A three-dimensional gadolinium-enhanced MR venography technique for imaging central veins

We evaluated the use of a three-dimensional gadolinium-enhanced MR venography technique in selected patients with suspected central venous abnormalities.

Thirty-seven patients with suspected thrombosis, stenosis, occlusion, or compression of the axillary vein, subclavian vein, brachiocephalic vein, or superior or inferior vena cava or with suspected malfunction of central venous catheters were imaged. For all patients, we obtained a three-dimensional dynamic gadolinium-enhanced (bolus injection, 30 40 ml) breath-hold spoiled gradient-recalled acquisition in the steady state as well as conventional venous images from either Doppler sonography, CT, or digital subtraction venography. Breathhold fast multiplanar spoiled gradient-recalled acquisitions in the steady state were obtained using the following parameters: TR/TE, 10.3/1.9; flip angle, 45 degrees; matrix size, 256 x 128; number of excitations, one; field of view, 36-48 cm; number of partitions, 28; and slice thickness, 2.54 mm. MR venograms and conventional images were interpreted by two observers in consensus who were unaware of clinical information and the diagnosis.

MR venograms were of diagnostic quality for all 37 patients. Thirteen patients had normal venous systems seen on both conventional and MR images. MR venography showed all nine venous stenoses, the one pericatheter fibrin sheath, and the one jugular vein thrombosis. Axillary or subclavian vein thrombosis was correctly diagnosed with MR venography in all four patients with this condition. Mediastinal venous compression was accurately depicted by MR venography in the five patients who had such compression. Finally, MR venography revealed the correct diagnosis in the three patients with inferior vena cava thrombus and tumor and the one patient with inferior vena cava compression. Thus, MR venography was 100% sensitive, specific, and accurate in the diagnosis of abnormalities affecting large central veins.

Compared with conventional imaging, gadolinium-enhanced breathhold MR venography is easy to perform, well tolerated, and highly accurate in depicting central venous abnormalities.