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Time-Resolved MR Angiography of the Central Veins of the Chest

¹ Both authors: Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Time-resolved MR angiography (MRA) of normal central veins in 73-year-old woman. See also Figure S1, AVI images, at www.ajronline.org. Inflow phase image shows gadolinium injection into right arm peripheral IV catheter and opacification of right subclavian vein, right brachiocephalic vein, superior vena cava (SVC), right heart, and pulmonary arteries.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Time-resolved MR angiography (MRA) of normal central veins in 73-year-old woman. See also Figure S1, AVI images, at www.ajronline.org. Arterial phase image shows maximal opacification of aorta and great vessels. Note residual opacification of right subclavian vein.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Time-resolved MR angiography (MRA) of normal central veins in 73-year-old woman. See also Figure S1, AVI images, at www.ajronline.org. Venous phase image shows mild diffuse narrowing of left internal jugular vein (arrow) with no collaterals. Right internal jugular, bilateral subclavian, and bilateral brachiocephalic veins as well as SVC are all widely patent. Note mild residual opacification of heart, arteries, and pulmonary vessels.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Chronic occlusion of right internal jugular vein shown on MR angiography in 63-year-old woman with end-stage renal disease and history of multiple prior central venous catheters. See also Figure S2, AVI images, at www.ajronline.org. Arterial phase image shows residual opacification of right subclavian vein from right arm injection.

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Chronic occlusion of right internal jugular vein shown on MR angiography in 63-year-old woman with end-stage renal disease and history of multiple prior central venous catheters. See also Figure S2, AVI images, at www.ajronline.org. Venous phase image shows abrupt nonvisualization of right internal jugular vein (asterisk) with large collateral vein (arrow) to right subclavian vein, consistent with longstanding chronic occlusion. Left internal jugular vein is not visualized but has multiple smaller left neck collaterals (arrowheads), suggestive of subacute occlusion. Left brachiocephalic vein is not visualized and is shown to be severely stenotic on high-spatial-resolution images (not shown). Left subclavian vein is not visualized but is shown to be widely patent on high-spatial-resolution images (not shown), likely secondary to physiologically slow flow.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Chronic subtotal occlusion of superior vena cava (SVC) and marked azygous collateralization shown on MR angiography in 16-year-old girl with sickle cell anemia and history of multiple central venous catheters. See also Figure S3, AVI images, at www.ajronline.org. Early inflow phase image shows left arm peripheral IV injection with minimal flow through nearly occluded SVC (thick arrow) and prompt filling of markedly enlarged collateralized azygous vein (thin arrow).

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Chronic subtotal occlusion of superior vena cava (SVC) and marked azygous collateralization shown on MR angiography in 16-year-old girl with sickle cell anemia and history of multiple central venous catheters. See also Figure S3, AVI images, at www.ajronline.org. Late inflow phase image shows filling of inferior vena cava and right atrium via azygous vein.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Chronic subtotal occlusion of superior vena cava (SVC) and marked azygous collateralization shown on MR angiography in 16-year-old girl with sickle cell anemia and history of multiple central venous catheters. See also Figure S3, AVI images, at www.ajronline.org. Arterial phase image.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —Chronic subtotal occlusion of superior vena cava (SVC) and marked azygous collateralization shown on MR angiography in 16-year-old girl with sickle cell anemia and history of multiple central venous catheters. See also Figure S3, AVI images, at www.ajronline.org. Venous phase image shows patency of left internal jugular, subclavian, and brachiocephalic veins and near occlusion of SVC. Note nonopacification of right central veins. High-spatial-resolution images (not shown) showed occlusion of right subclavian, internal jugular, and brachiocephalic veins.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Severe stenosis of right internal jugular vein shown on MR angiography in 62-year-old man with lung cancer. See also Figure S4, AVI images, at www.ajronline.org. Arterial phase image.

View larger version (153K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Severe stenosis of right internal jugular vein shown on MR angiography in 62-year-old man with lung cancer. See also Figure S4, AVI images, at www.ajronline.org. Venous phase image shows severe narrowing of right internal jugular vein (arrowhead) and collateral flow via asymmetrically prominent right external jugular vein (arrow).

View larger version (133K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Suboptimal visualization of deep vein thrombosis in right subclavian vein on time-resolved maximum-intensity-projection MR angiography images in 64-year-old woman with cholangiocarcinoma. See also Figure S5, AVI images, at www.ajronline.org. Arterial phase image shows no residual opacification of any venous structures, consistent with injection via central venous catheter.

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Suboptimal visualization of deep vein thrombosis in right subclavian vein on time-resolved maximum-intensity-projection MR angiography images in 64-year-old woman with cholangiocarcinoma. See also Figure S5, AVI images, at www.ajronline.org. Venous phase image shows nonvisualization of right subclavian vein (thick arrow) despite opacification of left subclavian vein, with no significant collateral vein opacification to suggest chronic occlusion. Although this suggests acute occlusion, technical issues cannot be excluded as cause of nonvisualization, as discussed previously. Note narrow, late-filling left internal jugular vein (thin arrow) and prominent collateralized left external jugular vein (arrowhead), suggesting chronic stenosis of left internal jugular vein. Although not evident on this low-resolution image, severe stenosis at its origin is confirmed on high-spatial-resolution images (not shown).

