ctv vs. mrv for imaging of venous disease · venous disease •mrv preferable method in most...
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CTV vs. MRV for imaging of venous
disease
Jos C. van den Berg, MD PhD
Ospedale Regionale di Lugano, sede Civico, Lugano
University of Bern
Switzerland
LINC 2018
Leipzig, January 30-February 2 2018
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Venous imaging
• Phlebography
– ‘gold standard’
– Invasive
– Risk of inducing DVT
• CT venography
• MR venography
– Standard contrast agents
– Blood pool contrast agents
Choi JW et al Int J Cardiovasc Imaging 2015;31:417-426
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Blood pool contrast agents
• Iron oxide BPA (USPIO)
• Gadolinium-based BPA (gadofosveset)
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Contrast kinetics
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Blood pool contrast agents
• Arterial phase– First-pass with 4 to 5-fold higher relaxivity
(shorter T1) as compared with extracellular-CA
– Lower bolus volume• Dose 0.03 mmol/kg
• Injection rate 1 ml/s (first pass imaging)
• Steady-state phase– High resolution MR angiography (contrast kinetics
allow for longer acquisition time)
– Late phase filling (collateral filling)
– Intravascular distribution for more than 1 h
– Can be used as back-up in case of operator error
Nikolaou K et al, Radiology 2006;241:861-872
Perreault P et al, Radiology 2003;229:811-820
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Applications
• Arterial imaging– Classic MRA indications (first pass)
– Novel indications (steady state)• TOS
• Multiple vascular bed imaging
• (T)EVAR follow-up– Endoleak detection
– Dynamic contrast enhanced studies
• Venous imaging– Deep venous thrombosis
– May-Thurner syndrome
– Venous mapping
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CTV-technique
• 100-150 ml non-ionic contrast
(370 mg iodine/ml)
• Flow-rate 2.5 ml/s
• Scan delay 5 minutes
Choi JW et al Int J Cardiovasc Imaging 2015;31:417-426
Chung JW et al JVIR 2004;15:249-256
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CTV
Occlusion VCI
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CTV
Occlusion VCI
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Phlebography
Occlusion VCI
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Phlebography
Occlusion VCI
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CTV
Deep venous thrombosis
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CTV
Deep venous thrombosis
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CTV
Deep venous thrombosis
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CTV
Occlusion CFV-tumour
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MRV-technique
• Standard Gd contrast medium or
bloodpool agents
– Gadobutrol (double dose 0.2 mmol/kg)
– Gadofosveset
(normal dose 0.25 mmol/ml; 10 ml)
• First-pass and steady-state imaging
• Both techniques equally reliable
• NB gadofosveset currently not available
in EuropeArnoldussen CWKP et al Eur Rad 2017;27:4986-4994
Thakor AS et al J Magn Res Imaging 2017;45:1559-1572
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MRV-technique
Arnoldussen CWKP et al Eur Rad 2017;27:4986-4994
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MRV
Deep venous thrombosis
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MRV
Deep venous thrombosis
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MRV
May-Thurner syndrome
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MRV
May-Thurner syndrome
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MRV
May-Thurner syndrome
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MRV
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MRV
Pelvic congestion syndrome
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MRV
Pelvic congestion syndrome
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MRV
Thoracic outlet syndrome
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MRV
Thoracic outlet syndrome
Neutral Abduction
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CTV vs. MRV
• CTV
– Less movement
artifacts
– Higher resolution
– Better visualization
surrounding
structures
– Readily available
• MRV
– Better contrast
enhancement
– BP agents allow long
scan window and yield
high quality images
– No-radiation exposure
– No CIN
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CTV vs. MRV
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CTV vs. MRV
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CTV vs. MRV
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CTV vs. MRV
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Venous imaging
• Importance of pre-interventional
imaging to visualize variant anatomy to
reduce radiation exposure
Barber B et al, JVIR 2012;23:211-215
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Conclusions
• Both CTV and MRV have a role in
diagnosis and pre-operative planning of
venous disease
• MRV preferable method in most
because of lack of radiation exposure
(young age group)
• For congenital occlusive disease CTV is
probably better
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CTV vs. MRV for imaging of venous
disease
Jos C. van den Berg, MD PhD
Ospedale Regionale di Lugano, sede Civico, Lugano
University of Bern
Switzerland
LINC 2018
Leipzig, January 30-February 2 2018