Differentiating exacerbation of chronic venous insufficiency from DVT among patients with history of past DVT: is the ultrasound still a “golden standard”
Journal Title: Postępy Nauk Medycznych - Year 2012, Vol 25, Issue 8
Abstract
<b>Aim. </b>The aim of the study was to evaluate and compare operator dependency in the diagnosis of recurrent DVT by means of colour coded ultrasonography, as compared to D-dimer levels.<br><b>Material and methods.</b> The study was designed as a prospective, randomized, interobserver one. Thirty one patients with suspected recurrent DVT were evaluated. All were diagnosed and treated in the Department of Vascular Surgery. Strict exclusion criteria for D-dimer tests were applied. The US examinations were performed independently by two experienced ultrasonographers, who were blinded from the result of D-dimer test results.<br><b>Results.</b> The overall interobserver agreement for all thrombotic changes (diagnosis of the first episode of DVT) seen on US was very high reaching av. κ value of 0.81. The statistical analysis (diagnosis of recurrent DVT) for κ agreement and for negative predictive value of US versus D-dimer test revealed, that the diagnosis of recurrence of DVT remains very poor among the two ultrasonographers. Moreover, interobserver variation of the US results in those cases is unacceptably high. The κ analysis for the agreement of US results suggesting recurrent DVT among patients with positive D-dimer result (> 450 μg/ml) revealed complete lack of agreement at all measured levels (κ values around 0 level).<br><b>Conclusions. </b>Colour coded ultrasonography continues to prove being extremely specific in the diagnosis of primary DVT, but has important limitations in the differential diagnosis of recurrent DVT. D-dimer test although highly nonspecific, may provide an extremely important adjunct for the differentiation of recurrent DVT from an episode of exacerbated CVI.<br>D-dimer tests should be considered as a first line diagnostic tool (along with the US) in the diagnosis of recurrent DVT.
Authors and Affiliations
Grzegorz Madycki, Walerian Staszkiewicz, Zbigniew Kwietniak, Piotr Słowiński
Keywords
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