View larger version (145K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —Suboptimal visualization of deep vein thrombosis in right subclavian vein on time-resolved maximum-intensity-projection MR angiography images in 64-year-old woman with cholangiocarcinoma. See also Figure S5, AVI images, at www.ajronline.org. Static high-spatial-resolution image shows prominent, nearly occlusive filling defect in origin of right subclavian vein (arrow), allowing confident diagnosis of venous thrombosis as cause of nonvisualization.

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —Partial anomalous pulmonary venous return shown on MR angiography in 48-year-old man with end-stage renal disease and history of multiple central venous catheters. See also Figure S6, AVI images, at www.ajronline.org. Inflow phase image shows left brachiocephalic vein and superior vena cava, right heart, and pulmonary artery opacification.

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —Partial anomalous pulmonary venous return shown on MR angiography in 48-year-old man with end-stage renal disease and history of multiple central venous catheters. See also Figure S6, AVI images, at www.ajronline.org. Arterial phase image also shows opacification of left upper lobe pulmonary vein (arrow).

View larger version (155K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —Partial anomalous pulmonary venous return shown on MR angiography in 48-year-old man with end-stage renal disease and history of multiple central venous catheters. See also Figure S6, AVI images, at www.ajronline.org. Venous phase image shows left upper lobe pulmonary vein (thin arrow) draining into left brachiocephalic vein. Also note right brachiocephalic vein occlusion (thick arrow) and multiple collateral veins (arrowheads).

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —Vascular tumor (non–small cell lung carcinoma) in left upper lobe invading anterior chest wall and compressing left central veins shown on MR angiography in 49-year-old woman. See also Figure S7, AVI images, at www.ajronline.org. Arterial phase image shows patent left subclavian artery. Note faint tumor enhancement (arrow) that is less pronounced than that of nearby thyroid gland.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —Vascular tumor (non–small cell lung carcinoma) in left upper lobe invading anterior chest wall and compressing left central veins shown on MR angiography in 49-year-old woman. See also Figure S7, AVI images, at www.ajronline.org. Early venous phase image better shows vascular mass (thick arrows) overlying left subclavian vessels and causing mild narrowing of left brachiocephalic vein (thin arrow). Left subclavian vein is suboptimally opacified and not visualized in region of mass.

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —Vascular tumor (non–small cell lung carcinoma) in left upper lobe invading anterior chest wall and compressing left central veins shown on MR angiography in 49-year-old woman. See also Figure S7, AVI images, at www.ajronline.org. Late venous phase image shows persistent opacification of vascular mass and late opacification of left arm veins. Left subclavian vein abruptly terminates in region of vascular mass, consistent with subtotal to complete occlusion (arrow). Note that right subclavian vein is not visualized throughout this study, although it was shown to be widely patent on high-spatial-resolution images (not shown).

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —Visualization of stent patency on MR angiography despite in-stent signal void due to eddy currents in 31-year-old woman with sickle cell anemia and stenoses of superior vena cava (SVC) and bilateral brachiocephalic vein after stenting. See also Figure S8, AVI images, at www.ajronline.org. Chest radiograph shows partly MR-compatible stent (arrows) in bilateral brachiocephalic veins extending into SVC.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —Visualization of stent patency on MR angiography despite in-stent signal void due to eddy currents in 31-year-old woman with sickle cell anemia and stenoses of superior vena cava (SVC) and bilateral brachiocephalic vein after stenting. See also Figure S8, AVI images, at www.ajronline.org. In initial inflow image, left axillary and subclavian veins are opacified by left arm peripheral IV injection with nonvisualization of segment of left brachiocephalic vein and SVC due to metallic stent susceptibility artifact (arrows). However, right heart is already opacified without significant collateral veins, ruling out subtotal or complete in-stent occlusion.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8C —Visualization of stent patency on MR angiography despite in-stent signal void due to eddy currents in 31-year-old woman with sickle cell anemia and stenoses of superior vena cava (SVC) and bilateral brachiocephalic vein after stenting. See also Figure S8, AVI images, at www.ajronline.org. Arterial phase image.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8D —Visualization of stent patency on MR angiography despite in-stent signal void due to eddy currents in 31-year-old woman with sickle cell anemia and stenoses of superior vena cava (SVC) and bilateral brachiocephalic vein after stenting. See also Figure S8, AVI images, at www.ajronline.org. Venous phase image shows right brachiocephalic nonvisualization at site of right brachiocephalic stent, but with visualization of multiple associated venous collaterals (arrows), suggestive of right brachiocephalic stent stenosis or occlusion.

