Suboptimal contrast opacification of dynamic head and neck MR angiography due to venous stasis and reflux: technical considerations for optimization.
OBJECTIVE
Contrast-enhanced head and neck MRA may be degraded by venous stasis and reflux of contrast into the jugular veins. The purpose of this study was to evaluate the relationship between venous stasis and reflux and the side of injection and other causal factors.


METHODS
One hundred twenty-six consecutive patients (94 males and 32 females) who underwent contrast-enhanced MRA were evaluated for the side of contrast injection (left, n = 65; right, n = 61), hypertension, and cardiac disease. The retrosternal space was measured in all patients with left-arm injections.


RESULTS
Eight patients (6.34%) had reflux into the jugular veins. The difference in the mean ages of patients with and without reflux was not significant (P = .069). There was a significant difference in the incidence of systemic hypertension in patients with (77.78%) and without reflux (23.73%; P = .007). There was no significant difference in the incidence of cardiac disease in patients with and without reflux (P = .323). The difference in the side of injection in patients with and without reflux (P = .005) and the difference in the mean retrosternal distance in the patients with left-arm injection with (7.2 mm) and without reflux (12.1 mm) were statistically significant (P < .001).


CONCLUSIONS
Compression of the left brachiocephalic vein between the sternum and a tortuous aorta and proximal vessels may lead to venous reflux that can degrade the quality of contrast-enhanced MRA. Our study suggests that venous reflux can be avoided by routinely injecting right-sided veins.
Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, India.
D R
DR
Hingwala
B
B
Thomas
C
C
Kesavadas
T R
TR
Kapilamoorthy
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016121:Brachiocephalic Veins / Q000473:pathology*; D002550:Cerebral Veins; D002648:Child; D003287:Contrast Media; D004824:Epidural Space / Q000098:blood supply; D005260:Female; D006801:Humans; D007601:Jugular Veins; D018810:Magnetic Resonance Angiography / Q000379:methods* / Q000592:standards*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014689:Venous Insufficiency / Q000209:etiology / Q000473:pathology*; D055815:Young Adult
D003287:Contrast Media