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Title: Deep venous thrombophlebitis: detection with 4-hour versus 24-hour platelet scintigraphy

Abstract

Thirty-one nonheparinized patients with suspected deep venous thrombophlebitis (DVT) underwent contrast venography and indium-111 platelet scintigraphy (In-111 PS). Venography permitted identification of acute DVT in 12 of 31 cases (39%). One additional patient was considered to have acute DVT despite nonconclusive venography results. In-111 PS results were positive at 4 hours in nine of 13 cases (69%) and at 24 hours in 12 of 13 cases (92%). Two of four patients with false-negative 4-hour In-111 PS studies had received warfarin. Thus, the sensitivity of 4-hour In-111 PS in patients not receiving anticoagulants was 82%. Venography results were negative for acute DVT in 18 cases, and 4-hour In-111 PS studies were negative or equivocal in each. In-111 PS is an alternative to contrast venography for detecting acute DVT. If 4-hour In-111 PS results are positive, anticoagulation can be initiated. Delayed images are necessary if the 4-hour images are negative or equivocal.

Authors:
; ; ; ; ; ; ;
Publication Date:
Research Org.:
Univ. of Iowa Hospitals, Iowa City
OSTI Identifier:
5725722
Resource Type:
Journal Article
Resource Relation:
Journal Name: Radiology; (United States); Journal Volume: 165:2
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BLOOD PLATELETS; SCINTISCANNING; VASCULAR DISEASES; DIAGNOSIS; VEINS; BIOMEDICAL RADIOGRAPHY; ANTICOAGULANTS; COMPARATIVE EVALUATIONS; CONTRAST MEDIA; INDIUM 111; PATIENTS; BETA DECAY RADIOISOTOPES; BIOLOGICAL MATERIALS; BLOOD; BLOOD CELLS; BLOOD VESSELS; BODY; BODY FLUIDS; CARDIOVASCULAR SYSTEM; COUNTING TECHNIQUES; DAYS LIVING RADIOISOTOPES; DIAGNOSTIC TECHNIQUES; DISEASES; DRUGS; ELECTRON CAPTURE RADIOISOTOPES; HEMATOLOGIC AGENTS; INDIUM ISOTOPES; INTERMEDIATE MASS NUCLEI; ISOMERIC TRANSITION ISOTOPES; ISOTOPES; MATERIALS; MEDICINE; MINUTES LIVING RADIOISOTOPES; NUCLEAR MEDICINE; NUCLEI; ODD-EVEN NUCLEI; ORGANS; RADIOISOTOPE SCANNING; RADIOISOTOPES; RADIOLOGY; 550601* - Medicine- Unsealed Radionuclides in Diagnostics; 550602 - Medicine- External Radiation in Diagnostics- (1980-)

