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Three-Dimensional CT Venography of Varicose Veins of the Lower Extremity: Image Quality and Comparison with Doppler Sonography

¹ Department of Radiology, Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul National University Medical Research Center, Clinical Research Institute, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Republic of Korea.
² Department of General Surgery, Seoul National University College of Medicine, Seoul National University Medical Research Center, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.

OBJECTIVE. The purpose of this study was to verify the imaging quality of CT venography in the clinical evaluation of the lower extremity superficial venous system and to correlate the CT and duplex sonographic findings about varicose veins.

SUBJECTS AND METHODS. One hundred consecutively registered patients with varicose veins underwent CT venography. The image quality of overall 3D volume rendering was rated, and the absolute attenuation of each component at the level of the knee was measured. Factors that affected visualization of varicose veins were identified. For comparison analysis, 50 of the 100 patients also underwent Doppler sonography, and saphenous vein size and morphologic features on CT were compared with the functional information from Doppler sonography.

RESULTS. The overall quality of 3D volume-rendered images in the visualization of varicose veins was excellent in 76% of patients, fair in 21%, and poor in 3%. The entire length of the great saphenous vein (GSV) was visualized with CT venography in 99.5% of 200 GSVs. The quality of 3D volume-rendered images was better when a thick subcutaneous layer, no skin changes, and no subcutaneous edema were present. Size of the GSV determined whether findings at CT venography and Doppler sonography correlated well, the linear regression coefficient being 0.72. At CT venography, the mean diameter of GSVs exhibiting insufficiency on duplex sonography was 7.0 mm, and the mean diameter of GSVs exhibiting competence on duplex sonography was 4.9 mm (p < 0.001). Prediction of GSV insufficiency with CT venography had a sensitivity of 98.2% and a specificity of 83.3%.

CONCLUSION. CT venography has adequate image quality for evaluation of the venous system of the lower extremities.

Keywords: 3D image • CT • CT venography • varicose veins

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