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1 Department of Radiology, University of California-San Francisco, 521 Parnassus
Ave., Rm. C-324C, Box 0628, San Francisco, CA 94143-0628.
2 Present address: Department of Radiology, University of Chicago Hospitals,
Chicago, IL.
3 Department of Medicine, University of California-San Francisco, San Francisco,
CA.
OBJECTIVE. The purpose of this investigation was to explore the clinical relevance of retrograde inferior vena cava or hepatic vein opacification during contrast-enhanced CT.
MATERIALS AND METHODS. We retrospectively identified 127 patients
who underwent contemporaneous contrast-enhanced CT of the chest or abdomen and
echocardiography. On CT, the presence of retrograde inferior vena cava or
hepatic vein opacification and the rate of IV contrast injection (> 3
mL/sec, high; 
3 mL/sec, low) were recorded. On echocardiography, the
presence of tricuspid regurgitation, pulmonary hypertension, or right
ventricular systolic dysfunction was recorded.
RESULTS. Retrograde inferior vena cava or hepatic vein opacification was more common in studies performed with a high rather than a low contrast injection rate (28/56 vs 6/71 patients, respectively; p < 0.01). This finding was 31% sensitive (5/16) and 98% specific (54/55) for right-sided heart disease at low contrast injection rates, and 81% sensitive (17/21) and 69% specific (24/35) at high injection rates. Multivariate logistic regression models showed that high injection rate, tricuspid regurgitation, pulmonary hypertension, and right ventricular systolic dysfunction were independent predictors of retrograde inferior vena cava or hepatic vein opacification (p < 0.05 for each).
CONCLUSION. Retrograde opacification of the inferior vena cava or hepatic veins on CT is a specific but insensitive sign of right-sided heart disease at low contrast injection rates, but the usefulness of this classic sign decreases with high injection rates. This realization is important because many centers increasingly use high-injection-rate CT.
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