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Desjardins B, Hanley M, Steigner ML, Aghayev A, Azene EM, Bennett SJ, Chandra A, Hedgire SS, Lo BM, Mauro DM, Ptak T, Singh-Bhinder N, Suranyi PS, Verma N, Dill KE. ACR Appropriateness Criteria® Suspected Upper Extremity Deep Vein Thrombosis. J Am Coll Radiol 2020; 17:S315-S322. [PMID: 32370975 DOI: 10.1016/j.jacr.2020.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 01/13/2023]
Abstract
This publication includes the appropriate imaging modalities to assess suspected deep vein thrombosis in the upper extremities. Ultrasound duplex Doppler is the most appropriate imaging modality to assess upper-extremity deep vein thrombosis. It is a noninvasive test, which can be performed at the bedside and used for serial evaluations. Ultrasound can also directly identify thrombus by visualizing echogenic material in the vein and by lack of compression of the vein walls from manual external pressure. It can indirectly identify thrombus from altered blood-flow patterns. It is most appropriate in the evaluation of veins peripheral to the brachiocephalic vein. CT venography and MR venography are not first-line imaging tests, but are appropriate to assess the central venous structures, or to assess the full range of venous structures from the hand to the right atrium. Catheter venography is appropriate if therapy is required. Radionuclide venography and chest radiography are usually not appropriate to assess upper-extremity deep vein thrombosis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Michael Hanley
- Panel Chair, University of Virginia Health System, Charlottesville, Virginia
| | | | - Ayaz Aghayev
- Brigham & Women's Hospital, Boston, Massachusetts
| | | | | | - Ankur Chandra
- Scripps Green Hospital, La Jolla, California; Society for Vascular Surgery
| | - Sandeep S Hedgire
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bruce M Lo
- Sentara Norfolk General/Eastern Virginia Medical School, Norfolk, Virginia; American College of Emergency Physicians
| | - David M Mauro
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Thomas Ptak
- University of Maryland Medical Center, Baltimore, Maryland
| | | | - Pal S Suranyi
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Karin E Dill
- Specialty Chair, UMass Memorial Medical Center, Worcester, Massachusetts
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ACR Appropriateness Criteria® Suspected Upper Extremity Deep Vein Thrombosis. J Am Coll Radiol 2012; 9:613-9. [DOI: 10.1016/j.jacr.2012.05.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 05/18/2012] [Indexed: 12/18/2022]
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