Clinical relevance of retrograde inferior vena cava or hepatic vein opacification during contrast-enhanced CT.
OBJECTIVE
The purpose of this investigation was to explore the clinical relevance of retrograde inferior vena cava or hepatic vein opacification during contrast-enhanced CT.


METHODS
We retrospectively identified 127 patients who underwent contemporaneous contrast-enhanced CT of the chest or abdomen and echocardiography. On CT, the presence of retrograde inferior vena cava or hepatic vein opacification and the rate of IV contrast injection (> 3 mL/sec, high; < or = 3 mL/sec, low) were recorded. On echocardiography, the presence of tricuspid regurgitation, pulmonary hypertension, or right ventricular systolic dysfunction was recorded.


RESULTS
Retrograde inferior vena cava or hepatic vein opacification was more common in studies performed with a high rather than a low contrast injection rate (28/56 vs 6/71 patients, respectively; p < 0.01). This finding was 31% sensitive (5/16) and 98% specific (54/55) for right-sided heart disease at low contrast injection rates, and 81% sensitive (17/21) and 69% specific (24/35) at high injection rates. Multivariate logistic regression models showed that high injection rate, tricuspid regurgitation, pulmonary hypertension, and right ventricular systolic dysfunction were independent predictors of retrograde inferior vena cava or hepatic vein opacification (p < 0.05 for each).


CONCLUSIONS
Retrograde opacification of the inferior vena cava or hepatic veins on CT is a specific but insensitive sign of right-sided heart disease at low contrast injection rates, but the usefulness of this classic sign decreases with high injection rates. This realization is important because many centers increasingly use high-injection-rate CT.
Yeh
Benjamin M
BM
Department of Radiology, University of California-San Francisco, 521 Parnassus Avenue, Rm. C-324C, Box 0628, San Francisco, CA 94143-0628, USA. benyeh@itsa.ucsf.edu
Kurzman
Philip
P
Foster
Elyse
E
Qayyum
Aliya
A
Joe
Bonnie
B
Coakley
Fergus
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000008:administration & dosage; D004452:Echocardiography; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006503:Hepatic Veins / Q000000981:diagnostic imaging*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging; D017380:Hypertrophy, Right Ventricular / Q000000981:diagnostic imaging; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging
D003287:Contrast Media