Research in Clinic and Laboratory

, Volume 20, Issue 1, pp 11–17 | Cite as

New developments in noninvasive diagnosis of deep vein thrombosis of the lower limbs

  • Paolo Prandoni
  • Anthonie W. A. Lensing


Since the clinical diagnosis of deep vein thrombosis (DVT) of the lower limbs is nonspecific, a confirmation by objective tests is mandatory. Recently, three new simple and reproducible methods of detecting DVT have been developed: computerized impedance plethysmography, standardized Doppler ultrasound, and compression ultrasonography. In three large prospective studies including consecutive outpatients with clinically suspected DVT, these tests were blindly evaluated versus phlebography, to determine diagnostic criteria and accuracy. The sensitivity for proximal DVT was 91% for computerized impedance plethysmography, 91% for standardized Doppler ultrasound and 100% for compression ultrasonography; sensitivity for all thrombi (including calf-vein thrombi) was 86, 85 and 91%, respectively; the specificity was 94% for computerized impedance plethysmography, and 99% for both standardized Doppler ultrasound and compression ultrasonography. The results of these studies demonstrate that all the three tests are highly specific and sensitive methods for the diagnosis of proximal DVT in symptomatic outpatients. However, isolated calf thrombi could not be detected adequately. Before these simple tests can be recommended as substitutes for phlebography, the safety of withholding anticoagulant therapy in patients with repeated normal tests should be assessed.


Compression ultrasonography Computerized impedance plethysmography Deep vein thrombosis Lower limbs Phlebography Standardized Doppler ultrasound 


