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Thromboembolic Disease

Variability of Interobserver Agreement in the Interpretation of CT Venography with CT Pulmonary Angiography

Kavita Garg1, Jennifer L. Kemp1,2, Paul D. Russ1 and Anna E. Barón3

1 Department of Radiology, Veterans Affairs Medical Center and University of Colorado, 1055 Clermont St., Denver, CO 80220.
2 Present address: Diversified Radiology of Colorado, P. C., 1601 E. 19th Ave., Denver, CO 80218.
3 Department of Preventive Medicine and Biometrics, School of Medicine, University of Colorado Health Sciences Center, 4200 E. 9th Ave., Denver, CO 80262.



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  		Fig. 1. —79-year-old man with acute deep venous thrombosis. Transverse CT venogram shows intraluminal filling defect in right common femoral vein (arrow), which is distended. Both observers interpreted this defect as evidence of deep venous thrombosis.

 


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  		Fig. 2. —66-year-old man with suboptimal opacification of veins. Transverse CT venogram shows apparent intraluminal filling defect in right iliac vein (arrow), which was interpreted as positive for deep venous thrombosis by one observer and negative by second observer. Consensus interpretation and sonography were negative for deep venous thrombosis.

 


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  		Fig. 3A. —69-year-oldman with deep venous thrombosis seen only on one slice. First transverse CT venogram slice at level of knee joint line shows intraluminal filling defect (arrow) in left lesser saphenous vein at confluence with popliteal vein. Defect was missed by one observer.

 


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  		Fig. 3B. —69-year-old man with deep venous thrombosis seen only on one slice. Transverse sonogram at same level as A shows intraluminal echogenic material distending lesser saphenous vein (arrows). Involved vein was not compressible and deep venous thrombosis extended 4-5 cm below knee.

 


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  		Fig. 4A. —75-year-old man with chronic deep venous thrombosis. Transverse CT venogram at inguinal ligament shows nonoccluding filling defect along posterior aspect of right common femoral vein (arrow). Defect was interpreted as evidence of acute deep venous thrombosis by both observers.

 


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  		Fig. 4B. —75-year-old man with chronic deep venous thrombosis. Longitudinal color Doppler sonogram of right common femoral vein shows thickening of posterior wall of right common femoral vein (arrowheads) consistent with chronic deep venous thrombosis. This finding was unchanged from previous sonogram obtained 6 months earlier (not shown).

 

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