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International Angiology 2000 September;19(3):220-227


language: English

Determining the stage of organisation and natural history of venous thrombosis using computer analysis

O’Shaughnessy A. M. ^, Fitzgerald D. E.

From the * Vascular Medicine Unit, James Connolly Memorial Hospital, Blanchardstown ^ Department of Anatomy, Trinity College, Dublin, Ireland


Backghround. In vitro stud­ies have shown that as the organ­isa­tion of a throm­bus pro­gress­es its ultra­sound appear­ance ­becomes more ech­o­gen­ic. When diag­nos­ing a deep vein throm­bo­sis (DVT) using ­duplex ultra­sound, an esti­ma­tion of the ­degree of organ­isa­tion of the throm­bus is made by assess­ing its echog­e­nic­ity. This meth­od is pure­ly sub­jec­tive and has many pit­falls.
Methods. A study was per­formed on 100 prox­i­mal DVTs from 89 ­patients diag­nosed by ­duplex ultra­sound. These imag­es were trans­ferred to a com­put­er and stan­dar­dised using, the adobe Photoshop™. The throm­bus in the image frame was out­lined and the grey scale ­median (GSM) cal­cu­lat­ed. The grey scale ­median which is a meas­ure of the echog­e­nic­ity of the throm­bus (indi­cat­ing the ­degree of organ­isa­tion), var­ied con­sid­er­ably from ­patient to ­patient.
Results. The ­results show that the level of organ­isa­tion of a throm­bus on ­initial diag­no­sis is unre­lat­ed to the clin­i­cal signs or dura­tion of symp­toms of the ­patient. This has fur­ther impli­ca­tions when con­sid­er­ing a ther­a­py ­regimen based on the dura­tion of symp­toms (e.g. throm­bol­y­sis). Additionally, the age of the ­patient, pre­dis­pos­ing fac­tors and bulk of the throm­bus ­appear to be unre­lat­ed to the value of the grey scale ­median at the ­initial visit. The ­initial grey scale ­median val­ues were then com­pared to those at a one ­week’s fol­low-up exam­ina­tion. Those with a low ­initial value of the grey scale ­median were found to ­increase, indi­cat­ing fur­ther organ­isa­tion, as expect­ed. However, ­patients with high­er ­initial grey scale ­median val­ues were found to fluc­tu­ate, some increas­ing and some decreas­ing. The ­increase the grey scale ­median was due to a more homog­e­nous appear­ance ­across the throm­bus as the organ­isa­tion pro­cess ­became more estab­lished. A ­decrease in grey scale ­median indi­cat­ed areas of lysis occur­ring with­in the throm­bus.
Conclusions. Measuring the value of the grey scale ­median is a quan­ti­ta­tive way of assess­ing the ­degree of organ­isa­tion of a deep vein throm­bo­sis. This can be used to asses the suit­abil­ity of ­patients for var­i­ous treat­ment ­regimen. It is also a use­ful means of assess­ing the long-term impli­ca­tions of dif­fer­ent ther­a­pies and could aid in deter­min­ing the long-term out­come for the ­patient.

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