MDCT venography in patients with suspected pulmonary embolism: diagnostic impact of pelvic vein evaluation in thromboembolic disease detection.

AIM: To assess the incremental value of pelvic vein-evaluation with Multidetector CT Venography (MDCT-V) for the diagnosis of thromboembolic disease in patients suspected of Pulmonary Embolism (PE).

METHODS

We retrospectively reviewed CT images of 440 patients (228 women and 212 men; mean age 63 ± 18 years) who underwent combined Multidetector CT Pulmonary Angiography (MDCT-PA) and MDCT-V for suspected PE. Frequency of PE, deep venous thrombosis (DVT), and venous thromboembolism (VTE) were assessed together with the incremental value of MDCT-V; the distribution of thrombi and the frequency of isolated clots in the inferior vena cava or iliac veins were also recorded for each patient.

RESULTS

PE was detected in 146 (33%) of 440 patients, DVT in 147 (33.4%) and VTE in 196 (44%). MDCT-V showed thrombi in 50 patients who did not have signs of PE at MDCT-PA. Thus, the addition of MDCT-V resulted in a 25% increase in thromboembolic disease detection (99% confidence interval: 22%, 28%). Among 147 patients with DVT, only four had thrombi in the iliac and/or in the inferior vena cava without femoral or popliteal vein thrombosis; however, all but one had also PE detected on MDCT-PA. Thus, the diagnostic value of MDCT pelvic vein evaluation was 2.7% in the diagnosis of DVT and 0.5% in the diagnosis of VTE.

CONCLUSION

In patients with suspected PE, evaluation of pelvic veins with MDCT-V has a limited impact on the diagnosis of thromboembolic disease and could be safely omitted.