Clinical value of deep vein thrombosis density on pre-contrast and post-contrast lower-extremity CT for prediction of pulmonary thromboembolism

Abstract

Background: There was a lack of studies assessing the relationship between deep vein thrombosis (DVT) Hounsfield unit (HU) density and pulmonary thromboembolism (PTE). Purpose: To evaluate the clinical value of DVT density measured on pre- and post-contrast lower-extremity computed tomography (CT) for the prediction of PTE. Material and Methods: From 2017 to 2021, patients who underwent pulmonary CT angiography within one week after diagnosis of DVT on lower-extremity CT were included in this retrospective study. Then, the patients without PTE were included in "DVT group" and those with both DVT and PTE were included in the "DVT-PTE group." The DVT HU density was measured by drawing free-hand region of interests (ROIs) within the thrombus at the most proximal filling defect level. A receiver operating characteristic (ROC) analysis was used to evaluate the predictive value of DVT density for the risk of PTE. Results: This study included a total of 94 patients (DVT group: n=56; DVT-PTE group: m=38). DVT density was significantly higher in the DVT-PTE group than the DVT group in both pre-contrast (53.5 +/- 6.2 HU vs. 44.1 +/- 7.9 HU; P<0.001) and post-contrast CT (67.0 +/- 8.6 HU vs. 57.1 +/- 10.6 HU; P<0.001). ROC analysis revealed that the area under curve, sensitivity, and specificity for predicting the risk of PTE were 0.739, 71.1%, and 64.2%, respectively, at a DVT density cutoff of 48.2 HU on pre-contrast CT and were 0.779, 73.7%, and 69.6% at a DVT density cutoff of 61.8 HU on post-contrast CT. Conclusion: The DVT density on both pre- and post-contrast CT could be a predictive factor of PTE.