Evaluation of central venous stenosis using the lateral thoracic pathway on low-dose CT

Collateral circulation is a biomarker of central venous stenosis (CVS). We attempted to identify the presence of CVS in hemodialysis patients using the lateral thoracic pathway (LTP) on low-dose computed tomography (CT).

A total of 355 patients with end-stage renal disease were retrospectively enrolled in this study and further divided into three subgroups (central vein catheters, CVC, 121; arteriovenous fistulas, AVF, 162; and arteriovenous grafts, AVG, 72). All patients underwent low-dose CT within 10 days prior to the intervention, and CT venography was used for demonstration if it was performed during this period. Patients were defined as positive LTP when vascular-like attenuation was present on either side of the anterolateral chest wall. The incidence of thoracic varices from physical examination and LTP on low-dose CT was calculated, and their sensitivity, specificity, positive predictive value, and negative predictive value for differentiating CVS were analyzed.

Compared with the non-CVS group, comorbidities were more common in the CVS group, and the access age was also longer (all P < 0.05). The rate of positive LTP is higher than that of thoracic varices (54.4% vs. 12.1%). There was no statistically significant difference in age and sex between the CVS and non-CVS (all P > 0.05), but thoracic varices and positive LTP were significantly higher in the CVS than in the non-CVS (all P < 0.001). In all groups, the sensitivity of LTP was significantly higher than that of the thoracic varices (CVC:0.939 vs. 0.303; AVF:0.956 vs. 0.400; AVG:0.917 vs. 0.208) and maintained a high negative predictive value (CVC:0.966; AVF:0.974; AVG:0.926). The Cohen's kappa values showed excellent reproducibility between the two radiologists (κ = 0.977).

Negative LTP help identify hemodialysis patients at lower risk of CVS and may reduce unnecessary interventions.