Assessment of Deep Vein Thrombosis Using Multidetector Computed Tomography After Arthroplasty: A Retrospective Comparative Study with Doppler Sonography


  •   Sami Smerat

  •   Azzam Alarab

  •   Maram Ghassan Sada

  •   Issa Al Hroush

  •   Marah Abu Muhsen

  •   Murad Abu Samra

  •   Moath Al-Makhamreh

  •   Sojood Mansour

  •   Mohammad Almashny

  •   Hasan Naji

  •   Mohammed Hjouj


Purpose: The purpose of this retrospective study was to compare the ability of indirect 128-row multidetector CT (MDCT) venography and doppler sonography to detect deep vein thrombosis (DVT) after knee or hip arthroplasty.

Methods and Materials: Replacement surgery was performed on a total of ten hip and sixty-eight knee joints in 52 patients. The evaluation of the presence of DVT is degraded by the beam hardening artifact; therefore, Axial CT images could not be used to assess DVT. The beam hardening artifact's z-axis length was measured. Deep vein thrombosis was studied to see how common it is and where it occurs. The CT venograms' diagnostic performance was assessed and compared to that of the gold standard diagnostic reference for DVT: doppler sonography.

Results: The beam hardening artifact had a z-axis length of 6.0 (mean standard deviation). Doppler sonography is a technique that allows you to see what's going on inside your body. In 30/52 individuals, DVT was found in the calf veins (58 percent of total population). The binary scale diagnostic test revealed that CT venography and doppler sonography had sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 93.33 percent, 90.91 percent, 90.91 percent, and 92.31 percent, respectively.

Conclusion: For the aim of evaluating post-arthroplasty patients, CT venography can be utilized as a substitute for doppler sonography.

Keywords: Arthroplasty, Doppler Sonography, DVT, MDCT


Elias A, Cadene A, Elias M, Puget J, Tricoire J, Colin C, et al. Extended lower limb venous ultrasound for the diagnosis of proximal and distal vein thrombosis in asymptomatic patients after total hip replacement. European Journal of Vascular and Endovascular Surgery. 2004; 27(4): 438-44. DOI:

Colwell CW. Managing thromboembolic risk in hip and knee arthroplasty: state of the art. Orthopedics. 2003; 26(2): S231-S6. DOI:

Lieberman JR, Hsu WK. Prevention of venous thromboembolic disease after total hip and knee arthroplasty. JBJS. 2005; 87(9): 2097-112. DOI:

Mehta J, Nicolaou N, Kiryluk S, Fordyce M. Venous leg ulcers after hip replacement: a clinical evaluation at 5 to 12 years. The Journal of Bone and Joint Surgery British Volume. 2003; 85(7): 960-2. DOI:

Wang C-J, Wang J-W, Weng L-H, Hsu C-C, Lo C-F. Outcome of calf deep-vein thrombosis after total knee arthroplasty. The Journal of Bone and Joint Surgery British Volume. 2003; 85(6): 841-4. DOI:

Della Valle CJ, Steiger DJ, DiCesare PE. Duplex ultrasonography in patients suspected of postoperative pulmonary embolism following total joint arthroplasty. American Journal of Orthopedics (Belle Mead, NJ). 2003; 32(8): 386-8.

Westrich GH, Salvati EA, Sharrock N, Potter HG, Sánchez PM, Sculco TP. The effect of intraoperative heparin administered during total hip arthroplasty on the incidence of proximal deep vein thrombosis assessed by magnetic resonance venography. The Journal of Arthroplasty. 2005; 20(1): 42-50. DOI:

Walker RH. Secondary prevention of venous thromboembolism in joint replacement using duplex ultrasonography. SLACK Incorporated Thorofare, NJ; 1994: 14-7. DOI:

Esses D, Birnbaum A, Bijur P, Shah S, Gleyzer A, Gallagher E. Ability of CT to alter decision making in elderly patients with acute abdominal pain. The American Journal of Emergency Medicine. 2004; 22(4): 270-2. DOI:

Mettler Jr FA, Thomadsen BR, Bhargavan M, Gilley DB, Gray JE, Lipoti JA, et al. Medical radiation exposure in the US in 2006: preliminary results. Health Physics. 2008; 95(5): 502-7. DOI:

Mettler Jr FA, Bhargavan M, Faulkner K, Gilley DB, Gray JE, Ibbott GS, et al. Radiologic and nuclear medicine studies in the United States and worldwide: frequency, radiation dose, and comparison with other radiation sources—1950–2007. Radiology. 2009; 253(2): 520-31. DOI:

Mettler FA, Wiest PW, Locken JA, Kelsey CA. CT scanning: patterns of use and dose. Journal of Radiological Protection. 2000; 20(4): 353. DOI:

Rosen MP, Sands DZ, Longmaid III HE, Reynolds KF, Wagner M, Raptopoulos V. Impact of abdominal CT on the management of patients presenting to the emergency department with acute abdominal pain. American Journal of Roentgenology. 2000; 174(5): 1391-6. DOI:

