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Clinical Application of Sonographic Elasticity Imaging for Aging of Deep Venous Thrombosis

Preliminary Findings

Departments of Radiology (J.M.R.), Biomedical Engineering (S.R.A., M.O., S.Y.E.), and Surgery (T.W.W.), University of Michigan, Ann Arbor, Michigan USA; and Institute of Mathematical Problems of Biology, Russian Academy of Sciences, Pushchino, Moscow Region, Russia (S.R.A.). Dr Aglyamov and Dr Emelianov are now with the Biomedical Engineering Department, University of Texas at Austin, Austin, Texas USA.

Address correspondence and reprint requests to Jonathan M. Rubin, MD, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109 USA; e-mail: jrubin{at}umich.edu.

Objective. Aging of deep venous thrombosis is an important and difficult clinical problem. Because it is known that thrombi harden as they mature, we have preliminarily tested sonographic elasticity imaging, a technique that estimates tissue hardness, to age venous thrombi. Methods. Two adult patients with lower extremity thrombi were studied. One had a clinically chronic thrombus (at least 3 years old), whereas the other patient’s thrombus was clinically subacute (25 days old). We performed freehand compression sonographic scans using a 5-MHz linear array transducer. Phase-sensitive B-scan frames were processed offline by a two-dimensional complex correlation-based adaptive speckle-tracking technique. The distribution of internal strains in the wall of the vein, thrombus, and surrounding tissue was analyzed. Clot hardness was normalized to the venous wall. Results. The chronic clot was homogeneous, and the strain in the chronic clot was at least 10 times smaller than that in the vessel wall. The subacute clot was much more heterogeneous, and, on average, the strain magnitude in the clot was 3 to 4 times greater than that in the vessel wall. Conclusions. In this preliminary work, the 2 thrombi appeared very different, and these results suggest that elasticity imaging may be able to age deep venous thrombosis.

Abbreviations: DVT, deep venous thrombosis

Key Words: compression sonography • deep venous thrombosis • elasticity imaging

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