Three-dimensional gadolinium-enhanced MR venographic evaluation of patency of central veins in the thorax: initial experience.

Abstract

To assess the usefulness of three-dimensional (3D) gadolinium-enhanced magnetic resonance (MR) venography for evaluation of thoracic central veins. A retrospective study included 15 patients who underwent 3D gadolinium-enhanced subtraction MR venography with a spoiled gradient-echo sequence before and at multiple times after intravenous administration of 30-40 mL of contrast material. Maximum intensity projection and multiplanar reconstruction images were used to categorize central veins as patent, occluded, or narrowed. Results were compared with findings (in 12 patients) at conventional venography (n = 3), attempted central venous catheter placement (n = 3), or surgery (n = 6). Medical records were retrospectively reviewed to determine if patient care was affected by MR venographic findings. By using MR venograms, an appropriate vessel could be identified for successful placement of a catheter, indwelling venous access device, or arteriovenous hemodialysis graft in all nine patients in whom placement was attempted. MR venography also was predictive of unsuccessful hemodialysis catheter placement in one patient. Conventional venographic findings confirmed MR venographic findings in three patients; in a fourth patient, conventional venography was unsuccessful due to inadequate access. MR venographic findings influenced treatment in 14 patients. On the basis of these initial results, 3D gadolinium-enhanced MR venography may facilitate comprehensive evaluation of abnormalities of the central veins in the thorax, particularly with regard to selection of venous access sites.