Purpose
In the past, several diagnostic modalities have been used to evaluate the lower extremity varicose veins. Sonography, although inexpensive and readily available, is limited by operator dependence, poor acoustic window in the pelvis, inacceessible anatomy, and body habitus and time consuming. Contrast venography is gold standard but it may be undesirable because its invasiveness, radiation exposure, incomplete filling of veins, and nephrotoxic and allergic reactions to iodinated contrast. Computed tomography (CT) venography without contrast media using volume rendering technique has been applied but limited to...
Methods and Materials
For 23 patients with 38 lower extremity varicose veins, MRV using time-of-flight (TOF), fat suppressed T2-weighted turbo spin echo (TSE) and balanced turbo field echo (bTFE)were compared (Table 1). The original images on 1.5 Tesla Gyroscan (Philips) were transferred to a workstation (M900 Quadra, ZIOSOFT Inc.) and 3D images were reconstructed using coronal maximum intensity projection (MIP, Fig.1), multiplaner reconstruction (MPR, Fig.2), and volume rendering (VR, Fig.3-5) techniques. For analysis, the veins were divided into superficial, deep venous systems, perforating and varicose veins, and were...
Results
Superficial, deep venous systems and perforating veins were best visualized on bTFE (p<.05, Fig.6), while varicose veins were equally visualized on TSE and bTFE (Table 3, Fig.7). TOF provided poor visibility except popliteal veins. Coexisting arterial system seen on bTFE could be discriminated from the deep venous system especially on axial MPR images (Fig.2). The varicose veins connected with the superficial venous systems and perforating veins on the surface of the muscle fascia were easily recognized on muscular VR using bTFE (Fig.8, 9, 10, 11,...
Conclusion
Contrast enhance (CE) MRV exploits the gadolinium induced venous signal using a fast 3D gradient echo sequence and may be performed using a direct or indirect approach. The direct approach involves injection of dilute contrast (1:20) in a peripheral vein and provides superior contrast-to-noise ratio, but evaluation is limited only to those veins that drain from the site of injection 2]. With the indirect approach, nondiluted contrast must be injected in a nontargeted vein and imaged during its first pass. The optimal timing is sometimes...
References
1] Caggiati A, Luccichenti G, Pavone P. Three- dimensional phlebography of the saphenous venous system. Circulation. 2000; 102(5): E33-5. 2] Ruehm SG, Wiesner W, Debatin JF. Pelvic and lower extremity veins: contrast-enhanced three-dimensional MR venography with a dedicated vascular coil-initial experience. Radiology. 2000 May; 215(2): 421-7. 3] Fraser DG, Moody AR, Davidson IR, Martel AL, Morgan PS. Deep venous thrombosis: diagnosis by using venous enhanced subtracted peak arterial MR venography versus conventional venography. Radiology. 2003; 226(3): 812-20. 2003 4] Holtz DJ, Debatin JF, McKinnon GC,...
Personal Information
Jun KOIZUMI1, M WADA2, Tomohiko HORIE1,Eri KIMURA1, Isao MURO1, Kazunori MYOJIN1, T NIIBORI2, Yutaka IMAI11. Department of Diagnostic RadiologySchool of Medicine, Tokai University, Isehara-city2. Department of Cardiovascular SurgeryNational Saitama Hospital, Wako-cityJAPANCorrespondence to;Jun KOIZUMI, MD, PhDDepartment of Diagnostic Radiology, School of Medicine, Tokai UniversityBohseidai, Isehara-city, Kanagawa-prefecture, 259-1193 JAPANphone; +81-463-93-1131 (ex.2400), fax; +81-463-93-6827e-mail;
[email protected]
