Recommendations for ultrasound imaging test protocols in patients with suspected deep venous thrombosis (DVT) developed at the 2016 Society of Radiologists in Ultrasound Consensus Conference were recently published in Circulation.
After open discussion and unanimous consensus among experts in venous imaging and DVT treatment, the recommendations were reached. They can be summarized into 5 key areas: patient selection, ultrasound protocols, serial and follow-up considerations, terminology for ultrasound reports, and diagnostic criteria.
For patients suspected of having DVT, the panel recommended that all patients be evaluated for pretest probability of DVT before ultrasound.
For those with low (unlikely) pretest probability, obtaining a high-sensitivity D-dimer is appropriate. With regard to ultrasound protocol, the panel recommended a comprehensive duplex ultrasound protocol from thigh to ankle with Doppler at selected sites rather than a limited or complete compression-only examination. Furthermore, the panel recommended a single point-of-care protocol that minimizes underdiagnoses of proximal DVT.
In addition, the panel recommended the term “chronic post-thrombotic change” to describe the residual material that persists after the acute presentation of DVT to avoid potential overtreatment of prior thrombus.
“Most current guidelines for venous ultrasound have multiple workflows that may lead to incorrect application of algorithms and, potentially, medical errors,” the panel wrote
They added, “For patients who need a venous ultrasound examination, adoption of a single, standardized complete duplex ultrasound examination will simplify the workup and follow-up of most patients.”
Needleman L, Cronan J, Lilly M, et al. Ultrasound for lower extremity deep venous thrombosis. Multidisciplinary recommendations from the Society of Radiologists in Ultrasound Consensus Conference [published April 2, 2018]. Circulation. doi:10.1161/CIRCULATIONAHA.117.030687