Distinguishing Recurrent from Residual Deep Venous Thrombosis

David Green, MD, PhD

Magnetic resonance direct thrombus imaging was highly sensitive in differentiating these conditions.

Differentiating between an acute recurrence of deep venous thrombosis (DVT) and a new event is difficult in patients with a history of DVT, especially in those with chronic pain and leg swelling. Laboratory evaluation that includes D-dimer testing and compression ultrasound might distinguish new thrombi from residual old DVT, but if these studies are not definitive, additional approaches such as magnetic resonance imaging (MRI) might be helpful.

To examine the usefulness of magnetic resonance direct thrombus imaging (MRDTI) in this setting, investigators in the Netherlands performed a prospective, multicenter study involving 39 patients with symptomatic, acute-recurrent DVT. The researchers also studied 42 asymptomatic persons who had previous history of DVT, ultrasonic evidence of chronic residual thrombosis, and a normal D-dimer test. The mean age of patients was 52, 64% were male, and the median time after the previous DVT was 83 months. All individuals received MRDTI that was interpreted by observers blinded to patient status.

MRDTI results were abnormal in 95% of patients with acute recurrent DVT and normal in all 42 asymptomatic patients; the sensitivity and specificity of MRDTI in these patients were 95% (95% confidence interval, 83%–99%) and 100% (95% CI, 92%–100%), respectively.

Citation(s):

Tan M et al. Ability of magnetic resonance direct thrombus imaging (MRDTI) to differentiate acute recurrent ipsilateral deep vein thrombosis from residual thrombosis. Blood 2014 Jun 13; [e-pub ahead of print].