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Deep Vein Thrombosis Detection
Publication Name:
Current Protocols in Magnetic Resonance Imaging
Unit Number:
Unit A13.2
DOI:
10.1002/0471142719.mia1302s04
Online Posting Date:
May, 2002 Abstract
Magnetic Resonance Angiography (MRA) is a robust and noninvasive technique for evaluating the vascular system with respect to deep venous thrombosis (DVT) of the lower extremities. This unit presents basic protocols for imaging the pelvic and lower extremity veins for evaluating DVT. A protocol is also provided for defining the sequence for imaging the pelvic and lower extremity veins with a stepping table.
Materials
Basic Protocol 1: Imaging the Pelvic and Lower Extremity Veins
Materials
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Normal saline (0.9% NaCl), sterile
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Extracellular contrast agents (e.g., Magnevist, Omniscan, or ProHance)
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Figures
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Figure A13.2.1Acute nonocclusive DVT. The MIP image (A) from a 2-D TOF MRV study shows a low intensity defect involving the left common iliac vein. This is a pitfall of extrinsic compression of the vein from the overlying common iliac artery as demonstrated on the transverse 2-D TOF source data (B) at that location. A nonocclusive low signal filling defect consistent with acute thrombus is seen in the left proximal superficial femoral vein. This is best visualized by reviewing the transverse 2-D TOF source data (C) and can be overlooked if only the MIP images are viewed. -
Figure A13.2.2Chronic lower extremity DVT. MIP images from the proximal (A), mid (B), and distal (C) stations of a 2-D TOF MRV study are shown. The stepping kinematic imaging platform (SKIP) was employed for rapid repositioning of the patient relative to the phased array coils when proceeding from one station to the next. Occlusive disease with collateral veins are shown at all stations. -
Figure A13.2.3Pulmonary 3-D contrast enhanced MRA followed by venous steady state imaging. The coronal contrast enhanced (Omniscan, Amersham Health) 3-D MRA MIP image of the proximal station to include the pulmonary vessels is shown (A) followed by the pelvic and thigh arterial anatomy (B). A single peripheral i.v. injection of contrast was employed along with stepping kinematic imaging platform (SKIP) for MRI table stepping. After stepping the table back to the proximal station, 30 sec later, a steady state image acquisition was made at both imaging stations again. The arterial phase data from (A) and (B) were used as a mask and subtracted from the steady state data. The MIP images of the subtracted data yield only venous anatomy at both stations (C, D).
Literature Cited
| Literature Cited | |
| Evans, A.J., Sostman, H.D., Knelson, M.H., Spritzer, C.E., Newman, G.E., Paine, S.S., and Beam, C.A. 1993. Detection of deep venous thrombosis: Prospective comparison of MR imaging with contrast venography. A.J.R. Am. J. Roentgenol. 161:131-135. | |
| Carpenter, J.P., Holland, G.A., Baum, R.A., Owen, R.S., Carpenter, J.T., and Cope, C. 1993. Magnetic resonance venography for the detection of deep venous thrombosis: Comparison with contrast venography and duplex Doppler ultrasonography. J. Vasc. Surg. 18:734-739. | |
| Lebowitz, J.A., Rofsky, N.M., Krinsky, G.A., and Weinreb, J.C. 1997. Gadolinium-enhanced body MR venography with subtraction technique. A.J.R. 169:755-758 | |
| Saeed, M., Wendland, W.F., Engelbrecht, M., Sakuma, H., and Higgins, C.B. 1998. Value of blood pool contrast agents in magnetic resonance angiography of the pelvis and lower extremities. Eur. Radiol. 8:1047-1053. | |
| Shellock, F.G. 1996. Pocket Guide to MR Procedures and Metallic Objects. (F.G. Shellock, ed.). Lippincott-Raven, Philadelphia. | |
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