A systematic review evaluating imaging techniques to determine chronicity of deep vein thrombosis

TL;DR

This review compares imaging techniques for determining the age of blood clots in deep vein thrombosis, finding MRI to be the most promising.

Contribution

The paper systematically evaluates the effectiveness of various imaging techniques for assessing DVT chronicity.

Findings

Ultrasound parameters like echogenicity and vein diameter were found unreliable for assessing DVT chronicity.

MRI demonstrated potential for differentiating thrombus age, while nuclear imaging and OCT showed high diagnostic accuracy.

Elastography showed promise by quantifying thrombus stiffness, but CT studies were limited.

Abstract

The objective of this systematic review is to evaluate the different imaging techniques used to assess thrombus chronicity in patients with deep venous thrombosis (DVT).

A systematic search of Medline, EMBASE, CENTRAL and Web of Science databases was performed to identify meta-analyses, systematic reviews, randomised controlled trials or observational studies investigating imaging techniques for assessing DVT chronicity.

Overall, 56 studies were reviewed. Various imaging modalities have been explored to assess DVT chronicity. Ultrasound parameters such as echogenicity and vein diameter proved unreliable, though elastography showed promise by quantifying thrombus stiffness. Computed Tomography (CT) studies were limited. In contrast, Magnetic Resonance Imaging (MRI) demonstrated potential for differentiating thrombus age, and nuclear imaging with targeted radiotracers, along with techniques like photoacoustic imaging and Optical coherence tomography (OCT), offered high diagnostic accuracy.

This review evaluated various imaging techniques for thrombus aging. No single modality is ideal, but MRI shows the greatest potential for advancement. In select populations, it may enhance cost-effectiveness and improve outcomes for catheter-based DVT interventions.

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