CT venography in suspected pulmonary thromboembolism

• Published in: Seminars in ultrasound, CT, and MRI Vol. 25; no. 1; pp. 67 - 80
• Main Authors: Katz, Douglas S, Loud, Peter A, Hurewitz, Adam N, Mueller, Richard, Grossman, Zachary D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2004
• Subjects: Abdomen - pathology; Algorithms; Angiography; Humans; Leg - diagnostic imaging; Leg - pathology; Pelvis - diagnostic imaging; Pelvis - pathology; Phlebography; Pulmonary Embolism - diagnostic imaging; Radiographic Image Interpretation, Computer-Assisted; Sensitivity and Specificity; Tomography, X-Ray Computed
• ISSN: 0887-2171; 1558-5034
• DOI: 10.1053/j.sult.2003.10.002

Pulmonary embolism (PE) and deep venous thrombosis (DVT) are a continuum and are difficult to diagnose clinically. Combined CT venography and pulmonary angiography (CTVPA) is a single examination that combines multidetector CT pulmonary angiography (CTPA) and CT venography (CTV) of the abdomen, pelvis, and lower extremities, providing “one-stop shopping” for venous thromboembolism without additional venipuncture or IV contrast, and it adds only a few additional minutes to scanning time. CTVPA rapidly and accurately examines the deep veins, reveals the presence, absence, and extent of deep venous thrombosis, serves as a baseline, and helps guide patient management. Multiple investigators have reported a high degree of accuracy when CTV is compared with venous ultrasound. There are some pitfalls in image interpretation, especially with regard to mixing artifacts, and there are continuing controversies as to exactly which parts of the abdomen, pelvis, and legs should be scanned routinely, the ideal timing of CTV acquisition relative to contrast injection, and the slice thickness and gap, if any, that should be used.