Imaging for Venous Insufficiency

Primary Imaging Modalities

Duplex ultrasound allows for analysis of venous compressibility and Doppler imaging of venous blood flow, providing accurate diagnosis of symptomatic DVT in femoral and popliteal veins, according to the American College of Radiology 1
Duplex ultrasound can be performed at bedside and is suitable for serial evaluations, as recommended by the American College of Radiology 2
Duplex ultrasound can directly identify thrombus by visualizing echogenic material in the vein and by lack of compression of vein walls from manual external pressure, as stated by the American College of Radiology 2
Duplex ultrasound should include evaluation of deep venous system, great saphenous vein (GSV), small saphenous vein (SSV), accessory saphenous veins, and perforating veins, according to the American College of Radiology 3

Duplex ultrasound has lower sensitivity for imaging central veins, such as pelvic veins, proximal subclavian vein, IVC, and SVC, as noted by the National Comprehensive Cancer Network 1
Duplex ultrasound has reduced sensitivity for diagnosing distal lower-extremity DVT and asymptomatic DVT, according to the National Comprehensive Cancer Network 1
Duplex ultrasound may be limited by bandages, casts, pain, obesity, or operator dependency, as stated by the National Comprehensive Cancer Network and the American College of Radiology 1, 3

Contrast-Enhanced CT Venography (CTV) is as accurate as ultrasonography in diagnosing femoropopliteal DVT, as reported by the National Comprehensive Cancer Network 1
CTV provides accurate imaging of large pelvic veins and IVC, according to the National Comprehensive Cancer Network and the American College of Radiology 1, 3
Magnetic Resonance Venography (MRV) provides sensitive and specific evaluation of pelvic veins and vena cava without nephrotoxic contrast agents, as stated by the National Comprehensive Cancer Network 1
MRV is superior for evaluating soft tissue and identifying causes of venous compression, according to the American College of Radiology 6

Ultrasound duplex Doppler is the most appropriate initial imaging modality for upper extremity venous insufficiency, as recommended by the American College of Radiology 2
Duplex ultrasound should be the first assessment of the lower extremity venous system, according to the American College of Radiology 3
For suspected iliocaval obstruction, additional imaging with CTV or MRV is recommended, as stated by the American College of Radiology and the National Comprehensive Cancer Network 3, 4