MR venography of the calf: value of flow-enhanced time-of-flight echoplanar imaging

Release of a tourniquet on the thigh and termination of Valsalva's maneuver result in a transient increase in venous blood flow in the leg. The purpose of this study was to determine the value of time-of-flight echoplanar imaging performed with these flow-enhancing methods to image the veins of the calf.

Flow volumes in the femoral veins in eight volunteers were determined with a two-dimensional phase-contrast MR imaging technique before and immediately, 20, 40, and 60 sec after termination of Valsalva's maneuver and thigh vein occlusion. Subsequently, the calf veins of 11 healthy volunteers were imaged with a two-dimensional four-shot echoplanar MR imaging technique. Forty-one 5-mm-thick sections were obtained over 10 sec immediately after termination of venous occlusion. Visibility of the three venous bundles was analyzed in the proximal, middle, and distal portions of the calf on the basis of a four-point scale. Finally, the calf of a single patient with documented DVT was imaged by the same MR imaging technique.

Both Valsalva's maneuver and venous occlusion caused significant increases in venous flow (p < .05) only during the first 20 sec after termination of the maneuver and the occlusion. Venous occlusion had a significantly greater effect than did Valsalva's maneuver (p < .05). Flow augmentation by venous occlusion of the thigh improved calf vein visualization with time-of-flight echoplanar MR imaging (p < .0001). Of the 99 calf vein segments examined, 93 were clearly seen. Thrombi were seen in the patient study.

Multishot time-of-flight echoplanar imaging can exploit the short-lived effect of mechanical flow-enhancing measures, resulting in good visualization of calf veins. The true diagnostic impact of this technique needs to be evaluated in a patient study.