High resolution, 3-dimensional Ferumoxytol-enhanced cardiovascular magnetic resonance venography in central venous occlusion

Journal of Cardiovascular Magnetic Resonance

Stephen T. Kee¹  Brian G. DeRubertis²  Sarah N. Khan³  Takegawa Yoshida³  J. Paul Finn³  John M. Moriarty³  Biraj Bista³  Puja Shahrouki³  Kim-Lien Nguyen³ 

[1] Department of Radiological Sciences, University of California, Los Angeles;Department of Surgery, University of California, Los Angeles;Diagnostic Cardiovascular Imaging Laboratory, University of California, Los Angeles;

关键词: Central venous occlusion;    Ferumoxytol;    Chronic kidney disease;    Magnetic resonance venography;    Diagnostic accuracy;   

DOI  :  10.1186/s12968-019-0528-5

来源: DOAJ

【 摘 要 】

Abstract Background Although cardiovascular magnetic resonance venography (CMRV) is generally regarded as the technique of choice for imaging the central veins, conventional CMRV is not ideal. Gadolinium-based contrast agents (GBCA) are less suited to steady state venous imaging than to first pass arterial imaging and they may be contraindicated in patients with renal impairment where evaluation of venous anatomy is frequently required. We aim to evaluate the diagnostic performance of 3-dimensional (3D) ferumoxytol-enhanced CMRV (FE-CMRV) for suspected central venous occlusion in patients with renal failure and to assess its clinical impact on patient management. Methods In this IRB-approved and HIPAA-compliant study, 52 consecutive adult patients (47 years, IQR 32–61; 29 male) with renal impairment and suspected venous occlusion underwent FE-CMRV, following infusion of ferumoxytol. Breath-held, high resolution, 3D steady state FE-CMRV was performed through the chest, abdomen and pelvis. Two blinded reviewers independently scored twenty-one named venous segments for quality and patency. Correlative catheter venography in 14 patients was used as the reference standard for diagnostic accuracy. Retrospective chart review was conducted to determine clinical impact of FE-CMRV. Interobserver agreement was determined using Gwet’s AC1 statistic. Results All patients underwent technically successful FE-CMRV without any adverse events. 99.5% (1033/1038) of venous segments were of diagnostic quality (score ≥ 2/4) with very good interobserver agreement (AC1 = 0.91). Interobserver agreement for venous occlusion was also very good (AC1 = 0.93). The overall accuracy of FE-CMRV compared to catheter venography was perfect (100.0%). No additional imaging was required prior to a clinical management decision in any of the 52 patients. Twenty-four successful and uncomplicated venous interventions were carried out following pre-procedural vascular mapping with FE-CMRV. Conclusions 3D FE-CMRV is a practical, accurate and robust technique for high-resolution mapping of central thoracic, abdominal and pelvic veins and can be used to inform image-guided therapy. It may play a pivotal role in the care of patients in whom conventional contrast agents may be contraindicated or ineffective.

【 授权许可】

Unknown