Rosen MP, Siewert B, Sands DZ, Bromberg R, Edlow J, Raptopoulos V. Value of abdominal CT in the emergency department for patients with abdominal pain. European Radiology. 2003; 13(2): 418-24. DOI:

Catalano C, Fraioli F, Laghi A, Napoli A, Bezzi M, Pediconi F, et al. Infrarenal aortic and lower-extremity arterial disease: diagnostic performance of multi–detector row CT angiography. Radiology. 2004; 231(2): 555-63. DOI:

Haar Gt. Ultrasonic imaging: safety considerations. Interface Focus. 2011; 1(4): 686-97. DOI:

Byun SS, Kim JH, Kim YJ, Chun YS, Park CH, Kim W-H. Evaluation of deep vein thrombosis with multidetector row CT after orthopedic arthroplasty: a prospective study for comparison with Doppler sonography. Korean Journal of Radiology. 2008; 9(1): 59-66. DOI:

Noble JA, Boukerroui D. Ultrasound image segmentation: a survey. IEEE Transactions on Medical Imaging. 2006; 25(8): 987-1010. DOI:

Abolmaesumi P, Salcudean SE, Zhu W-H, Sirouspour MR, DiMaio SP. Image-guided control of a robot for medical ultrasound. IEEE Transactions on Robotics and Automation. 2002; 18(1): 11-23. DOI:

Mintz GS, Nissen SE, Anderson WD, Bailey SR, Erbel R, Fitzgerald PJ, et al. American College of Cardiology clinical expert consensus document on standards for acquisition, measurement and reporting of intravascular ultrasound studies (ivus) A report of the american college of cardiology task force on clinical expert consensus documents developed in collaboration with the european society of cardiology endorsed by the society of cardiac angiography and interventions. Journal of the American College of Cardiology. 2001; 37(5): 1478-92. DOI:

Mintz GS, Popma JJ, Pichard AD, Kent KM, Satler LF, Chiu Wong S, et al. Arterial remodeling after coronary angioplasty: a serial intravascular ultrasound study. Circulation. 1996; 94(1): 35-43. DOI:

Sulieman A, Adam H, Mahmoud M, Hamid O, Alkhorayef M, Bradley DA. Radiogenic risk assessment for abdominal vascular computed tomography angiography. Radiation Physics and Chemistry. 2020; 168: 108523. DOI:

Fleischmann D, Rubin GD. Quantification of intravenously administered contrast medium transit through the peripheral arteries: implications for CT angiography. Radiology. 2005; 236(3): 1076-82. DOI:

Ligon BL, editor Biography: history of developments in imaging techniques: Egas Moniz and angiography. Seminars in pediatric infectious diseases; 2003: Elsevier. DOI:

Mueller RL, Sanborn TA. The history of interventional cardiology: cardiac catheterization, angioplasty, and related interventions. American Heart Journal. 1995; 129(1): 146-72. DOI:

Waugh JR, Sacharias N. Arteriographic complications in the DSA era. Radiology. 1992; 182(1): 243-6. DOI:

Scoutt L, Zawin M, Taylor K. Doppler US. Part II. Clinical applications. Radiology. 1990; 174(2): 309-19. DOI:

Krnic, Vucic, Sucic. Duplex scanning compared with intra-arterial angiography in diagnosing peripheral arterial disease: three analytical approaches. Vasa. 2006; 35(2): 86-91. DOI:

Wardlaw J, Chappell F, Best J, Wartolowska K, Berry E. Non-invasive imaging compared with intra-arterial angiography in the diagnosis of symptomatic carotid stenosis: a meta-analysis. The Lancet. 2006; 367(9521): 1503-12. DOI:

Heijenbrok-Kal MH, Kock MC, Hunink MM. Lower extremity arterial disease: multidetector CT angiography-meta-analysis. Radiology. 2007; 245(2): 433-9. DOI:

Schoenhagen P, Halliburton SS, Stillman AE, Kuzmiak SA, Nissen SE, Tuzcu EM, et al. Noninvasive imaging of coronary arteries: current and future role of multi–detector row CT. Radiology. 2004; 232(1): 7-17. DOI:

Rybicki FJ, Nallamshetty L, Yucel EK, Holtzman SR, Baum RA, Foley WD, et al. ACR Appropriateness Criteria® on Recurrent Symptoms Following Lower-Extremity Angioplasty. Journal of the American College of Radiology. 2008; 5(12): 1176-80. DOI:

Szapiro D, Ghaye B, Willems V, Zhang L, Albert A, Dondelinger RF. Evaluation of CT time-density curves of lower-limb veins. Investigative Radiology. 2001; 36(3): 164-9. DOI:

Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous thromboembolism: a public health concern. American Journal of Preventive Medicine. 2010; 38(4): S495-S501. DOI:

Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Archives of Internal Medicine. 1998; 158(6): 585-93. DOI:

