From the Departments of Surgery (M.J.J., H.K., M.N., J.Y.C., Y.H., T.W.K., Y.P.C.), Radiology (G.Y.K., D.I.G.), Pulmonology (J.S.L.), and Clinical Epidemiology and Biostatistics (M.J.K.), University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Radiology. 2019 Dec;293(3):687-694. doi: 10.1148/radiol.2019190358. Epub 2019 Oct 8.
Background Acute deep venous thrombi (DVT) have higher Hounsfield unit values than chronic (bland) thrombi at CT venography. Purpose To determine the relationship between DVT thrombus density found on CT venography images to the presence of acute pulmonary embolism (PE) and the future risk of postthrombotic syndrome (PTS) in patients with DVT. Materials and Methods In this retrospective study, patients were divided into two groups: PE with DVT group and DVT-only group. Wells scores were recorded. Thrombus density ratios were calculated (DVT thrombus Hounsfield units/surrounding vein Hounsfield units). The presence or absence of PTS was determined from the results of the Venous Insufficiency Epidemiologic and Economic Study on Quality of Life (VEINES-QOL) questionnaires given to the patients with DVT. Statistical analyses used receiver operating characteristic curves and Spearman correlation analyses. Results Eighty-six patients were included; the mean age was 60 years ± 17 (51 men; PE with DVT group, 54 patients [63%]; DVT-only group, 32 patients [37%]). The mean thrombus density ratio was significantly higher in the PE with DVT group than in the DVT-only group (53.6% ± 12.4 [standard deviation] vs 42.8% ± 11.9, respectively; < .001). At multivariable analysis, Wells score greater than 4 (odds ratio, 12.0; 95% confidence interval [CI]: 3.0, 47; < .001) and higher thrombus density ratio (odds ratio, 1.1; 95% CI: 1.0, 1.2; = .001) were independent predictors of PE. The diagnostic performance for the thrombus density ratio (area under the receiver operating characteristic curve, 0.74; 95% CI: 0.63, 0.85; < .001) may be more discriminative than that of the Wells score (area under the receiver operating characteristic curve, 0.70; 95% CI: 0.59, 0.81; = .002) for the presence of PE. In subgroup analysis, the thrombus density ratio and VEINES-QOL score were correlated ( = 0.61; 95% CI: 0.30, 0.80; < .001). Conclusion Deep venous thrombosis (DVT) density ratio at CT venography was associated with acute pulmonary embolism in patients with lower-extremity DVT. © RSNA, 2019
背景 在 CT 静脉造影中，急性深静脉血栓（DVT）的 Hounsfield 单位值高于慢性（良性）血栓。目的 确定 CT 静脉造影图像上 DVT 血栓密度与急性肺栓塞（PE）的存在以及 DVT 患者发生血栓后综合征（PTS）的未来风险之间的关系。材料与方法 在这项回顾性研究中，患者分为两组：PE 合并 DVT 组和单纯 DVT 组。记录 Wells 评分。计算血栓密度比（DVT 血栓的 Hounsfield 单位数/周围静脉的 Hounsfield 单位数）。根据 DVT 患者的静脉功能不全流行病学和经济研究生活质量（VEINES-QOL）问卷的结果，确定是否存在 PTS。统计学分析使用受试者工作特征曲线和斯皮尔曼相关分析。结果 共纳入 86 例患者，平均年龄 60 岁±17 岁（51 例男性；PE 合并 DVT 组 54 例[63%]；单纯 DVT 组 32 例[37%]）。PE 合并 DVT 组的平均血栓密度比明显高于单纯 DVT 组（分别为 53.6%±12.4%[标准差]和 42.8%±11.9%；<.001）。多变量分析显示，Wells 评分大于 4 分（比值比，12.0；95%置信区间[CI]：3.0，47；<.001）和较高的血栓密度比（比值比，1.1；95%CI：1.0，1.2；=.001）是 PE 的独立预测因素。血栓密度比（受试者工作特征曲线下面积，0.74；95%CI：0.63，0.85；<.001）的诊断性能可能优于 Wells 评分（受试者工作特征曲线下面积，0.70；95%CI：0.59，0.81；=.002）对 PE 的存在的诊断性能。在亚组分析中，血栓密度比与 VEINES-QOL 评分相关（= 0.61；95%CI：0.30，0.80；<.001）。结论 CT 静脉造影时 DVT 密度比与下肢 DVT 患者的急性 PE 相关。
