Skip to main content
Top
Published in: Skeletal Radiology 10/2019

01-10-2019 | Magnetic Resonance Imaging | Scientific Article

Characterization of intramuscular calf vein thrombosis on routine knee MRI

Authors: David P. Duncan, Michael Taddonio, Eric Y. Chang, Brady K. Huang

Published in: Skeletal Radiology | Issue 10/2019

Login to get access

Abstract

Objective

Literature regarding intramuscular calf vein thrombosis (IMCVT) or infrapopliteal deep vein thrombosis (DVT) evaluation by magnetic resonance imaging (MRI) is limited, particularly with regard to routine unenhanced knee examinations. We attempt to correlate routine unenhanced MRI findings with ultrasound evaluations of the lower extremity deep venous system.

Materials and methods

The radiology information system was searched, yielding a total of 67 patients who had undergone both routine knee MRI and duplex ultrasound examinations within 14 days. The MRI examination findings recorded were the presence and pattern of edema, segmental vein dilation, intraluminal signal on fluid-sensitive sequences, and abnormal hyperintense signal on axial T1-weighted sequences. The presence and extent of thrombus more centrally (i.e., intramuscular calf vein thrombosis with or without extension into the popliteal vein) was reassessed on ultrasound.

Results

When comparing patients with positive (n = 13) and negative (n = 54) ultrasound, there were significant differences in each of these parameters: perivascular edema, intramuscular edema, focal vein dilation, and abnormal fluid-sensitive signal. In the subset of patients with popliteal extension of the intramuscular calf vein thrombosis compared with those without any deep vein thrombosis, there was a statistically significant increase in peripopliteal edema, abnormal fluid-sensitive signal, and abnormal hyperintense T1 signal.

