Combined CT Venography and Pulmonary Angiography in Suspected Thromboembolic Disease : Diagnostic Accuracy for Deep Venous Evaluation

• Published in: American journal of roentgenology (1976) Vol. 174; no. 1; pp. 61 - 65
• Main Authors: Loud, Peter A, Katz, Douglas S, Klippenstein, Donald L, Shah, Rakesh D, Grossman, Zachary D
• Format: Journal Article
• Language: English
• Published: Leesburg, VA Am Roentgen Ray Soc 01.01.2000; American Roentgen Ray Society
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiovascular system; Contrast Media - administration & dosage; Female; Femoral Vein - diagnostic imaging; Humans; Injections, Intravenous; Investigative techniques, diagnostic techniques (general aspects); Leg - blood supply; Male; Medical sciences; Middle Aged; Phlebography; Pneumology; Popliteal Vein - diagnostic imaging; Pulmonary Artery - diagnostic imaging; Pulmonary Embolism - diagnostic imaging; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Tomography, X-Ray Computed; Ultrasonography; Veins - diagnostic imaging; Venous Thrombosis - diagnostic imaging; Sonography; Human; Radiodiagnosis; Angiography; Respiratory disease; Radiologic investigation; Lower limb; Cardiovascular disease; Thrombosis; Venous disease; Vascular disease; Pulmonary embolism; Medical imagery; Computerized axial tomography; Deep vein; Diagnosis; Comparative study
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/ajr.174.1.1740061

Combined CT venography and pulmonary angiography is a new diagnostic test that evaluates both pulmonary embolism and deep venous thrombosis (DVT) in a single study. Our purpose was to compare the CT venous findings with lower extremity venous sonography. Seventy-one consecutive patients with suspected pulmonary embolism underwent helical CT pulmonary angiography during rapid i.v. infusion of contrast medium. Axial scans at 5-cm intervals from the patient's upper calves to the diaphragm were generated 3.5 min after the beginning of contrast medium injection. CT venous phase images were interpreted prospectively and compared with subsequent bilateral lower extremity venous sonography performed within 12 hr. DVT was revealed by CT venous phase images in 19 patients, 12 of whom also had pulmonary embolism. CT and sonographic findings correlated exactly in the femoropopliteal deep venous system, where most pulmonary emboli originate. CT venous phase images also revealed pelvic extension of DVT in six patients and isolated vena cava thrombus in one patient. CT venous phase imaging at the time of CT pulmonary angiography is comparable with venous sonography in the evaluation of femoropopliteal DVT. The iliac veins and vena cava, vessels poorly shown on sonography but sometimes the source of significant pulmonary emboli, are also depicted by CT venography.