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DOI:10.2214/AJR.08.1919
AJR 2009; 192:1731-1738
© American Roentgen Ray Society

Original Research

Time-Resolved MR Angiography in the Evaluation of Central Thoracic Venous Occlusive Disease

Kambiz Nael1, Mayil Krishnam1, Stefan G. Ruehm1, Henrik J. Michaely1,2, Gerhard Laub3 and J. Paul Finn1

1 Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, 10945 Le Conte Ave., Ste. 3371, Los Angeles, CA 90095-7206.
2 University Medical Center Mannheim. University of Heidelberg, Heidelberg, Germany.
3 Siemens Medical Solutions, Malvern, PA.

OBJECTIVE. The objective of our study was to assess the feasibility and diagnostic performance of time-resolved MR angiography (MRA) in the evaluation of central thoracic venous occlusive disease and to compare time-resolved MRA with conventional MRA and catheter angiography.

MATERIALS AND METHODS. Twenty patients (eight women and 12 men; age range, 19–74 years) with suspected central thoracic venous occlusive disease underwent time-resolved MRA using time-resolved angiography with interleaved stochastic trajectories (TWIST) and parallel acquisition, followed by conventional MRA. Catheter angiography was performed within 1–14 days after MRA and was available for a total of 60 segments for correlation. Time-resolved and conventional MRA images were evaluated in separate reading sessions by two independent radiologists for image quality and level of confidence and degree of venoocclusive disease. The interobserver and intermodality agreement, sensitivity, and specificity were calculated using catheter angiography as the standard of reference.

RESULTS. Time-resolved MRA resulted in diagnostic-quality images that did not differ significantly in quality compared with conventional MRA. Thirty-one segmental venous stenoses were identified. The kappa coefficient revealed moderate intermodality agreement ({kappa} = 0.54; 95% CI, 0.32–0.76) between time-resolved MRA and conventional MRA. When compared with catheter angiography, the sensitivity and specificity for the diagnosis of significant stenosis (≥ 70%) were 87.5% and 68% for time-resolved MRA and 90% and 90% for conventional MRA, respectively.

CONCLUSION. Time-resolved MRA, as described in this study, has the potential to be used as an initial and screening diagnostic tool obviating conventional MRA and its associated higher contrast dose in normal and near-normal examinations. However, because of its relatively lower specificity, adjunct use of conventional MRA is still required for accurate grading of venous occlusive disease.

Keywords: central thoracic veins • hemodynamics • low contrast dose • nephrogenic systemic fibrosis • time-resolved MR angiography • TWIST


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