DISCREPANCIES BETWEEN PHLEBOGRAPHY AND DU PLEX ULTRASONOGRAPHY FOR THE DIAGNOSIS OF ASYMPTOMATIC VENOUS THROMBOSIS AFTER TOTAL HIP-ARTHROPLASTY - FALSE-NEGATIVE VENOGRAPHY OR FALSE-POSITIVE DUPLEX ULTRASONOGRAPHY
Mt. Barrellier et al., DISCREPANCIES BETWEEN PHLEBOGRAPHY AND DU PLEX ULTRASONOGRAPHY FOR THE DIAGNOSIS OF ASYMPTOMATIC VENOUS THROMBOSIS AFTER TOTAL HIP-ARTHROPLASTY - FALSE-NEGATIVE VENOGRAPHY OR FALSE-POSITIVE DUPLEX ULTRASONOGRAPHY, Journal des maladies vasculaires, 23(3), 1998, pp. 183-190
Objectives. Assess the diagnostic performance of phlebography and disc
repancies with duplex ultrasonography in screening for asymptomatic de
ep vein thrombosis after total hip arthroplasty: Search for arguments
which would favor contributing false-negatives or false-positives to o
ne of the two exploration methods. Patients and methods. The study inc
luded 24 patients who underwent the 2 explorations independently betwe
en day 7 and day 14 in a multicentric therapeutic trial of a new hepar
in. Discrepancies between the two techniques were recorded. Diagnostic
performance of phlebography was calculated from contingency tables. T
he phlebograms were then reviewed with knowledge of the duplex ultraso
nographic findings. The course of the venous thrombus after treatment
was monitored with duplex ultrasonography. Results. Phlebography allow
ed the diagnosis of thrombus formation in 9 patients. Ultrasonography
provided the diagnosis in 14 cases out of 24. Sensitivity of phlebogra
phy compared with duplex ultrasonography was 64 % (95 % CI = 35.1 - 87
.2) (9/14) and specificity was 100 % (95 % CI = 69.1 - 100) (10/10). S
everal localizations were not visualized with phlebography: 3 partiall
y obstructive thrombi near the femoral junction, and 38 distal thrombi
including 31 soleus thrombi (fig. 5). When the phlebograms were revie
wed again, defects compatible with a partial thrombus were found for t
he 3 proximal localizations and for 2 of the distal localizations (fig
. 1, 2, 4) None of the soleus localizations were visualized. Duplex ul
trasonographic follow-up concerned 12 of the 14 patients with a thromb
us identified by duplex ultrasonography involving 44 localizations. In
five case, the operator was different from the operator for the initi
al duplex ultrasonography. Follow-up revealed: 1 new localization, 37
narrowings and 6 repermeabilizations. Discussion. The coherence of the
duplex ultrasonographic follow-up and the presence of images compatib
le with partial thrombus on the revised phlebograms which had been ini
tially interpreted as wash out flow constitute a group of arguments su
ggesting that the discrepancies observed should be considered as phleb
ography false-negatives. This defect in the sensitivity of phlebograph
y has been reported by others in the literature both for distal and pr
oximal localizations.