Kearon C. Natural history of venous thromboembolism. Circulation. 2003; 107(23_suppl_1): I-22-I-30. DOI:

Galanaud J-P, Kahn SR. Postthrombotic syndrome: a 2014 update. Current Opinion in Cardiology. 2014; 29(6): 514-9. DOI:

Kahn SR, Shrier I, Julian JA, Ducruet T, Arsenault L, Miron MJ, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Annals of Internal Medicine. 2008; 149(10): 698-707. DOI:

Søgaard KK, Schmidt M, Pedersen L, Horváth–Puhó E, Sørensen HT. 30-year mortality after venous thromboembolism: a population-based cohort study. Circulation. 2014; 130(10): 829-36. DOI:

Wheeler B, Anderson Jr FA. Diagnostic methods for deep vein thrombosis. Pathophysiology of Haemostasis and Thrombosis. 1995; 25(1-2): 6-26. DOI:

Comerota A, White J, Katz ML. Diagnostic methods for deep vein thrombosis: Venous Doppler examination, phleborheography, iodine-125 fibrinogen uptake, and phlebography. American Journal of Surgery. 1985; 4.

Lim K-E, Hsu W-C, Hsu Y-Y, Chu P-H, Ng C-J. Deep venous thrombosis: comparison of indirect multidetector CT venography and sonography of lower extremities in 26 patients. Clinical Imaging. 2004; 28(6): 439-44. DOI:

Garg K, Kemp JL, Wojcik D, Hoehn S, Johnston RJ, Macey LC, et al. Thromboembolic disease: comparison of combined CT pulmonary angiography and venography with bilateral leg sonography in 70 patients. American Journal of Roentgenology. 2000; 175(4): 997-1001. DOI:

Thomas S, Goodacre S, Sampson F, Van Beek E. Diagnostic value of CT for deep vein thrombosis: results of a systematic review and meta-analysis. Clinical Radiology. 2008; 63(3): 299-304. DOI:

Taffoni MJ, Ravenel JG, Ackerman SJ. Prospective comparison of indirect CT venography versus venous sonography in ICU patients. American Journal of Roentgenology. 2005; 185(2): 457-62. DOI:

White RH, McGahan JP, Daschbach MM, Hartling RP. Diagnosis of deep-vein thrombosis using duplex ultrasound. Annals of Internal Medicine. 1989; 111(4): 297-304. DOI:

Cronan J, Dorfman G, Scola F, Schepps B, Alexander J. Deep venous thrombosis: US assessment using vein compression. Radiology. 1987; 162(1): 191-4. DOI:

Duwe KM, Shiau M, Budorick NE, Austin JH, Berkmen YM. Evaluation of the lower extremity veins in patients with suspected pulmonary embolism: a retrospective comparison of helical CT venography and sonography. American Journal of Roentgenology. 2000; 175(6): 1525-31. DOI:

Begemann PG, Bonacker M, Kemper J, Guthoff AE, Hahn KE, Steiner P, et al. Evaluation of the deep venous system in patients with suspected pulmonary embolism with multi-detector CT: a prospective study in comparison to Doppler sonography. Journal of Computer Assisted Tomography. 2003; 27(3): 399-409. DOI:

Delis K, Hunt N, Strachan R, Nicolaides A. Incidence, natural history and risk factors of deep vein thrombosis in elective knee arthroscopy. Thrombosis and Haemostasis. 2001; 86(09): 817-21. DOI:

Leutz DW, Stauffer ES. Color duplex Doppler ultrasound scanning for detection of deep venous thrombosis in total knee and hip arthroplasty patients: Incidence, location, and diagnostic accuracy compared with ascending venography. The Journal of Arthroplasty. 1994; 9(5): 543-8. DOI:

Davidson BL, Elliott CG, Lensing AW, Group*> RHA. Low accuracy of color Doppler ultrasound in the detection of proximal leg vein thrombosis in asymptomatic high-risk patients. Annals of Internal Medicine. 1992; 117(9): 735-8. DOI:

Ciccone WJ, Fox PS, Neumyer M, Rubens D, PARRISH WM, PELLEGRINI VD. Ultrasound surveillance for asymptomatic deep venous thrombosis after total joint replacement. JBJS. 1998; 80(8): 1167-74. DOI:

Sugimoto H, Richardson T, Webster MW, Makaroun MS, Eskandari MK. Is color-flow duplex a good diagnostic test for detection of isolated calf vein thrombosis in high-risk patients? Angiology. 2000; 51(9): 705-10. DOI:

Garino JP, Lotke PA, Kitziger KJ, Steinberg ME. Deep venous thrombosis after total joint arthroplasty. The role of compression ultrasonography and the importance of the experience of the technician. JBJS. 1996; 78(9): 1359-65. DOI:

O'Leary DH, Kane RA, Chase BM. A prospective study of the efficacy of B‐scan sonography in the detection of deep venous thrombosis in the lower extremities. Journal of Clinical Ultrasound. 1988; 16(1): 1-8. DOI:

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