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Peng L, Liu Y, Lv C, Shen W, Wu Y, Zhang J, Fu Z. Evaluating the stage of deep vein thrombosis: the diagnostic accuracy of shear wave elastography and super-microvascular imaging. Quant Imaging Med Surg 2024; 14:6882-6894. [PMID: 39281150 PMCID: PMC11400703 DOI: 10.21037/qims-23-1822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/22/2024] [Indexed: 09/18/2024]
Abstract
Background Assessing the age of deep vein thrombosis (DVT) is crucial for guiding treatment approaches. Two-dimensional shear-wave elastography (2D-SWE) and super-microvascular imaging (SMI), as emerging techniques for tissue elasticity assessment and intrathrombus microvascular analysis, are pivotal for accurate thrombus age determination. This research endeavors to classify DVT into acute, subacute, and chronic ages utilizing these imaging methods. Methods The study is a prospective, single-center, inpatient investigation that utilized convenience sampling for participant recruitment. Patients with a symptom duration of <6 months who were found to have lower-extremity DVT on ultrasound (US) between January 2021 and March 2022 after craniocerebral trauma (CT) or bone injury (BI) operations were included in this study. Participants were divided into three groups based on the duration of DVT, measured from the first diagnosis of thrombosis by US to the follow-up with 2D-SWE and SMI: acute (≤14 days), subacute (15-30 days), and chronic (31 days to 6 months) All patients underwent 2D-SWE and SMI using an Aplio i700 Ultrasound System equipped with a PLT-1005BT line array probe. Diagnostic performance was assessed using the area under the receiver operating characteristic (ROC) curve. Results The maximum value of the elastic modulus for DVT (DVT_Emax), the mean value of the elastic modulus for DVT (DVT_Emean), and SMI's flow distribution scoring pattern for DVT (SMI_scoring) emerged as significant predictors for acute and chronic, with high area under the ROC curve (AUC) of acute [AUC (95% confidential interval): 0.95 (0.89-0.97), 0.96 (0.91-0.98), 0.93 (0.88-0.97) in 39 patients] and chronic [AUC (95% confidential interval): 0.88 (0.81-0.93), 0.94 (0.88-0.97), 0.91 (0.84-0.95) in 51 patients], respectively. However, these indices had lower efficacy for subacute prediction [AUC (95% confidential interval): 0.51 (0.42-0.60), 0.54 (0.46-0.63), 0.53 (0.44-0.62), in 47 patients]. Combining DVT_Emean with SMI_scoring improved performance in predicting subacute: 0.90 (0.83-0.94) than related features alone. Conclusions Both 2D-SWE and SMI can be used to assess acute and chronic DVT in patients with CT and BI after surgeries. This combination is a promising adjunctive technique for identifying the subacute phase of DVT in these patients.
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Affiliation(s)
- Lin Peng
- Department of General Practice, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Yan Liu
- Department of Ultrasound, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Chunju Lv
- Department of Ultrasound, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Wenyi Shen
- Department of Ultrasound, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Yanqing Wu
- Department of Ultrasound, Xintai People's Hospital, Tai'an, China
| | - Jiajun Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Zunfeng Fu
- Department of Ultrasound, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
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Carini FC, Angriman F, Scales DC, Munshi L, Burry LD, Sibai H, Mehta S, Ferreyro BL. Venous thromboembolism in critically ill adult patients with hematologic malignancy: a population-based cohort study. Intensive Care Med 2024; 50:222-233. [PMID: 38170226 DOI: 10.1007/s00134-023-07287-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/17/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE The aim of this study was to describe the incidence of venous thromboembolism (VTE) and major bleeding among hospitalized patients with hematologic malignancy, assessing its association with critical illness and other baseline characteristics. METHODS We conducted a population-based cohort study of hospitalized adults with a new diagnosis of hematologic malignancy in Ontario, Canada, between 2006 and 2017. The primary outcome was VTE (pulmonary embolism or deep venous thrombosis). Secondary outcomes were major bleeding and in-hospital mortality. We compared the incidence of VTE between intensive care unit (ICU) and non-ICU patients and described the association of other baseline characteristics and VTE. RESULTS Among 76,803 eligible patients (mean age 67 years [standard deviation, SD, 15]), 20,524 had at least one ICU admission. The incidence of VTE was 3.7% in ICU patients compared to 1.2% in non-ICU patients (odds ratio [OR] 3.08; 95% confidence interval [CI] 2.77-3.42). The incidence of major bleeding was 7.6% and 2.4% (OR 3.33; 95% CI 3.09-3.58), respectively. The association of critical illness and VTE remained significant after adjusting for potential confounders (OR 2.92; 95% CI 2.62-3.25). We observed a higher incidence of VTE among specific subtypes of hematologic malignancy and patients with prior VTE (OR 6.64; 95% CI 5.42-8.14). Admission more than 1 year after diagnosis of hematologic malignancy (OR 0.64; 95% CI 0.56-0.74) and platelet count ≤ 50 × 109/L at the time of hospitalization (OR 0.63; 95% CI 0.48-0.84) were associated with a lower incidence of VTE. CONCLUSION Among patients with hematologic malignancy, critical illness and certain baseline characteristics were associated with a higher incidence of VTE.
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Affiliation(s)
- Federico C Carini
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Medicine, University Health Network, Toronto, ON, Canada.
- Department of Medicine, Sinai Health System, Toronto, ON, Canada.
- Mount Sinai Hospital, 600 University Avenue, Suite 5-292, Toronto, ON, M5G 1X5, Canada.
| | - Federico Angriman
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Damon C Scales
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- ICES (Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
| | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
| | - Lisa D Burry
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
- Department of Pharmacy, Sinai Health System, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Hassan Sibai
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sangeeta Mehta
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
| | - Bruno L Ferreyro
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
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