Central veins of the chest: evaluation with time-resolved MR angiography.
OBJECTIVE
To retrospectively assess the diagnostic performance of time-resolved magnetic resonance (MR) angiography in the detection of stenoses and occlusions in the central veins of the chest, with angiographic and surgical findings and consensus readings serving as the reference standard.


METHODS
Institutional review board approval was obtained, and the informed consent requirement was waived for this HIPAA-compliant study. Retrospective analysis was performed with 27 consecutive patients (12 male, 15 female; age range, 16-67 years) who underwent MR venography of the central veins. Six radiologists with varying levels of experience interpreted the studies. For each study, the readers were presented with time-resolved maximum intensity projection (MIP) images only, high-spatial-resolution images only, or both. Sensitivity and specificity were calculated for detection of stenoses and occlusions, as well as for confidence levels, study interpretation time, and determination of the side of the body on which upper extremity contrast material injection was performed.


RESULTS
The addition of time-resolved angiographic images to the high-spatial-resolution images resulted in improved specificity in the detection of venous occlusions (0.99 vs 0.96, P = .03), in reader confidence (P < .001), and in the ability to infer the side of injection (83% correct compared with 32% correct, P < .001), without increasing the average time required for study interpretation. Use of time-resolved angiographic data sets as a stand-alone technique had high sensitivity (0.95) but only moderate specificity (0.56) in the detection of venous stenoses or occlusions.


CONCLUSIONS
Time-resolved angiographic images are a useful adjunct to high-spatial-resolution images in the evaluation of central venous stenoses and occlusions.
Kim
Charles Y
CY
Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710, USA.
Mirza
Rizvan A
RA
Bryant
Joshua A
JA
Whiting
Eric D
ED
Delong
David M
DM
Spritzer
Charles E
CE
Merkle
Elmar M
EM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003251:Constriction, Pathologic; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013909:Thorax / Q000098:blood supply*; D014652:Vascular Diseases / Q000175:diagnosis*
D003287:Contrast Media; D019786:Gadolinium DTPA