Lisette van Dam

MRI for diagnosis of recurrent ipsilateral DVT 2 17 Procedures Consecutive patients who fulfilled all inclusion criteria and met none of the exclusion criteria were eligible for inclusion and managed according the study algorithm ( Figure 1 ). The diagnosis and treatment decision were based solely on the result of the MRDTI of the affected leg which was performed within 24 hours of inclusion. MRDTI was performedwith a 1.5 or 3.0 Tesla unit withmaximumgradient amplitude of 45 mT/m, slew rate of 200 T/m/s, using an integrated 16-channel posterior coil and a 16-channel anterior body coil for signal reception. 15-17 In case MRDTI was not instantly available at the time of presentation, and in the absence of absolute contraindications, patients received a single dose of therapeutic anticoagulation as per local treatment guidelines. Acute recurrent DVT as diagnosed by the MRDTI protocol was defined as a high signal in the location of a deep vein segment against the suppressed background greater than that observed in the corresponding or contiguous segments of the ipsilateral vein as judged by the attending radiologist. 12,13 Patients with a MRDTI negative for DVT were left untreated, or treatment remained unadjusted if they already received anticoagulant treatments due to a previous indication. In these patients a standardized CUS examination within 48 hours after the MRDTI was performed. This examination served as a reference test in case a patient returned with symptoms of DVT recurrence during the follow- up period but was not used for management decisions at baseline. In case of a MRDTI positive for DVT, anticoagulant treatment was initiated in accordance with international and local guidelines or modified in patients with a recurrent DVT on anticoagulant therapy. All patients were followed for the occurrence of recurrent symptomatic VTE, anticoagulation-associated major bleeding and all-cause mortality over a period of three months after inclusion. Patients were instructed to return to the hospital before the 3-month appointment if symptoms of recurrent VTE occurred, at which time objective tests were performed. 18-20