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  1. 1.
    Appelman P. T., de Jong T. E., Lampman L. E.: Deep venous thrombosis of the leg: US findings — Radiology163, 743, 1987.PubMedGoogle Scholar
  2. 2.
    Barnes R. W., Wu K. K., Hoack J. C.: Fallibility of the clinical diagnosis of venous thrombosis — J. Amer. med. Ass.234, 605, 1975.CrossRefGoogle Scholar
  3. 3.
    Bendick P. J.: Pitfalls of the Doppler examination for venous thrombosis — Amer. J. Surg.149, 320, 1983.Google Scholar
  4. 4.
    Bettman M. A., Paulin S.: Leg phlebography: the incidence, nature and modification of undesirable side effects — Radiology122, 101, 1977.Google Scholar
  5. 5.
    Cranley J. J., Canos A. J., Sull W. J.: The diagnosis of deep venous thrombosis: fallibility of clinical symptoms and signs — Arch. Surg.111, 34, 1976.PubMedGoogle Scholar
  6. 6.
    Cronan J. J., Dorfman G. S., Grusmark J.: Lower-extremity deep venous thrombosis: further experience with and refinements of US assessment — Radiology168, 101, 1988.PubMedGoogle Scholar
  7. 7.
    Cronan J. J., Dorfman G. S., Scola F. H., Schepps B., Alexander J.: Deep venous thrombosis: US assessment using vein compression — Radiology162, 191, 1987.PubMedGoogle Scholar
  8. 8.
    Dauzat M. M., Laroche J. P., Charras C., Blin B., Domingo-Faye M. M., Sainte-Luce P., Domergue A., Lopez F. M., Janbon C.: Real-time B-mode ultrasonography for better specificity in the noninvasive diagnosis of deep venous thrombosis — J. Ultrasound Med.5, 625, 1986.PubMedGoogle Scholar
  9. 9.
    Haeger K.: Problems of acute deep venous thrombosis. I. The interpretation of signs and symptoms — Angiology20, 219, 1969.PubMedCrossRefGoogle Scholar
  10. 10.
    Hirsh J.: Venous Thrombosis and Pulmonary Embolism. Diagnostic Methods. Churchill Livingstone, Edinburgh, 1987; p. 1.Google Scholar
  11. 11.
    Hoek J. A., Lensing A. W. A., ten Cate J. W., Borm J. J. J., Nurmohamed M. T., Cogo A., Courant A., Prandoni P., Ling E.: The clinical utility of objective diagnostic tests for diagnosing deep vein thrombosis of the leg — Brit. J. clin. Pract.43 (Suppl. 65), 26, 1989.Google Scholar
  12. 12.
    Huisman M. V., Buller H. R., ten Cate J. W., Heijermans H. S. F., van der Laan J., van Maanen D. J.: Management of clinically suspected acute venous thrombosis in outpatients with serial impedance plethysmography in a community hospital setting — Arch. intern. Med.149, 511, 1989.PubMedCrossRefGoogle Scholar
  13. 13.
    Huisman M. V., Buller H. R., ten Cate J. W., Vreeken J.: Serial impedance plethysmography for suspected deep venous thrombosis in outpatients: the Amsterdam General Practitioner Study — New Engl. J. Med.314, 823, 1986.PubMedGoogle Scholar
  14. 14.
    Hull R., Hirsh J., Carter C. J., Jay R. M., Ockelford P. A., Buller H. R., Turpie A. G. G., Powers P., Kinch D., Dodd P. E., Gill G. J., Leclerc J. R., Gent M.: Diagnostic efficacy of impedance plethysmography for clinically suspected deep-vein thrombosis: a randomized trial — Ann. intern. Med.102, 21, 1985.PubMedGoogle Scholar
  15. 15.
    Hull R., Hirsh J., Sackett D. L., Powers P., Turpie A. G. G., Walker I.: Combined use of leg scanning and impedance plethysmography for clinically suspected deep-vein thrombosis: an alternative to phlebography — New Engl. J. Med.296, 1947, 1977.Google Scholar
  16. 16.
    Hull R., Hirsh J., Sackett D. L., Taylor D. W., Carter C. J., Turpie A. G. G., Powers P., Gent M.: Clinical validity of a negative venogram in patients with clinically suspected venous thrombosis — Circulation64, 622, 1981.PubMedGoogle Scholar
  17. 17.
    Hull R., Hirsh J., Sackett D. L., Taylor D. W., Carter C. J., Turpie A. G. G., Zielinsky A., Powers P., Gent M.: Replacement of venography in suspected venous thrombosis by impedance plethysmography and I-125 fibrinogen leg scanning: a less invasive approach — Ann. intern. Med.94, 12, 1981.PubMedGoogle Scholar
  18. 18.
    Hull R., Taylor D. W., Hirsh J., Sackett D. L., Powers P., Turpie A. G. G., Walker I.: Impedance plethysmography: the relationship between venous filling and sensitivity and specificity for proximal vein thrombosis — Circulation58, 898, 1978.PubMedGoogle Scholar
  19. 19.
    Hull R., van Aken W. G., Hirsh J., Gallus A. S., Hoicka G., Turpie A. G. G., Walker I., Gent M.: Impedance plethysmography using the occlusive technique in the diagnosis of venous thrombosis — Circulation53, 696, 1976.PubMedGoogle Scholar
  20. 20.
    Langsfeld M., Hershey F. B., Thorpe L., Auer A. I., Binnington H. B., Hurley J. J., Woods J. J.: Duplex B-mode imaging for the diagnosis of deep venous thrombosis — Arch. Surg.122, 587, 1987.PubMedGoogle Scholar
  21. 21.
    Lensing A. W. A., Levi M., Buller H. R., Prandoni P., Agnelli G., ten Cate J. W.: Objective Doppler ultrasound for the diagnosis of deep-vein thrombosis — Ann. intern. Med. (In press).Google Scholar
  22. 22.
    Lensing A. W. A., Prandoni P., Brandjes D., Huisman P. M., Vigo M., Tomasella G., Krekt J., ten Cate J. W., Huisman M. V., Buller H. R.: Detection of deep-vein thrombosis by real-time B-mode ultrasonography — New Engl. J. Med.320, 342, 1989.PubMedGoogle Scholar
  23. 23.
    McLachlan M. S. F., Thomson J. G., Taylor D. W., Kelly M. E., Sackett D. L.: Observer variation in the interpretation of lower limb venograms — Amer. J. Roentgenol.132, 227, 1979.Google Scholar
  24. 24.
    O’Leary D. H., Kane R. A., Chase B. M.: A prospective study of the efficacy of B-scan sonography in the detection of deep venous thrombosis in the lower extremities — J. clin. Ultrasound16, 1, 1988.PubMedCrossRefGoogle Scholar
  25. 25.
    Prandoni P., Jonker J. J. C., Huisman M. V., Vigo M., Borm J. J. J., Lensing A. W. A., ten Cate J. W., Buller H. R., Sing A. K., Ruol A.: Computerized impedance plethysmography: accuracy in the detection of proximal deep vein thrombosis in symptomatic outpatients — (Submitted for publication).Google Scholar
  26. 26.
    Prandoni P., Lensing A. W. A., Vigo M., Zambon G., Breda A., Cuppini S., Ruol A.: Fallibility of the clinical diagnosis of deep venous thrombosis of the lower limbs. A prospective study — Ann. Ital. Med. intern.3, 93, 1988.Google Scholar
  27. 27.
    Sullivan E. D., Peter D. J., Cranley J. J.: Real-time B-mode venous ultrasound — J. vasc. Surg.1, 465, 1984.PubMedCrossRefGoogle Scholar
  28. 28.
    Sumner D. S., Lambeth A.: Reliability of Doppler ultrasound in the diagnosis of acute venous thrombosis both above and below the knee — Amer. J. Surg.138, 205, 1979.PubMedCrossRefGoogle Scholar
  29. 29.
    Voorhoeve R., Bruyninckx C. M., van Gerwen J., van den Borne H.: The value of Doppler ultrasound studies in the diagnosis of venous thrombosis. Results in 100 consecutively studied patients — Ned. T. Geneesk.128, 2297, 1984.PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • Paolo Prandoni
    • 1
  • Anthonie W. A. Lensing
    • 2
  1. 1.Clinica Medica IIUniversità degli Studi di PadovaPadovaItalia
  2. 2.Academic Medical CenterUniversity of AmsterdamThe Netherlands

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