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CME Evaluation

Oral Communication Session

Venous Thromboembolism

Session: Deep and superficial vein thrombosis

OC 44.4 - CT venography compared with ultrasonography for detection of peripherally inserted central venous catheter-related thrombosis: a prospective cohort study

Monday, June 24, 2024
15:30 – 15:45 ICT
Room: Ballroom B4

    Presenting Author(s)

  • Noori Guman, MD

    MD, PhD Student
    Amsterdam UMC location University of Amsterdam, Vascular Medicine, Amsterdam, Netherlands
    Amsterdam, Noord-Holland, Netherlands

    • Co-Author(s)

  • BV

    Bart M. Van Dooremaal

    Physician assistant
    Department of Radiology & Nuclear medicine, Amsterdam UMC, Amsterdam, the Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • LB

    Ludo F. Beenen

    Radiologist
    Department of Radiology & Nuclear medicine, Amsterdam UMC, Amsterdam, the Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • MS

    Maeke J. Scheerder

    Radiologist
    Department of Radiology & Nuclear medicine, Amsterdam UMC, Amsterdam, the Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • AB

    Anne-Marie L. Becking

    MD, PhD student
    Amsterdam UMC location University of Amsterdam, Vascular Medicine, Amsterdam, Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • ML

    Michiel F. Lagerweij

    Physician assistant
    Department of Radiology & Nuclear medicine, Amsterdam UMC, Amsterdam, the Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • IZ

    IJsbrand A. Zijlstra

    Interventional radiologist
    Department of Radiology & Nuclear medicine, Amsterdam UMC, Amsterdam, the Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • MM

    Martijn Meijerink

    Interventional radiologist
    Department of Radiology & Nuclear medicine, Amsterdam UMC, Amsterdam, the Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • Hv

    Hanneke W. M. van Laarhoven

    Professor, MD, PhD
    Department of Medical Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • PB

    Patrick M. Bossuyt

    Professor in Epidemiology
    Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands;
    Amsterdam, Noord-Holland, Netherlands

  • Peter Verhamme, MD PhD

    Professor
    Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
    Leuven, Vlaams-Brabant, Belgium

  • HB

    Harry Buller

    emeritus professor
    Amsterdam UMC location University of Amsterdam, Vascular Medicine, Amsterdam, Netherlands
    Amsterdam, Noord-Holland, Netherlands

  • Michiel Coppens

    MD, PhD
    Department of Vascular Medicine, Amsterdam UMC location University of Amsterdam
    Amsterdam, Noord-Holland, Netherlands

  • Nick van Es, MD PhD

    Internist-vascular medicine
    Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
    Amsterdam, Noord-Holland, Netherlands

Background: Ultrasonography is the primary tool for detection of upper-extremity deep vein thrombosis (DVT) related to a peripherally inserted central venous catheter (PICC). Computed tomography (CT) venography may offer a higher sensitivity, while additionally providing information about the superior caval vein, contralateral veins, and central pulmonary arteries.

Aims: To compare the diagnostic accuracy of CT venography with ultrasonography for screening-detected PICC-related VTE in cancer patients.

Methods: Consecutive cancer patients aged ≥18 years and scheduled for PICC placement were enrolled between April 2022 and October 2023. Exclusion criteria included recent DVT ( < 6 months ago), current anticoagulation, contra-indications for CT. At day 20±5, screening was performed by (1) a complete compression ultrasonography and duplex of the neck and upper extremity and (2) CT venography of the neck, upper extremity, and chest. Patients were followed from PICC placement until the date of a symptomatic venous thromboembolism (VTE), or screening, whichever occurred first. The primary outcome included upper-extremity DVT, caval vein and atrial thrombosis, and pulmonary embolism. CT scans were adjudicated by a radiologist blinded to initial readings. Sensitivity was estimated based on a composite reference standard including both tests and compared with a paired McNemar’s test.

Results: Forty-one patients were included (see Table for characteristics), of whom 19 (46%) were diagnosed with VTE, including 16 (39%) asymptomatic VTE detected at screening and three (7.3%) symptomatic VTE. Anticoagulant therapy was initiated in 15 (79%) patients with VTE. Screening CT venography missed five asymptomatic events (sensitivity, 69%; 95%-CI, 44-86) and screening ultrasonography missed four (sensitivity, 75%; 95%-CI, 50-90; P=0.73). Thrombi missed by CT venography were located across all upper extremity deep veins, while ultrasonography missed events mostly located in the subclavian and more central veins (Figure).

Conclusion(s): These results make it unlikely that the sensitivity of CT venography exceeds that of ultrasonography in the detection of asymptomatic PICC-related DVT.