Retrospective analysis of intravertebral collateral enhancement  in patients with central venous obstruction.
OBJECTIVE
To compare prevalence and patterns of intravertebral collateral enhancement in patients with and without central venous obstruction (CVO).


METHODS
Chest CTs performed between 1/1/2000 and 12/15/2012 with reports containing terms indicating CVO were identified. All contrast enhanced CTs were examined for the presence of CVO and collateral venous pathways. If intravertebral collateral enhancement was present, the pattern was recorded as nodular, linear, or both.


RESULTS
In 209 suspected cases of CVO, 53 (25 %) were confirmed with obstruction and 156 (75 %) were without obstruction. In patients with CVO, 47 % (25/53) demonstrated collateral venous flow through an intravertebral marrow pathway compared to 5 % (8/156) of patients without CVO (P < 0.0001). The most common level of enhancement was the upper thoracic spine, involving only the vertebral body. Nodular, linear, and combined nodular-linear enhancement patterns were seen with similar frequency. Nodular intravertebral collateral enhancement was mistaken for sclerotic metastases in 33 % (3/9) of cases.


CONCLUSIONS
Intravertebral collateral enhancement was seen in almost half the patients with CVO and when nodular enhancement is present, it is important to differentiate between metastatic lesions and enhancement related to CVO.
F Joseph
FJ
Simeone
Debbie L
DL
Bennett
Connie Y
CY
Chang
Ambrose J
AJ
Huang
Susan V
SV
Kattapuram
Miriam A
MA
Bredella
Martin
M
Torriani
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D013904:Thoracic Vertebrae / Q000098:blood supply*; D014057:Tomography, X-Ray Computed; D014689:Venous Insufficiency / Q000000981:diagnostic imaging*; D055815:Young Adult
D003287:Contrast Media