MR-ANGIOGRAPHY FOR MAPPING POTENTIAL CENTRAL VENOUS ACCESS SITES IN PATIENTS WITH ADVANCED VENOUS OCCLUSIVE DISEASE

OBJECTIVE. Patients who depend on long-term central venous catheter su pport frequently develop thrombi in central veins, An accurate, noninv asive technique is needed to find patent central veins for future acce ss, We evaluated the suitability of MR angiography for this use. SUBJE CTS AND METHODS. Using five healthy volunteers and 19 patients who had malfunctioning central Venous catheters and a history of central veno us occlusive disease, we tested the ability of MR angiography to asses s central Vein status, Three radiologists experienced in MR angiograph y blindly interpreted both source images and three-dimensional reconst ructed images. RESULTS. In the volunteers, MR angiography provided dia gnostic-quality images of the internal and external jugular, innominat e, 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 ve nography in 27 segments, by sonography in 32 segments, and by attempte d 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 suc cessful line placements and 80% of failures, Interobserver interpretat ions varied by 44%. MR angiography directly influenced therapy in 19 o f 21 studies. CONCLUSION. We conclude that MR angiography provides ris k-free, thorough, relatively accurate, and clinically useful assessmen t of most available central Venous access sites, although interpretati on may prove difficult in patients with extensive occlusions because o f complex collateral drainage patterns.