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Role of CT venography in the diagnosis and treatment of benign thoracic central venous obstruction.

Kim H, Chung JW, Park JH, Yin YH, Park SH, Yoon CJ, Choi YH - Korean J Radiol (2003 Jul-Sep)

Bottom Line: The following features were analyzed by two observers: the cause, degree, and extent of venous obstruction; associated thrombosis; and implications for the planning of treatment.In all patients, CT venography depicted the causes of obstruction, including extrinsic compression of the left brachiocephalic vein, and mediastinal inflammatory pseudotumor.In evaluating the status of central veins proximal to long segmental obstruction, and associated thrombosis, CT venography was superior to digital subtraction venography.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea. chungjw@radcom.snu.ac.kr

ABSTRACT

Objective: To evaluate the role of CT venography in the diagnosis and treatment of benign thoracic central venous obstruction.

Materials and methods: Eighteen patients who had undergone both CT venography and digital subtraction venography were prospectively enrolled in this study. The following features were analyzed by two observers: the cause, degree, and extent of venous obstruction; associated thrombosis; and implications for the planning of treatment. CT venography and digital subtraction venography were compared in defined venous segments, and the degree of obstruction, and correlation was expressed using Spearman's rank correlation coefficient.

Results: In all patients, CT venography depicted the causes of obstruction, including extrinsic compression of the left brachiocephalic vein, and mediastinal inflammatory pseudotumor. Interobserver agreement regarding classification of the degree of obstruction was judged as good for CT venography (K=0.864), and in evaluating this, there was significant correlation between CT venography and digital subtraction venography (reader 1: Rs = 0.58, p < 0.01; reader 2: Rs = 0.56, p < 0.01). In evaluating the status of central veins proximal to long segmental obstruction, and associated thrombosis, CT venography was superior to digital subtraction venography. In half of all patients, the findings of CT venography led to changes in the treatment plan.

Conclusion: The findings of CT venography correlated closely with those of digital subtraction venography, and the former accurately depicted the degree and extent of benign venous obstruction.

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Related in: MedlinePlus

Dynamic obstruction of the left brachiocephalic vein due to extrinsic compression.A. Transverse CT scan obtained during inspiration after ipsilateral contrast material injection shows a moderate degree of stenosis (curved arrow) in the left brachiocephalic vein due to extrinsic compression between the right brachiocephalic artery and sternum.B. Digital subtraction venography at expiration reveals complete occlusion of the left brachiocephalic vein (arrow), and prominent collateral veins.C. Digital subtraction venography at inspiration demonstrates restoration of blood flow through the left brachiocephalic vein, without the involvement of collateral veins. This phenomenon indicates that according to the point reached in the respiration cycle, extrinsic compression of the left brachiocephalic vein between the arch vessels and the sternum exaggerated at inspiration, can cause dynamic obstruction.
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Figure 2: Dynamic obstruction of the left brachiocephalic vein due to extrinsic compression.A. Transverse CT scan obtained during inspiration after ipsilateral contrast material injection shows a moderate degree of stenosis (curved arrow) in the left brachiocephalic vein due to extrinsic compression between the right brachiocephalic artery and sternum.B. Digital subtraction venography at expiration reveals complete occlusion of the left brachiocephalic vein (arrow), and prominent collateral veins.C. Digital subtraction venography at inspiration demonstrates restoration of blood flow through the left brachiocephalic vein, without the involvement of collateral veins. This phenomenon indicates that according to the point reached in the respiration cycle, extrinsic compression of the left brachiocephalic vein between the arch vessels and the sternum exaggerated at inspiration, can cause dynamic obstruction.

Mentions: At CT venography, both readers identified all the 24 stenotic sites demonstrated at digital subtraction venography. Fourteen patients had one stenotic site, three patients had two, and one patient had four; the degree of obstruction was grade I at three sites, grade II at ten, grade III at nine, and grade IV at two. Interobserver agreement was good (κ=0.864). Regarding the degree of stenosis, there was significant correlation between CT venography and digital subtraction venography (reader 1: Rs =0.58, p < 0.01; reader 2: Rs = 0.56, p < 0.01). Reader 1 underestimated two cases of complete occlusion as severe stenosis (Fig. 1), and reader 2 underestimated one such case as severe stenosis and overestimated one case of severe stenosis as complete occlusion. In two patients with dynamic obstruction due to extrinsic compression of the left brachiocephalic vein, both readers reported moderate or severe stenosis at CT venography (Fig. 2).


