Abstract
Purpose
The purpose was to compare first-pass and delayed-phase thoracic computed tomography
(CT) venography for the evaluation of suspected central thoracic venous pathology.
Material and methods
CT images and medical records of all patients who underwent thoracic CT venography
over a 5-year period were retrospectively reviewed. Both first-pass (18 s) and delayed-phase (60 s) venous images were obtained in all patients. The images were reviewed in random
order by three readers using a semiquantitative visual grading scheme for image quality,
including artifacts and the uniformity of venous enhancement. In addition, enhancement
was quantitatively evaluated. The presence and type of venous pathology, and overall
diagnostic confidence were recorded and compared. Reference verification was performed
when available.
Results
Eighteen patients formed the study group, mean age 49.5 years and 28% male. Dual-arm injection was successful in 72% of exams. All readers
reported more streak artifacts on first-pass imaging than delayed imaging (72%–94%
vs. 27%–44%, respectively; P<.05). First-pass imaging had significantly higher measured enhancement across all
central venous segments than delayed imaging (mean HU range 212–906 HU vs. 173–414
HU; P<.05) but also had significantly more heterogeneous enhancement (mean S.D. range 75–1058
HU vs. 67–378 HU; P<.05). For overall diagnosis, reader agreement, accuracy, and confidence levels were
higher for delayed-phase images (P<.05).
Conclusion
Indirect thoracic CT venography using delayed-phase imaging alone may be sufficient
for evaluating clinically suspected central venous abnormality.
Keywords
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Article info
Publication history
Published online: February 11, 2015
Accepted:
February 5,
2015
Received in revised form:
January 14,
2015
Received:
July 3,
2014
Footnotes
☆Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000433.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
