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<p>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 (<i>p</i> &lt; 0.001). Thrombus elasticity robustly correlated with the period of DVT diagnosis (i.e., lower elasticity with increasing thrombus chronological age; <i>ρ</i> = −0.70, <i>p</i> &lt; 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; <i>ρ</i> = 0.85, <i>p</i> &lt; 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.</p> Graphical Abstract <p>Framework for thrombus elasticity assessment via advanced real-time strain elastography, and potential clinical usefulness of enhanced non-invasive DVT characterization.</p> <p></p>

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Non-Invasive Characterization of Lower Extremity Deep Vein Thrombosis via Advanced Ultrasound Elastography: A Prospective Pilot Study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月7日

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  • Nicola Potere,
  • Mattia Giulianelli,
  • Matteo Candeloro,
  • Maria Domenica Guglielmi,
  • Silvana Pardi,
  • Marcello Di Nisio,
  • Ettore Porreca

摘要

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.

Graphical Abstract

Framework for thrombus elasticity assessment via advanced real-time strain elastography, and potential clinical usefulness of enhanced non-invasive DVT characterization.