EVALUATION OF SOME NEW DIAGNOSTIC MODALITIES FOR DEEP VENOUS THROMBOSIS
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The aim of this work is to evaluate some new diagnostic modalities; Ddimer test, Duplex imaging arid MR venography; for Deep Venous Thrombosis (DVT). Thirty patients were included in this study with clinically suspected DVT. Full history taking and thorough clinical examination together with routin laboratory investigation, resting ECG, Trans-thoracic Echo-Doppler, Murex D-dirner test and Duplex imaging were done for all patients. MR yenography was done only for the 16 cases with the clinical pretest intermediate probability for DVT. The results of the present study showed that 20 cases showed positive Duplex, 7 with popliteal, 7 femoral and 6 cases with femoral and popliteal DVT. 19 cases showed positive D-dimer test Vs 11 with negative test. The /6 cases subjected to MR venography showed results coincide with same findirugs as Duplex apart from 3 cases in which soleal and ilia( DVT not detected by Duplex study. Conclusion: From the results it was found that: Duplex ultrasonography is now considered the diagnostic modality of choice in evaluation of the venous system of lower limbs. Because of its safety, accuracy, high specificity and sensitivity and its availability, all these makes it a modality of choice. D-dimer test, is specific degradation product of fibrin, in our study and other studies have shown its high sensitivity moderate specificity and high negative predictive value for suspected eep vein thrombosis. Its value varies from one study to another according to the type of D-dimer assay used in the study. When D-dimer test combined with clinical pretest probability its negative predictive value is markedly increased up to 100%. MR venography and Duplex sonography have been found to be identical for evaluation of DVT in venous system as regard of popliteal and femoral veins, but it is superior to Duplex study in evaluating venous systern of the pelvis and iliac veins. Its availability, lack of operator experience and its cost limit its application. Recommendation: Duplex ultrasound is the diagnostic modality of choice for DVT of lower limbs and MR venograph.y is preferable only in selected cases. D-dimer test when combined with clinical probability is a good negative test which can reduced the need for Duplex imaging.