Conclusion

Imaging findings on routine unenhanced MRI have a high rate of concordance with duplex ultrasound performed through the calf in the detection of intramuscular calf vein thrombosis.
Literature
1.
go back to reference Caggiati A, Bergan JJ, Gloviczki P, et al. Nomenclature of the veins of the lower limbs: an international interdisciplinary consensus statement. J Vasc Surg. 2002;36(2):416–22.CrossRef Caggiati A, Bergan JJ, Gloviczki P, et al. Nomenclature of the veins of the lower limbs: an international interdisciplinary consensus statement. J Vasc Surg. 2002;36(2):416–22.CrossRef
2.
go back to reference MacDonald PS, Kahn SR, Miller N, Obrand D. Short-term natural history of isolated gastrocnemius and soleal vein thrombosis. J Vasc Surg. 2003;37(3):523–7.CrossRef MacDonald PS, Kahn SR, Miller N, Obrand D. Short-term natural history of isolated gastrocnemius and soleal vein thrombosis. J Vasc Surg. 2003;37(3):523–7.CrossRef
3.
go back to reference Gillet JL, Perrin MR, Allaert FA. Short-term and mid-term outcome of isolated symptomatic muscular calf vein thrombosis. J Vasc Surg. 2007;46(3):513–9.CrossRef Gillet JL, Perrin MR, Allaert FA. Short-term and mid-term outcome of isolated symptomatic muscular calf vein thrombosis. J Vasc Surg. 2007;46(3):513–9.CrossRef
4.
go back to reference Hill SL, Holtzman GI, Martin D, Evans P, Toler W, Goad K. The origin of lower extremity deep vein thrombi in acute venous thrombosis. Am J Surg. 1997;173(6):485–90.CrossRef Hill SL, Holtzman GI, Martin D, Evans P, Toler W, Goad K. The origin of lower extremity deep vein thrombi in acute venous thrombosis. Am J Surg. 1997;173(6):485–90.CrossRef
5.
go back to reference Labropoulos N, Webb M, Kang SS, et al. Patterns and distribution of isolated calf deep vein thrombosis. J Vasc Surg. 1999;30(5):787–91.CrossRef Labropoulos N, Webb M, Kang SS, et al. Patterns and distribution of isolated calf deep vein thrombosis. J Vasc Surg. 1999;30(5):787–91.CrossRef
6.
go back to reference De Maeseneer MG, Bochanen N, van Rooijen G, Neglén P. Analysis of 1,338 patients with acute lower limb deep venous thrombosis (DVT) supports the inadequacy of the term “proximal DVT”. Eur J Vasc Endovasc Surg. 2016;51(3):415–20.CrossRef De Maeseneer MG, Bochanen N, van Rooijen G, Neglén P. Analysis of 1,338 patients with acute lower limb deep venous thrombosis (DVT) supports the inadequacy of the term “proximal DVT”. Eur J Vasc Endovasc Surg. 2016;51(3):415–20.CrossRef
7.
go back to reference Rose SC, Zwiebel WJ, Miller FJ. Distribution of acute lower extremity deep venous thrombosis in symptomatic and asymptomatic patients: imaging implications. J Ultrasound Med. 1994;13(4):243–50.CrossRef Rose SC, Zwiebel WJ, Miller FJ. Distribution of acute lower extremity deep venous thrombosis in symptomatic and asymptomatic patients: imaging implications. J Ultrasound Med. 1994;13(4):243–50.CrossRef
8.
go back to reference Goodacre S, Sampson F, Thomas S, Van Beek E, Sutton A. Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis. BMC Med Imaging 5:6. Goodacre S, Sampson F, Thomas S, Van Beek E, Sutton A. Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis. BMC Med Imaging 5:6.
9.
go back to reference Parellada AJ, Morrison WB, Reiter SB, et al. Unexpected lower extremity deep venous thrombosis simulating musculoskeletal pathology. Skeletal Radiol. 2006;35(9):659–64.CrossRef Parellada AJ, Morrison WB, Reiter SB, et al. Unexpected lower extremity deep venous thrombosis simulating musculoskeletal pathology. Skeletal Radiol. 2006;35(9):659–64.CrossRef
10.
go back to reference Shulman RM, Buchan C, Bleakney RR, White LM. Low prevalence of unexpected popliteal DVT detected on routine MRI. Clin Imaging. 2016;40(1):79–85.CrossRef Shulman RM, Buchan C, Bleakney RR, White LM. Low prevalence of unexpected popliteal DVT detected on routine MRI. Clin Imaging. 2016;40(1):79–85.CrossRef
11.
go back to reference Liu PT, Ilaslan H. Unicompartmental muscle edema: an early sign of deep venous thrombosis. Skeletal Radiol. 2003;32(1):41–5.CrossRef Liu PT, Ilaslan H. Unicompartmental muscle edema: an early sign of deep venous thrombosis. Skeletal Radiol. 2003;32(1):41–5.CrossRef
12.
go back to reference Westerbeek RE, Van Rooden CJ, Tan M, et al. Magnetic resonance direct thrombus imaging of the evolution of acute deep vein thrombosis of the leg. J Thromb Haemost. 2008;6(7):1087–92.CrossRef Westerbeek RE, Van Rooden CJ, Tan M, et al. Magnetic resonance direct thrombus imaging of the evolution of acute deep vein thrombosis of the leg. J Thromb Haemost. 2008;6(7):1087–92.CrossRef
13.
go back to reference Sampson FC, Goodacre SW, Thomas SM, van Beek EJR. The accuracy of MRI in diagnosis of suspected deep vein thrombosis: systematic review and meta-analysis. Eur Radiol. 2007;17(1):175–81.CrossRef Sampson FC, Goodacre SW, Thomas SM, van Beek EJR. The accuracy of MRI in diagnosis of suspected deep vein thrombosis: systematic review and meta-analysis. Eur Radiol. 2007;17(1):175–81.CrossRef
14.
go back to reference Katz DS, Fauauff KF, Kranz AO, Hon M. Imaging of deep venous thrombosis: a multimodality overview. Appl Radiol. 2014;43(3):6–16. Katz DS, Fauauff KF, Kranz AO, Hon M. Imaging of deep venous thrombosis: a multimodality overview. Appl Radiol. 2014;43(3):6–16.
15.
