Clinical Applications

Indications for MR imaging of the central thoracic veins include the investigation of superior vena cava syndrome, assessment of mediastinal abnor

Fig. 5a-d. Indirect contrast-enhanced MR venography of the central thoracic veins. Imaging was performed following the administration of 0.3 mmol/kg paramagnetic contrast agent in the right antecubital vein. 3D data sets were acquired (a) in the arterial and (b) venous phase. A high grade stenosis (arrows) of the superior vena cava is best depicted on the (c) subtracted data set and (d) coronal reformatted image

Central Venogram

Fig. 5a-d. Indirect contrast-enhanced MR venography of the central thoracic veins. Imaging was performed following the administration of 0.3 mmol/kg paramagnetic contrast agent in the right antecubital vein. 3D data sets were acquired (a) in the arterial and (b) venous phase. A high grade stenosis (arrows) of the superior vena cava is best depicted on the (c) subtracted data set and (d) coronal reformatted image malities with potential vascular involvement, and evaluation of anatomical variants such as a left-sided superior vena cava or arteriovenous (AV) malformations. MR venography can also be employed to monitor therapeutic success in cases of DVT.

Superior vena cava syndrome is characterized by cyanosis and swelling of the head, neck and arm in combination with the distension of veins on the neck and trunk. The most common cause accounting for approximately 90% of cases is me-diastinal neoplastic disease, usually primary or secondary lung tumors, and lymphoma. The most common benign causes are mediastinal fibrosis and thrombosis secondary to central venous catheters or transvenous pacing wires. Obstruction of any of the major veins which drain into the SVC may occur as part of thoracic outlet syndrome.

Persistent left SVC syndrome [15] occurs in about 0.3% of the population. It is found with higher frequency (ca. 4.3%) in patients with congenital cardiac disease. Left SVC syndrome may occur in isolation but is more frequently found in association with a right SVC. The left SVC commonly drains into the coronary sinus or less frequently into the left atrium.

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