Evaluation of the lower extremity veins in patients with suspected pulmonary embolism: a retrospective comparison of helical CT venography and sonography. 2000 ARRS Executive Council Award I. American Roentgen Ray Society

OBJECTIVE: In patients undergoing a combined CT angiographic and CT venographic protocol, the accuracy of helical CT venography for the detection of deep venous thrombosis was compared with that of lower extremity sonography. MATERIALS AND METHODS: Patients who had undergone a combined CT angiographic and CT venographic protocol and sonography of the lower extremities within 1 week were identified. The final reports were evaluated for the presence or absence of deep venous thrombosis. Statistical measures for the identification of deep venous thrombosis with helical CT venography were calculated. In each true-positive case, the location of the thrombus identified with both techniques was compared. All false-positive and false-negative cases were reviewed to identify the reasons for the discrepancies. RESULTS: Seventy-four patients were included. There were eight patients (11%) with true-positive findings, 61 patients (82%) with true-negative findings, four patients (5%) with false-positive findings, and one patient (1%) with a false-negative finding. When comparing helical CT venography with sonography for the detection of lower extremity deep venous thrombosis, the sensitivity measured 89%; specificity, 94%; positive predictive value, 67%; negative predictive value, 98%; and accuracy, 93%. Of the eight true-positive cases, five had sites of thrombus that were in agreement on both CT venography and sonography. Of the five discordant cases, four were false-positives and one was a false-negative. Possible explanations for all discrepancies were identified. CONCLUSION: Compared with sonography, CT venography had a 93% accuracy in identifying deep venous thrombosis. However, the positive predictive value of only 67% for CT venography suggests that sonography should be used to confirm the presence of isolated deep venous thrombosis before anticoagulation is initiated. In addition, interpretation of CT venography should be performed with knowledge of certain pitfalls.