Venous filling defects on portal venous phase CT of the abdomen and pelvis: clinical implications and positive predictive value for diagnosing deep venous thrombosis

• Published in: Abdominal imaging 2014-06, Vol.39 (3), p.554-561
• Main Authors: Horvath, Jeffrey J., Looney, Christopher B., Nelson, Rendon C., Kim, Charles Y.
• Format: Article
• Language: English
• Subjects: Abdomen - blood supply; Abdomen - diagnostic imaging; Contrast Media; Female; Gadolinium; Gastroenterology; Hepatology; Humans; Image Processing, Computer-Assisted - methods; Imaging; Iopamidol; Male; Medicine; Medicine & Public Health; Middle Aged; Multidetector Computed Tomography - methods; Organometallic Compounds; Pelvis - blood supply; Pelvis - diagnostic imaging; Portal Vein - diagnostic imaging; Predictive Value of Tests; Prevalence; Radiographic Image Enhancement - methods; Radiography, Abdominal - methods; Radiology; Reproducibility of Results; Sensitivity and Specificity; Ultrasonography; Venous Thrombosis - diagnostic imaging; Venous Thrombosis - epidemiology
• ISSN: 0942-8925; 2366-004X; 1432-0509; 2366-0058
• DOI: 10.1007/s00261-014-0077-1

Purpose To determine the prevalence, resulting clinical decisions, and the positive predictive value (PPV) of venous filling defects detected on portal venous phase (PVP) CT. Methods Over a 3-year period, 42412 consecutive patients underwent a PVP abdominopelvic CT; of these, 348 reports mentioned a filling defect concerning for deep venous thrombosis (DVT) in the IVC, iliac, or common femoral veins. Ninety-three patients underwent a reference standard venous imaging study. Results The prevalence of venous filling defects in CT reports was 0.82% ( n  = 348). Reports worded with higher degrees of certainty were statistically more likely to result in treatment, while lower certainty was correlated with additional confirmatory imaging. The PPV for detection of DVT was 77%. The presence of peri-vascular stranding or vessel expansion increased the PPV of PVP CT to 95% and 100%, respectively. Conclusion While the PPV for filling defects on PVP CT was modest, it was substantially improved if peri-venous stranding or vessel expansion was present.