Korean J Radiol.  2008 Feb;9(1):59-66. 10.3348/kjr.2008.9.1.59.

Evaluation of Deep Vein Thrombosis with Multidetector Row CT after Orthopedic Arthroplasty: a Prospective Study for Comparison with Doppler Sonography

• Byun SS
• Kim JH
• Kim YJ
• Chun YS
• Park CH
• Kim WH

• KMID: 1734276
• DOI: http://doi.org/10.3348/kjr.2008.9.1.59

Abstract

OBJECTIVE
This prospective study evaluated the ability of indirect 16-row multidetector CT venography, in comparison with Doppler sonography, to detect deep vein thrombosis after total hip or knee replacement. MATERIALS AND METHODS: Sixty-two patients had undergone orthopedic replacement surgery on a total of 30 hip joints and 54 knee joints. The CT venography (scan delay time: 180 seconds; slice thickness/increment: 2/1.5 mm) and Doppler sonography were performed 8 to 40 days after surgery. We measured the z-axis length of the beam hardening artifact that degraded the image quality so that the presence of deep vein thrombosis couldn't be evaluated on the axial CT images. The incidence and location of deep vein thrombosis was analyzed. The diagnostic performance of the CT venograms was evaluated and compared with that of Doppler sonography as a standard of reference. RESULTS: The z-axis length (mean +/- standard deviation) of the beam hardening artifact was 4.5 +/- 0.8 cm in the arthroplastic knees and 3.9 +/- 2.9 cm in the arthroplastic hips. Deep vein thrombosis (DVT) was found in the popliteal or calf veins on Doppler sonography in 30 (48%) of the 62 patients. The CT venography has a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 90%, 97%, 96%, 91% and 94%, respectively. CONCLUSION: The ability of CT venography to detect DVT was comparable to that of Doppler sonography despite of beam hardening artifact. Therefore, CT venography is feasible to use as an alternative modality for evaluating post-arthroplasty patients.

Keyword

Veins, thrombosis; Computed tomography (CT), angiography; Ultrasound (US), Doppler studies

MeSH Terms

Adult
Aged
Aged, 80 and over
*Arthroplasty, Replacement, Hip
*Arthroplasty, Replacement, Knee
Artifacts
Female
Humans
Leg/*blood supply
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Sensitivity and Specificity
Tomography, X-Ray Computed/*methods
Venous Thrombosis/etiology/*radiography/*ultrasonography

Figure

• 

  Fig. 1 A 63-year-old female underwent left total knee arthroplasty. A. Note the degradation of the image quality of the 3.5 cm-long segment (between the two arrows) in the popliteal fossa on the three-dimensional volume rendered image. B. An axial CT image shows the non-enhancing, low-attenuated lesions surrounded by contrast material within the left calf veins (asterisks). C. Color Doppler sonography reveals a hypoechoic lesion partially obstructing the left calf vein. There were blood flow signals surrounding the lesion.

• 

  Fig. 2 A 46-year-old female underwent left total hip arthroplasty. A. The three-dimensional volume rendering image shows the degradation of image quality along the long segment (between the two arrows) due to beam hardening artifact by the arthroplastic joint material. However, the entire common and superficial femoral veins, except for a 2 cm-long segment, could be evaluated for whether deep vein thrombosis was present or not. B. An axial CT image shows beam hardening artifact traversing the adjacent superficial femoral vein (arrow). C. A coronal image shows non-enhancing, low-attenuated lesions surrounded by contrast material within the left calf veins (arrows). Doppler sonography confirmed the deep vein thrombosis (not shown).

• 

  Fig. 3 A 54-year-old female underwent left total hip and knee arthroplasty simultaneously. A, B. Doppler sonography without (A) and with compression (B) revealed deep vein thrombosis in the left calf vein. The blood flow signal means partial occlusion of the left calf veins. After compression, the deep vein thrombosis lesion showed no compressibility. However, deep vein thrombosis was initially undetected on the CT venograms. C. On the retrospective analysis, a coronal CT image showed a small, non-occlusive thrombus (arrows) within the left calf vein.

• 

  Fig. 4 A 32-year-old female underwent right total hip arthroplasty. An axial CT image showed non-enhancing, low-attenuated lesions surrounded by high-attenuated tissue in the right calf (arrows). However, there was no definite evidence of deep vein thrombosis in the right calf vein despite the repeated sonographic examinations. This was a false-positive case.

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