ArticleInternal and emergency medicine2025
Non-Invasive Characterization of Lower Extremity Deep Vein Thrombosis via Advanced Ultrasound Elastography: A Prospective Pilot Study.
Article in Internal and emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Duplex ultrasonography is the preferred non-invasive imaging technique for diagnosing lower extremity deep vein thrombosis (DVT), but considered largely unreliable for determining thrombus-specific features. Elastosonography techniques including real-time strain elastography (RT-SE) are widely used in clinical practice to assess tissue elasticity, but its potential remains largely unrealized in DVT, where RT-SE might provide adjunct information on thrombus biomechanical properties potentially aiding clinical decision-making. This single-center prospective pilot study investigates the use of modern RT-SE imaging enhanced with an advanced quantification software for reconstructive tissue elasticity analysis in patients with symptomatic acute lower-extremity DVT objectively diagnosed within 6 months of enrollment. Between-group differences in median thrombus elasticity, assessed via a newly proposed elasticity biomarker, namely thrombus tissue deformation index, were evaluated using Mann-Whitney U or Kruskal-Wallis tests. Relationships between thrombus elasticity and patient-, DVT- and anticoagulation-related factors were assessed through Spearman's rank-order correlation. Thirty-eight deep venous thrombi were analyzed using advanced RT-SE, in addition to standard duplex ultrasonography (i.e., triplex ultrasonography). Median thrombus elasticity was 25.7% (interquartile range [IQR], 22.1-26.1), 20.8% (IQR, 17.1-22.1), and 3.8% (IQR, 1.3-6.6) in acute, sub-acute, and chronic DVT, respectively (p < 0.001). Thrombus elasticity robustly correlated with the period of DVT diagnosis (i.e., lower elasticity with increasing thrombus chronological age; ρ = -0.70, p < 0.0001). Elasticity of chronic thrombi inversely correlated with dynamic changes in residual vein obstruction (i.e., higher elasticity of thrombi undergoing smaller size reduction over time; ρ = 0.85, p < 0.0001). These findings preliminarily identify modern advanced RT-SE imaging as a viable and easily-implementable tool for enhanced non-invasive thrombus characterization, with the potential to inform thrombus-guided management strategies in patients with DVT.
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