Role of CT venography in the diagnosis and treatment of benign thoracic central venous obstruction.

Kim H, Chung JW, Park JH, Yin YH, Park SH, Yoon CJ, Choi YH - Korean J Radiol (2003 Jul-Sep)

Dynamic obstruction of the left brachiocephalic vein due to extrinsic compression.A. Transverse CT scan obtained during inspiration after ipsilateral contrast material injection shows a moderate degree of stenosis (curved arrow) in the left brachiocephalic vein due to extrinsic compression between the right brachiocephalic artery and sternum.B. Digital subtraction venography at expiration reveals complete occlusion of the left brachiocephalic vein (arrow), and prominent collateral veins.C. Digital subtraction venography at inspiration demonstrates restoration of blood flow through the left brachiocephalic vein, without the involvement of collateral veins. This phenomenon indicates that according to the point reached in the respiration cycle, extrinsic compression of the left brachiocephalic vein between the arch vessels and the sternum exaggerated at inspiration, can cause dynamic obstruction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698080&req=5

Figure 2: Dynamic obstruction of the left brachiocephalic vein due to extrinsic compression.A. Transverse CT scan obtained during inspiration after ipsilateral contrast material injection shows a moderate degree of stenosis (curved arrow) in the left brachiocephalic vein due to extrinsic compression between the right brachiocephalic artery and sternum.B. Digital subtraction venography at expiration reveals complete occlusion of the left brachiocephalic vein (arrow), and prominent collateral veins.C. Digital subtraction venography at inspiration demonstrates restoration of blood flow through the left brachiocephalic vein, without the involvement of collateral veins. This phenomenon indicates that according to the point reached in the respiration cycle, extrinsic compression of the left brachiocephalic vein between the arch vessels and the sternum exaggerated at inspiration, can cause dynamic obstruction.
Mentions: At CT venography, both readers identified all the 24 stenotic sites demonstrated at digital subtraction venography. Fourteen patients had one stenotic site, three patients had two, and one patient had four; the degree of obstruction was grade I at three sites, grade II at ten, grade III at nine, and grade IV at two. Interobserver agreement was good (κ=0.864). Regarding the degree of stenosis, there was significant correlation between CT venography and digital subtraction venography (reader 1: Rs =0.58, p < 0.01; reader 2: Rs = 0.56, p < 0.01). Reader 1 underestimated two cases of complete occlusion as severe stenosis (Fig. 1), and reader 2 underestimated one such case as severe stenosis and overestimated one case of severe stenosis as complete occlusion. In two patients with dynamic obstruction due to extrinsic compression of the left brachiocephalic vein, both readers reported moderate or severe stenosis at CT venography (Fig. 2).

Bottom Line: The following features were analyzed by two observers: the cause, degree, and extent of venous obstruction; associated thrombosis; and implications for the planning of treatment.In all patients, CT venography depicted the causes of obstruction, including extrinsic compression of the left brachiocephalic vein, and mediastinal inflammatory pseudotumor.In evaluating the status of central veins proximal to long segmental obstruction, and associated thrombosis, CT venography was superior to digital subtraction venography.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea. chungjw@radcom.snu.ac.kr

ABSTRACT

Objective: To evaluate the role of CT venography in the diagnosis and treatment of benign thoracic central venous obstruction.

Materials and methods: Eighteen patients who had undergone both CT venography and digital subtraction venography were prospectively enrolled in this study. The following features were analyzed by two observers: the cause, degree, and extent of venous obstruction; associated thrombosis; and implications for the planning of treatment. CT venography and digital subtraction venography were compared in defined venous segments, and the degree of obstruction, and correlation was expressed using Spearman's rank correlation coefficient.

Results: In all patients, CT venography depicted the causes of obstruction, including extrinsic compression of the left brachiocephalic vein, and mediastinal inflammatory pseudotumor. Interobserver agreement regarding classification of the degree of obstruction was judged as good for CT venography (K=0.864), and in evaluating this, there was significant correlation between CT venography and digital subtraction venography (reader 1: Rs = 0.58, p < 0.01; reader 2: Rs = 0.56, p < 0.01). In evaluating the status of central veins proximal to long segmental obstruction, and associated thrombosis, CT venography was superior to digital subtraction venography. In half of all patients, the findings of CT venography led to changes in the treatment plan.

Conclusion: The findings of CT venography correlated closely with those of digital subtraction venography, and the former accurately depicted the degree and extent of benign venous obstruction.

Show MeSH
Related in: MedlinePlus