Contribution of direct CT venography in the diagnosis of central veno-occlusive disease in hemodialysis patients.

Congress:

ECR 2020

Poster Number:

C-01767

Type:

Educational Exhibit

Keywords:

Performed at one institution, Not applicable, Embolism / Thrombosis, Diagnostic procedure, CT-High Resolution, CT-Angiography, CT, Veins / Vena cava, Vascular, Thorax

Authors:

E. Remenyi; Guayaquil/EC

DOI:

10.26044/ecr2020/C-01767

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-01767

Table 1: Incidence of stenosis and occlusion of the inthatoracic veins.

Fig. 1: Fig. 1: Direct CTV 3D reconstruction in left BCT occlusion (arrows in a,b) in...

Fig. 2: Fig. 2: Patient with occlusion of the SVC and right BCT union in a patient with...

Fig. 3: Fig. 3: Direct CTV 3D reconstruction in a patient with patent right...

Fig. 4: Fig. 4: Direct CTV 3D reconstruction in a patient with (A) patent...

Fig. 5: Fig. 5: Patient with critical stenosis of SVC. (A) Coronal section of direct...

Fig. 6: Fig. 6: Direct CTV (A) Coronal MIP and (B) 3D reconstruction in a patient with...

Fig. 7: Fig 8: Direct CTV 3D Reconstruction in a patient with right subclavian,...

Findings and procedure details

Methods and technique

A total of 20 patients under hemodialysis with history of multiple vascular accesses and clinical suspicion of veno-occlusive disease of the intrathoracic central veins, characterized by pain, edema and superficial collateral circulation, underwent direct CT venography

A 128 detector-row CT scanner was used to perform all the scans. Catheterization of the peripheral distal veins is performed in both upper extremities with an 18-gauge intravenous catheter connected through a proximal and distal male luer locks extension set with the patient in a supine position. Two-phase iso-osmolar 70 ml iodine contrast (Ioversol 350 mg/ml) followed by a 30ml bolus of 0.9% saline solution was injected with an automatic injector at a flow rate of 3 ml/s.

Skull-caudal images are acquired with a delay of 7 seconds after contrast injection from the base of the neck to the hands. Scan parameters are 64*0.625 mm, 120 kVp, 150 mAs/slice with online dose modulation, pitch of 0.8, rotation time of 0.5 s for the whole lung.

Interpretation

The raw data were reconstructed using special software and workstations dedicated to angiographic procedures, including interactive viewing of multiplanar reconstruction images in an axial source, 2D coronal maximum intensity projections (MIP), 3D MIP and volume rendering (VR) reconstructions. The assessment and analysis were performed by an interventional radiologist with high expertise in vascular images.

Imaging findings of veno-occlusive disease of the intrathoracic central veins

Veno-occlusive disease of the intrathoracic central veins was diagnosed in all cases. The most common finding was venous occlusion (12), followed by stenosis (5) or both (3). The brachiocephalic venous trunk (84.2%) was the most affected site followed by the subclavian vein (52.6%), superior vena cava (15.7%), axillary (15.7%), basilic (5.2%) and brachial (5.2%). The affected side corresponded with vascular access in most cases.

Brachiocephalic venous trunk (BCT).- 16 patients presented isolated BCT veno-occlusive disease (Fig. 1) (Fig. 2)
or with another compromised venous location.

Subclavian vein.- 9 patients presented subclavian vein involvement, 8 with combined or isolated occlusion (Fig. 3), and 1 with significant stenosis (Fig. 4).

Superior Vena Cava (SVC).-3 patients presented significant stenosis of the BCT with the involvement of the VCS, of which 2 stenosis (Fig. 5) and in 1 occlusion was observed.

Axillary, Basilic and Brachial veins.- Veno-occlusive disease of superficial veins of the upper limbs was observed in 3 cases. Occlusion of the right axillary and basilar vein (Fig. 6), occlusion of the right axillary and brachial vein with ipsilateral subclavian involvement (Fig. 7) and right axillary vein stenosis associated with occlusion of the right BCT.