic accuracy of magnetic resonance noncontrast thrombus imaging (MR-NCTI) for the diagnosis of UEDVT.

Methods: In this international multicenter diagnostic study, we prospectively included patients with clinically suspected UEDVT who were managed according to a diagnostic algorithm that included a clinical decision rule (CDR), D-dimer test, and diagnostic imaging. UEDVT was confirmed by CUS or (computed tomography [CT]) venography. UEDVT was excluded by (1) an unlikely CDR and normal D-dimer, (2) a normal serial CUS or (3) a normal (CT) venography. Within 48 h after the final diagnosis was established, patients underwent MR-NCTI. MR-NCTI images were assessed post hoc by two independent radiologists unaware of the presence or absence of UEDVT. The sensitivity, specificity, and interobserver agreement of MR-NCTI for UEDVT were determined.

Results: Magnetic resonance noncontrast thrombus imaging demonstrated UEDVT in 28 of 30 patients with UEDVT and was normal in all 30 patients where UEDVT was ruled out, yielding a sensitivity of 93% (95% CI 78-99) and specificity of 100% (95% CI 88-100). The interobserver agreement of MR-NCTI had a kappa value of 0.83 (95% CI 0.69-0.97).

Conclusions: Magnetic resonance noncontrast thrombus imaging is an accurate and reproducible method for diagnosing UEDVT. Clinical outcome studies should determine whether MR-NCTI can replace venography as the second-line imaging test in case of inconclusive CUS.

Keywords: anticoagulation; deep vein thrombosis; diagnosis; diagnostic imaging; magnetic resonance imaging.

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Conflict of interest statement

We declare no competing interests.

Figures

FIGURE 1
FIGURE 1
Diagnostic algorithm in suspected upper extremity deep vein thrombosis (UEDVT). Note: CDR, clinical decision rule; CT, computed tomography; CUS, compression ultrasonography
FIGURE 2
FIGURE 2
Flowchart of study patients. Note: MRI, magnetic resonance imaging; PE, pulmonary embolism; UEDVT, upper extremity deep vein thrombosis; VTE, venous thromboembolism
FIGURE 3
FIGURE 3
Magnetic resonance imaging of the right upper extremity in coronal view of a patient diagnosed with acute deep vein thrombosis in right brachial and axillar vein. (A) Magnetic resonance direct thrombus imaging (MRDTI) and (B) three‐dimensional turbo spin‐echo spectral attenuated inversion recovery (3D TSE‐SPAIR) showing high signal intensity in brachial and axillar vein (arrows) compatible with an acute thrombus
See this image and copyright information in PMC

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