Rose S C, Gomes A S, Yoon H C
Department of Radiological Sciences, UCLA Medical Center 90024-1721, USA.
AJR Am J Roentgenol. 1996 May;166(5):1181-7. doi: 10.2214/ajr.166.5.8615266.
Patients who depend on long-term central venous catheter support frequently develop thrombi in central veins. An accurate, noninvasive technique is needed to find patent central veins for future access. We evaluated the suitability of MR angiography for this use.
Using five healthy volunteers and 19 patients who had malfunctioning central venous catheters and a history of central venous occlusive disease, we tested the ability of MR angiography to assess central vein status. Three radiologists experienced in MR angiography blindly interpreted both source images and three-dimensional reconstructed images.
In the volunteers, MR angiography provided diagnostic-quality images of the internal and external jugular, innominate, subclavian, axillary, femoral, and iliac veins, and of the superior and inferior venae cavae. Interobserver interpretations did not vary. In the patients, MR angiography of venous patency was confirmed by venography in 27 segments, by sonography n 32 segments, and by attempted line placement in 21 placements. Images were diagnostically adequate in 206 of 216 segments (95%). For detection of occlusion, sensitivity was 97% and specificity was 94%. MR angiography predicted 100% of successful line placements and 80% of failures. Interobserver interpretations varied by 44%. MR angiography directly influenced therapy in 19 of 21 studies.
We conclude that MR angiography provides risk-free, thorough, relatively accurate, and clinically useful assessment of most available central venous access sites, although interpretation may prove difficult in patients with extensive occlusions because of complex collateral drainage patterns.
长期依赖中心静脉导管支持的患者，其中心静脉常形成血栓。需要一种准确的非侵入性技术来寻找通畅的中心静脉以备将来使用。我们评估了磁共振血管造影在此用途上的适用性。
我们使用5名健康志愿者以及19名中心静脉导管出现故障且有中心静脉闭塞性疾病病史的患者，测试磁共振血管造影评估中心静脉状况的能力。3名擅长磁共振血管造影的放射科医生对源图像和三维重建图像进行了盲法解读。
在志愿者中，磁共振血管造影提供了颈内静脉、颈外静脉、无名静脉、锁骨下静脉、腋静脉、股静脉和髂静脉以及上、下腔静脉的诊断质量图像。观察者间的解读没有差异。在患者中，27个节段的静脉通畅情况通过静脉造影得到证实，32个节段通过超声检查得到证实，21次置管尝试中有21次通过置管情况得到证实。216个节段中有206个节段（95%）的图像诊断足够。对于闭塞的检测，敏感性为97%，特异性为94%。磁共振血管造影预测了100%的成功置管和80%的置管失败。观察者间的解读差异为44%。在21项研究中有19项研究中，磁共振血管造影直接影响了治疗。
我们得出结论，磁共振血管造影可对大多数可用的中心静脉穿刺部位进行无风险、全面、相对准确且具有临床实用性的评估，尽管对于存在广泛闭塞且侧支引流模式复杂的患者，解读可能会很困难。
