Diagnostic accuracy of computed tomography venography compared with ultrasonography for detection of peripherally inserted central venous catheter-related thrombosis in patients with cancer: the DETECT study.

BACKGROUND: Ultrasonography is the primary diagnostic imaging modality for upper extremity deep vein thrombosis related to peripherally inserted central venous catheters (PICCs). Computed tomography (CT) venography may offer higher sensitivity while additionally providing information about the superior vena cava and central pulmonary arteries.

OBJECTIVES: We compared the diagnostic accuracy of CT venography with ultrasonography for screen-detected PICC-related venous thromboembolism (VTE).

METHODS: Consecutive adult patients with cancer were enrolled before PICC placement. On day 20 ± 5, screening was performed by compression ultrasonography and duplex of the neck and upper extremity and CT venography of the neck, upper extremity, and chest. The primary outcome included upper extremity deep vein thrombosis, vena cava and right atrial thrombosis, and pulmonary embolism. CT scans were adjudicated by 2 radiologists blinded to initial readings. The sensitivity of CT and ultrasonography was estimated using VTE on either test as a combined standard.

RESULTS: Forty one patients participated (median age 61 years, 51% female), of whom 18 (44%) were diagnosed with PICC-related VTE, including 15 asymptomatic detected at screening and 3 symptomatic VTE prior to screening. Screening CT venography missed 6 events (sensitivity, 60%; 95% CI, 36-80) and ultrasonography missed 3 (sensitivity, 80%; 95% CI, 55-93). Thrombi missed by CT venography were located across cannulated upper extremity deep veins, while ultrasonography missed thrombi in the brachiocephalic and more central veins.

CONCLUSION: Both CT venography and ultrasonography missed VTE at screening. Results indicate that it is unlikely that the sensitivity of CT venography alone exceeds that of ultrasonography in detection of asymptomatic PICC-related VTE.