MR angiography for mapping potential central venous access sites in patients with advanced venous occlusive disease

Patients who depend on long-term central venous catheter support frequently develop thrombi in central veins. An accurate, noninvasive technique is needed to find patent central veins for future access. We evaluated the suitability of MR angiography for this use.

Using five healthy volunteers and 19 patients who had malfunctioning central venous catheters and a history of central venous occlusive disease, we tested the ability of MR angiography to assess central vein status. Three radiologists experienced in MR angiography blindly interpreted both source images and three-dimensional reconstructed images.

In the volunteers, MR angiography provided diagnostic-quality images of the internal and external jugular, innominate, subclavian, axillary, femoral, and iliac veins, and of the superior and inferior venae cavae. Interobserver interpretations did not vary. In the patients, MR angiography of venous patency was confirmed by venography in 27 segments, by sonography n 32 segments, and by attempted line placement in 21 placements. Images were diagnostically adequate in 206 of 216 segments (95%). For detection of occlusion, sensitivity was 97% and specificity was 94%. MR angiography predicted 100% of successful line placements and 80% of failures. Interobserver interpretations varied by 44%. MR angiography directly influenced therapy in 19 of 21 studies.

We conclude that MR angiography provides risk-free, thorough, relatively accurate, and clinically useful assessment of most available central venous access sites, although interpretation may prove difficult in patients with extensive occlusions because of complex collateral drainage patterns.