Contrast Enhanced Ultrasound of the lower limb deep venous system: a technical feasibility study. Technical innovation.

BACKGROUND

A clear diagnosis of deep venous thrombosis (DVT) is still challenging: many patients with unclear compression/duplex-sonography undergo a trial of anticoagulative treatment with the immanent risk of systemic hemorrhagic complications. As contrast enhanced ultrasound (CEUS) has the potential to visualize the blood pool, we conducted this pilot study to determine its potential in the characterization of the deep venous system of the lower limb.

MATERIAL AND METHODS

CEUS was performed with a 9-3 MHz broadband linear transducer (iU22®, Philips, USA) after the standard-application of a second-generation contrast agent (SonoVue®, Bracco, Italy) in three healthy volunteers. Transverse US-scans were performed for depiction of the fibular-, posterior tibial-vein group, the popliteal, femoral, the external iliacal and the inferior caval vein at defined levels.

RESULTS

On our three volunteers the intended segments of the deep venous system of the lower limb were visualized clearly between 45 and 350 seconds by CEUS. The continuous proximal ward scanning demonstrated the venous topography up to the external iliac veins.

DISCUSSION AND CONCLUSIONS

These preliminary results show that the use of CEUS is at least promising in the detection and characterization of the deep venous system of the lower limb. This should be pathbreaking, especially in patients with e.g. high Body Mass Index, local edema, diffuse inflammation etc. undergoing sonographic assessment for suspected deep vein thrombosis not definable by complete compression venous ultrasound or duplex ultrasound.