CT for the Diagnosis of Venous Thromboembolic Disease
Spiral CT, venous ultrasound, ventilation-perfusion scanning, and D-dimer tests are routinely used in the diagnosis of venous thromboembolic disease. Advances in multidetector spiral CT and the combination of CT pulmonary angiography and venography as a one-step evaluation of venous thromboembolic disease have markedly improved detection of subsegmental emboli and deep pelvic venous thrombi and decreased the role of conventional pulmonary angiography. As CT has improved, many have questioned what "gold standard" CT should be compared with. Recent clinical outcome studies suggest that CT results are as good as pulmonary angiography and conventional imaging algorithms. Because the sensitivity of CT pulmonary angiography now exceeds 85%, it also appears that it is also more cost effective than other diagnostic approaches.
Venous thromboembolism (VTE) is a common disorder. However, because of the nonspecific signs and symptoms of the disease, the clinical diagnosis is very difficult. Accurate diagnosis of VTE is essential, because appropriate diagnosis and treatment decreases morbidity from 8 to 30% to 1 to 2%. Chest radiograph, ventilation-perfusion (V/Q) scanning, spiral CT, pulmonary angiography, venous ultrasound, magnetic resonance angiography (MRA), transesophageal echocardiography, and D-dimer tests are currently used in diagnosing VTE. In the last decade, with improving helical CT imaging, CT for the diagnosis of pulmonary embolism (PE) has won widespread acceptance. With the addition of CT venography (CTV) to CT pulmonary angiography (CTPA), veins of the pelvis and lower extremities can be evaluated for deep venous thrombosis (DVT) without giving additional contrast material. Although the accuracy of CT is better in lobar and segmental arteries, recent studies have shown improvement in visualization of subsegmental arteries. Many centers are using CT as a first-line study in evaluation of VTE.
Spiral CT, venous ultrasound, ventilation-perfusion scanning, and D-dimer tests are routinely used in the diagnosis of venous thromboembolic disease. Advances in multidetector spiral CT and the combination of CT pulmonary angiography and venography as a one-step evaluation of venous thromboembolic disease have markedly improved detection of subsegmental emboli and deep pelvic venous thrombi and decreased the role of conventional pulmonary angiography. As CT has improved, many have questioned what "gold standard" CT should be compared with. Recent clinical outcome studies suggest that CT results are as good as pulmonary angiography and conventional imaging algorithms. Because the sensitivity of CT pulmonary angiography now exceeds 85%, it also appears that it is also more cost effective than other diagnostic approaches.
Venous thromboembolism (VTE) is a common disorder. However, because of the nonspecific signs and symptoms of the disease, the clinical diagnosis is very difficult. Accurate diagnosis of VTE is essential, because appropriate diagnosis and treatment decreases morbidity from 8 to 30% to 1 to 2%. Chest radiograph, ventilation-perfusion (V/Q) scanning, spiral CT, pulmonary angiography, venous ultrasound, magnetic resonance angiography (MRA), transesophageal echocardiography, and D-dimer tests are currently used in diagnosing VTE. In the last decade, with improving helical CT imaging, CT for the diagnosis of pulmonary embolism (PE) has won widespread acceptance. With the addition of CT venography (CTV) to CT pulmonary angiography (CTPA), veins of the pelvis and lower extremities can be evaluated for deep venous thrombosis (DVT) without giving additional contrast material. Although the accuracy of CT is better in lobar and segmental arteries, recent studies have shown improvement in visualization of subsegmental arteries. Many centers are using CT as a first-line study in evaluation of VTE.
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