go back to reference Campbell I. Chi-squared and Fisher-Irwin tests of two-by-two tables with small sample recommendations. Stat Med. 2007;26(19):3661–75.CrossRef Campbell I. Chi-squared and Fisher-Irwin tests of two-by-two tables with small sample recommendations. Stat Med. 2007;26(19):3661–75.CrossRef
16.
go back to reference Smitaman E, Flores DV, Mejía Gómez C, Pathria MN. MR imaging of atraumatic muscle disorders. Radiographics. 2018;38(2):500–22.CrossRef Smitaman E, Flores DV, Mejía Gómez C, Pathria MN. MR imaging of atraumatic muscle disorders. Radiographics. 2018;38(2):500–22.CrossRef
17.
go back to reference Flores DV, Mejía Gómez C, Estrada-Castrillón M, Smitaman E, Pathria MN. MR imaging of muscle trauma: anatomy, biomechanics, pathophysiology, and imaging appearance. Radiographics. 2018;38(1):124–48.CrossRef Flores DV, Mejía Gómez C, Estrada-Castrillón M, Smitaman E, Pathria MN. MR imaging of muscle trauma: anatomy, biomechanics, pathophysiology, and imaging appearance. Radiographics. 2018;38(1):124–48.CrossRef
18.
go back to reference Sule AA, Chin TJ, Handa P, Earnest A. Should symptomatic, isolated distal deep vein thrombosis be treated with anticoagulation? Int J Angiol. 2009;18:83–7.CrossRef Sule AA, Chin TJ, Handa P, Earnest A. Should symptomatic, isolated distal deep vein thrombosis be treated with anticoagulation? Int J Angiol. 2009;18:83–7.CrossRef
19.
go back to reference Masuda E, Kistner RL, Musikasinthorn C, Liquido F, Geling O, He Q. The controversy of managing calf vein thrombosis. J Vasc Surg. 2012;55(2):550–61.CrossRef Masuda E, Kistner RL, Musikasinthorn C, Liquido F, Geling O, He Q. The controversy of managing calf vein thrombosis. J Vasc Surg. 2012;55(2):550–61.CrossRef
20.
go back to reference De Martino RR, Wallaert JB, Rossi AP, Zbehlik AJ, Suckow B, Walsh DB. A meta-analysis of anticoagulation for calf deep venous thrombosis. J Vasc Surg. 2012;56(1):228–31.CrossRef De Martino RR, Wallaert JB, Rossi AP, Zbehlik AJ, Suckow B, Walsh DB. A meta-analysis of anticoagulation for calf deep venous thrombosis. J Vasc Surg. 2012;56(1):228–31.CrossRef
21.
go back to reference Utter GH, Dhillon TS, Salcedo ES, et al. Therapeutic anticoagulation for isolated calf deep vein thrombosis. JAMA Surg. 2016;151(9):e161770.CrossRef Utter GH, Dhillon TS, Salcedo ES, et al. Therapeutic anticoagulation for isolated calf deep vein thrombosis. JAMA Surg. 2016;151(9):e161770.CrossRef
22.
go back to reference Righini M, Galanaud JP, Guenneguez H, et al. Anticoagulant therapy for symptomatic calf deep vein thrombosis (CACTUS): a randomised, double-blinded, placebo-controlled trial. Lancet Haematol. 2016;3(12):e556–62.CrossRef Righini M, Galanaud JP, Guenneguez H, et al. Anticoagulant therapy for symptomatic calf deep vein thrombosis (CACTUS): a randomised, double-blinded, placebo-controlled trial. Lancet Haematol. 2016;3(12):e556–62.CrossRef
23.
go back to reference Schwarz T, Buschmann L, Beyer J, Halbritter K, Rastan A, Schellong S. Therapy of isolated calf muscle vein thrombosis: a randomized, controlled study. J Vasc Surg. 2010;52(5):1246–50.CrossRef Schwarz T, Buschmann L, Beyer J, Halbritter K, Rastan A, Schellong S. Therapy of isolated calf muscle vein thrombosis: a randomized, controlled study. J Vasc Surg. 2010;52(5):1246–50.CrossRef
24.
go back to reference Sales CM, Haq F, Bustami R, Sun F. Management of isolated soleal and gastrocnemius vein thrombosis. J Vasc Surg. 2010;52(5):1251–4.CrossRef Sales CM, Haq F, Bustami R, Sun F. Management of isolated soleal and gastrocnemius vein thrombosis. J Vasc Surg. 2010;52(5):1251–4.CrossRef
25.
go back to reference Lautz TB, Abbas F, Novis Walsh SJ, et al. Isolated gastrocnemius and soleal vein thrombosis: should these patients receive therapeutic anticoagulation? Ann Surg. 2009;251(4):735–42.CrossRef Lautz TB, Abbas F, Novis Walsh SJ, et al. Isolated gastrocnemius and soleal vein thrombosis: should these patients receive therapeutic anticoagulation? Ann Surg. 2009;251(4):735–42.CrossRef
26.
go back to reference Bradley WG Jr, Waluch V, Lai KS, Fernandez EJ, Spalter C. The appearance of rapidly flowing blood on magnetic resonance images. AJR Am J Roentgenol. 1984;143(6):1167–74.CrossRef Bradley WG Jr, Waluch V, Lai KS, Fernandez EJ, Spalter C. The appearance of rapidly flowing blood on magnetic resonance images. AJR Am J Roentgenol. 1984;143(6):1167–74.CrossRef
27.
go back to reference Bradley WG Jr, Waluch V. Blood flow: magnetic resonance imaging. Radiology. 1985;154(2):443–50.CrossRef Bradley WG Jr, Waluch V. Blood flow: magnetic resonance imaging. Radiology. 1985;154(2):443–50.CrossRef
28.
go back to reference Whittemore AR, Bradley WG, Jinkins JR. Comparison of cocurrent and countercurrent flow-related enhancement in MR imaging. Radiology. 1989;170(1):265–71.CrossRef Whittemore AR, Bradley WG, Jinkins JR. Comparison of cocurrent and countercurrent flow-related enhancement in MR imaging. Radiology. 1989;170(1):265–71.CrossRef
Metadata
Title
Characterization of intramuscular calf vein thrombosis on routine knee MRI
Authors
David P. Duncan
Michael Taddonio
Eric Y. Chang
Brady K. Huang
Publication date
01-10-2019
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 10/2019
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-019-03213-0

Other articles of this Issue 10/2019

Skeletal Radiology 10/2019 Go to the issue