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —Limited and delayed visualization of subclavian veins on MR angiography in 45-year-old woman with normal central veins. Central venous catheter was used for contrast injection. See also Figure S9, AVI images, at www.ajronline.org. Arterial phase image.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —Limited and delayed visualization of subclavian veins on MR angiography in 45-year-old woman with normal central veins. Central venous catheter was used for contrast injection. See also Figure S9, AVI images, at www.ajronline.org. Mid venous phase image shows normal bilateral internal jugular veins, normal right brachiocephalic vein, and superior vena cava. Note that left brachiocephalic vein is not well seen on this image, although it was shown to be normal on high-spatial-resolution images (not shown).

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9C —Limited and delayed visualization of subclavian veins on MR angiography in 45-year-old woman with normal central veins. Central venous catheter was used for contrast injection. See also Figure S9, AVI images, at www.ajronline.org. Late venous phase image approximately 15 seconds after B shows maximum but poor opacification of bilateral subclavian veins (arrows).

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10A —Poor visualization of left brachiocephalic vein on MR angiography in 53-year-old woman with breast cancer. See also Figure S10, AVI images, at www.ajronline.org. Inflow phase image after injection into left arm IV catheter shows opacification of left subclavian vein, left brachiocephalic vein (arrow), and superior vena cava (SVC), all of which are widely patent.

View larger version (153K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10B —Poor visualization of left brachiocephalic vein on MR angiography in 53-year-old woman with breast cancer. See also Figure S10, AVI images, at www.ajronline.org. Arterial phase image.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10C —Poor visualization of left brachiocephalic vein on MR angiography in 53-year-old woman with breast cancer. See also Figure S10, AVI images, at www.ajronline.org. Early venous phase image shows opacification of bilateral internal jugular veins, left subclavian vein, right brachiocephalic vein, and SVC, but poor opacification of left brachiocephalic vein (arrow) despite previously shown patency. This may be at least partially attributable to overlapping aortic arch opacification.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10D —Poor visualization of left brachiocephalic vein on MR angiography in 53-year-old woman with breast cancer. See also Figure S10, AVI images, at www.ajronline.org. Late venous phase image shows persistently poor opacification of left brachiocephalic vein (arrow) despite minimal aortic arch opacification, likely because of transient compression between aorta and sternum. Note that right subclavian vein is not well opacified on any images, although it was widely patent on high-spatial-resolution images (not shown).

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11A —Multiple central venous occlusions shown on MR angiography in 67-year-old woman with metastatic lung cancer and multiple prior central venous catheters who is presenting with acute right arm and facial swelling. See also Figure S11, AVI images, at www.ajronline.org. Arterial phase image. Note suboptimal patient positioning due to severe scoliosis.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11B —Multiple central venous occlusions shown on MR angiography in 67-year-old woman with metastatic lung cancer and multiple prior central venous catheters who is presenting with acute right arm and facial swelling. See also Figure S11, AVI images, at www.ajronline.org. Venous phase image shows nonvisualization of any normal central veins and opacification of various collateral veins, including hemiazygous system (arrow). High-spatial-resolution images (not shown) showed subtotal occlusions of brachiocephalic veins and superior vena cava, with patent but diffusely narrow bilateral subclavian and left internal jugular veins and occluded right internal jugular vein.

View larger version (161K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12A —Superior vena cava (SVC) occlusion and pseudoocclusion of enlarged azygous vein collateral shown on MR angiography in 41-year-old woman with end-stage renal disease [6]. See also Figure S12, AVI images, at www.ajronline.org. Coronal high-spatial-resolution image shows narrowing and irregularity of SVC (arrow), although it is not clear whether severe stenosis or complete occlusion is present because of motion artifact and volume averaging with adjacent pulmonary veins.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12B —Superior vena cava (SVC) occlusion and pseudoocclusion of enlarged azygous vein collateral shown on MR angiography in 41-year-old woman with end-stage renal disease [6]. See also Figure S12, AVI images, at www.ajronline.org. Initial inflow phase image shows opacification of right subclavian and brachiocephalic veins, with abrupt termination of mid-SVC (thick arrow) and opacification of markedly enlarged azygous vein (thin arrows) that is nonopacified in its central portion.

View larger version (152K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12C —Superior vena cava (SVC) occlusion and pseudoocclusion of enlarged azygous vein collateral shown on MR angiography in 41-year-old woman with end-stage renal disease [6]. See also Figure S12, AVI images, at www.ajronline.org. Immediately subsequent inflow phase image shows opacification of inferior vena cava, right heart, and pulmonary arteries, consistent with chronic total occlusion of SVC.

View larger version (163K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12D —Superior vena cava (SVC) occlusion and pseudoocclusion of enlarged azygous vein collateral shown on MR angiography in 41-year-old woman with end-stage renal disease [6]. See also Figure S12, AVI images, at www.ajronline.org. High-resolution image shows complete patency of enlarged azygous vein (arrow). This falsely apparent occlusion on time-resolved maximum-intensity-projection images is caused by exclusion of this very posterior structure from anteroposterior field of view. However, because of simultaneous opacification of both segments depicted on time-resolved technique, it can be safely inferred that nonopacification is merely artifactual.

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