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

OBJECTIVE. We evaluated the use of a three-dimensional gadolinium-enhanced MR venography technique in selected patients with suspected central venous abnormalities. SUBJECTS AND METHODS. Thirty-seven patients with suspected thrombosis, sten osis, occlusion, or compression of the axillary vein, subclavian vein, brac hiocephalic vein, or superior or inferior vena cava or with suspected malfu nction of central venous catheters were imaged. For all patients, we obtain ed a three-dimensional dynamic gadolinium-enhanced (bolus injection, 30-40 mi) breath-hold spoiled gradient-recalled acquisition in the steady state a s well. as conventional venous images from either Doppler sonography, CT, o r digital subtraction venography. Breath-hold fast multiplanar spoiled grad ient-recalled acquisitions in the steady state were obtained using the foll owing 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 part itions, 28; and slice thickness, 2.5-4 mm. MR venograms and conventional im ages were interpreted by two observers in consensus who were unaware of cli nical information and the diagnosis. RESULTS. MR venograms were of diagnostic quality for all 37 patients. Thirt een patients had normal venous systems seen on both conventional and MR ima ges. MR venography showed all nine venous stenoses, the one pericatheter fi brin sheath, and the one jugular vein thrombosis. Axillary or subclavian ve in thrombosis was correctly diagnosed with MR venography in all four patien ts with this condition. Mediastinal venous compression was accurately depic ted by MR venography in the five patients who had such compression. Finally , MR venography revealed the correct diagnosis in the three patients with i nferior vena cava thrombus and tumor and the one patient with inferior vena cava compression. Thus, MR venography was 100% sensitive, specific, and ac curate in the diagnosis of abnormalities affecting large central veins. CONCLUSION. Compared with conventional imaging, gadolinium-enhanced breath- hold MR venography is easy to perform, well tolerated, and highly accurate in depicting central venous abnormalities.