3D gadolinium-enhanced MRI venography: Evaluation of central chest veins and impact on patient management

AIM: To assess the value of a simplified 3D gadolinium-enhanced magnetic re sonance imaging (MRI) venography for central chest veins. MATERIALS AND METHODS: In this retrospective study of 24 patients, the MRI findings and medical records were reviewed to determine whether MRI results correlated with subsequent findings, and to determine the effect on clinic al management. 3D steady state gradient-echo sequence, fast imaging with st eady state precession (FISP), was used. We employed a simplified protocol n ot requiring bolus timing or subtraction to achieve rapid data acquisition and hence good compliance in this group of frail patients. Following intrav enous administration of a bolus of gadolinium, two acquisitions were obtain ed in order to ensure adequate opacification of all veins. Individual parti tions and maximum intensity projections were then analysed to determine whe ther the veins were patent, stenosed or occluded. RESULTS: The indications for MRI were to assess the patency of central vein s for the purpose of cannulation or arteriovenous fistula formation in 17 p atients. Out of the 12 patients who proceeded to an intervention, MRI venog raphy successfully predicted an appropriate site in 10 patients. In the rem aining seven patients, MRI venography was valuable in confirming or excludi ng the clinical suspicion of central venous thrombosis and directly influen ced the management in five patients. CONCLUSION: 3D gadolinium-enhanced MRI venography is a valuable means of pr oviding a global representation of the central venous system and guiding su bsequent central venous cannulation. (C) 2001 The Royal College of Radiolog ists.