Citation Formats

Seabold, J.E., Conrad, G.R., Ponto, J.A., Kimball, D.A., Frey, E.E., Ahmed, F., Coughlan, J.D., and Jensen, K.C.. Deep venous thrombophlebitis: detection with 4-hour versus 24-hour platelet scintigraphy. United States: N. p., 1987. Web. doi:10.1148/radiology.165.2.3659356.
Seabold, J.E., Conrad, G.R., Ponto, J.A., Kimball, D.A., Frey, E.E., Ahmed, F., Coughlan, J.D., & Jensen, K.C.. Deep venous thrombophlebitis: detection with 4-hour versus 24-hour platelet scintigraphy. United States. doi:10.1148/radiology.165.2.3659356.
Seabold, J.E., Conrad, G.R., Ponto, J.A., Kimball, D.A., Frey, E.E., Ahmed, F., Coughlan, J.D., and Jensen, K.C.. 1987. "Deep venous thrombophlebitis: detection with 4-hour versus 24-hour platelet scintigraphy". United States. doi:10.1148/radiology.165.2.3659356.
@article{osti_5725722,
title = {Deep venous thrombophlebitis: detection with 4-hour versus 24-hour platelet scintigraphy},
author = {Seabold, J.E. and Conrad, G.R. and Ponto, J.A. and Kimball, D.A. and Frey, E.E. and Ahmed, F. and Coughlan, J.D. and Jensen, K.C.},
abstractNote = {Thirty-one nonheparinized patients with suspected deep venous thrombophlebitis (DVT) underwent contrast venography and indium-111 platelet scintigraphy (In-111 PS). Venography permitted identification of acute DVT in 12 of 31 cases (39%). One additional patient was considered to have acute DVT despite nonconclusive venography results. In-111 PS results were positive at 4 hours in nine of 13 cases (69%) and at 24 hours in 12 of 13 cases (92%). Two of four patients with false-negative 4-hour In-111 PS studies had received warfarin. Thus, the sensitivity of 4-hour In-111 PS in patients not receiving anticoagulants was 82%. Venography results were negative for acute DVT in 18 cases, and 4-hour In-111 PS studies were negative or equivocal in each. In-111 PS is an alternative to contrast venography for detecting acute DVT. If 4-hour In-111 PS results are positive, anticoagulation can be initiated. Delayed images are necessary if the 4-hour images are negative or equivocal.},
doi = {10.1148/radiology.165.2.3659356},
journal = {Radiology; (United States)},
number = ,
volume = 165:2,
place = {United States},
year = 1987,
month =
}
  • Forty-seven /sup 111/In-platelet scintigraphs (In-PS) were analyzed retrospectively to identify sources of diagnostic error and to optimize the diagnostic criteria for active deep venous thrombophlebitis (DVT). The results of In-PS were compared with contrast venography, additional diagnostic studies, and clinical outcome. Three patterns of platelet localization emerged as the best predictors of active DVT: (a) focal or (b) linear 4-hr localization, or (c) an asymmetric blood-pool pattern on 4-hr imaging that evolved into a focal or linear pattern by 16 to 24 hr. All false-positive studies had abnormal patterns confined to the inguinal region at 24 hr. All patients withmore » false-negative studies had received heparin between 4 and 24 hr. The potential pitfalls encountered in the evaluation of the iliac, femoral, and popliteal veins are reviewed and the importance of delayed imaging in selected cases is emphasized.« less
  • Deep venous thrombophlebitis may escape clinical detection. Three cases are reported in which whole-body gallium 67 scintigraphy was used to detect unsuspected deep venous thrombophlebitis related to indwelling catheters in three children who were being evaluated for fevers of unknown origin. Two of these children had septicemia from Candida organisms secondary to these venous lines. Gallium 67 scintigraphy may be useful in the detection of complications of indwelling venous catheters.
  • Deep venous thrombophlebitis may escape clinical detection. Three cases are reported in which whole-body gallium 67 scintigraphy was used to detect unsuspected deep venous thrombophlebitis related to indwelling catheters in three children who were being evaluated for fevers of unknown origin. Two of these children had septicemia from Candida organisms secondary to these venous lines. Gallium 67 scintigraphy may be useful in the detection of complications of indwelling venous catheters.
  • Five hundred indium-111 labeled platelet imaging studies (387 donor and 113 autologous) were performed postoperatively in 473 patients who had undergone total hip replacement, total knee replacement, or internal fixation of a hip fracture to detect occult deep venous thrombosis. All patients had been anticoagulated prophylactically with aspirin, warfarin sodium (Coumadin), or dextran. Thirty-four possible cases of proximal deep venous thrombosis were identified in 28 asymptomatic patients. To verify the scan results, 31 venograms were performed in 25 patients (three refused). In 21 of 31 cases, totally occlusive thrombi were detected; in 5 cases, partially occlusive thrombi were detected; inmore » 5 cases, no thrombus was seen. No patient who had a negative scan nor any patient who had a verified positive scan (and received appropriate heparin therapy) subsequently developed symptoms or signs of pulmonary embolism. One hundred forty-one indium study patients also underwent Doppler ultrasonography/impedance plethysmography (Doppler/IPG) as a comparative non-invasive technique. In 137 cases, the results of the indium study and Doppler/IPG studies were congruent. The indium study had no false negative results that were detected by Doppler/IPG. No patient had any clinically evident toxicity. These results suggest that indium-111 labeled platelet scanning is a safe, noninvasive means for identifying DVT in high risk patients.« less
  • Indium 111 platelet imaging for the detection of deep vein thrombosis and pulmonary emboli was performed in 171 patients after abdominal and pelvic surgery. Fifteen patients were found to have inadequate circulating blood pools of indium 111 platelets, making the study nondiagnostic. Of 156 patients with technically satisfactory images, 46 (29.5%) had images consistent with deep venous thrombosis and/or pulmonary emboli. The incidence, time of occurrence, and location of thromboemboli was similar to those of other reports of postoperative patients groups studied by iodine 125 fibrinogen uptake testing. Eighty patients had normal indium 111 platelets and 30 patients had diffuselymore » distributed indium 111 platelets found in the operative field, suggesting accumulation in a postoperative hematoma. None of these results was confused with a diagnosis of deep venous thrombosis. When compared with another accurate diagnostic test in 23 patients, indium 111 platelet imaging was found to have a sensitivity of 100% and specificity of 90%. The technique of indium 111 platelet imaging is performed easily in patients after surgery with some limitations as to the use of donor platelets and the occasionally altered imaging of the operative site. This diagnostic technique enjoys the distinct advantage in that it allows surveillance of the legs, pelvis, abdomen, and chest by a single method, making it a near-ideal method of postoperative thromboembolism surveillance.« less