The sciatic vein is a rare embryonic vein often associated with KTS. MDCT examinations were performed with a 16-MDCT scanner (LightSpeed 16, GE Healthcare). kV/mA/rot time … MDCT is helpful for visualizing the full length of venous structures and for evaluating extremity length and thickness on one image. 6A,6B,6C). In addition, Doppler US may help evaluate variceal reflux but … Copyright © 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. Other signs include small retracted veins and ultimately a fibrous cord replacing the vein. The contrast material was diluted (1:3) to avoid artifacts. Radiography [10], Doppler sonography [11], and conventional venography also can be used [3, 12, 13]. The images were sent to a workstation (Advantage ADW 4.2, GE Healthcare; or View Pro-X version 3, Rogan-Delft). 7). The renal vein, gonadal vein, internal iliac vein, greater saphenous vein, deep femoral vein, and lesser saphenous vein are visible on CT venography but are usually poorly opacified or are not opacified on state-of-the-art ascending venography and are among the most difficult to study on sonography (Fig. Cutaneous vascular lesions usually involve the affected limb. Contrast material with a concentration of 350 mg I/mL (iomeprol, Iomeron 350, Bracco–Altana Pharma) was administered with an automatic injector into the subcutaneous superficial veins of both feet simultaneously through a 22-gauge IV line at a rate of 1.5 mL/s for each extremity. Multi-slice computed tomography has become the main method to diagnose and evaluate the intensity of acute pulmonary embolism (PE). 4 and 5). The legs and abdomen usually contain one vein per artery. The incidence of duplicated venous segments in the lower extremity is high. 2A, 2B and 6A, 6B, 6C). Abnormalities of the iliac vein and inferior vena cava are rare. The above-mentioned dye will flow through this line and into your vein. Medline, Google Scholar; 15 Hull RD, Raskeb GE, Coates G, Panju AA, Gill GJ. Plaster does not produce artifacts. Partial clot recanalization may result in a heterogeneous lumen and strands (Fig. 8). CT Venogram C+ (last updated 05/16/13, last reviewed 5/29/2018) INDICATION: r/o Venous abdominal/pelvic thrombosis. DVT is a large, quickly developing blood clot in one of the major blood vessels in the leg, which can disrupt blood flow to the heart and possibly lead to a heart attack or stroke. CT venography has been shown to have similar performance as that of lower extremity ultrasound for detecting DVT, and many institutions worldwide at the present time use protocols with CT venography incorporated into CT pulmonary angiography examination (8, 10). A predilection for this disorder is seen in young women in their 2 nd to 4 th decades, usually after prolonged immobilization or pregnancy. Sensitivities of 89-100% and specificities of 94-100% have been reported and compared with sonography [ 3, 4, 6 ]. Lower limb venography remains the imaging modality of choice for detection of asymptomatic deep vein thrombosis (DVT) in clinical trials of anticoagulant agents. Your doctor may use it to find blood clots, identify a vein for use in a bypass procedure or dialysis access, or to assess varicose veins before surgery. 3 On conventional venography, clot is identified as a filling defect, or is implied by complete non-filling of a vein. 1A, 1B, 1C). A retrospective review of 427 consecutive patients having both CTPA and CTLV performed to evaluate patients suspected of PE … 1 and 2) in as many as 15% of patients. Although duplication of the deep venous system below the knee is the usual anatomy, the popliteal vein, superficial femoral vein, and inferior vena cava may be occasionally duplicated, or a single left-sided inferior vena cava may be present (Figs. Sensitivities of 89-100% and specificities of 94-100% have been reported and compared with sonography [3, 4, 6]. 2A, 2B), duplication (Fig. Leg venography is a procedure where contrast material is injected through a catheter in a vein to help visualize the internal structures by using x-rays. CONCLUSION. Lower extremity venography is best performed with the patient in the reverse Trendelenburg position at 30 to 60 degrees. It is a reliable and reproducible imaging technique with high sensitivity and specificity offering a complete upper limb venous mapping before creating an AVF for hemodialysis. Deep venous thrombosis (DVT) and pulmonary embolism are described as two aspects of the same continuum—venopulmonary thromboembolic disease, which results in significant morbidity and mortality [1]. Other signs of acute DVT include upstream venous dilatation compared with the normal contralateral side, perivenous soft-tissue infiltration suggestive of edema, a dense rim due to contrast staining in the vasa vasorum of the venous wall or contrast accumulation delineating the intraluminal clot, and opacification of collateral veins [1, 2] (Fig. CT venography is a new concept for complete assessment of the vascular abnormalities of KTS. 3) [8, 14]. Acquisition was triggered automatically when the contrast material reached the level of the femoral vein or the saphenous vein close to the main femoral vein. We searched the local hospi-tal’s radiology information database to identify all The radiologist should also be aware of interpretative difficulties inherent to the CT examination of limb veins. The duplicated segments of the superficial femoral vein vary in length and join the main venous trunk. Lower limb angiography 303847009; children: CT venography of vein of lower limb 772247005; Femoral phlebography 45689001; Fluoroscopic venography of lower limb 418881009; Leg venogram - ascending 241268006; Leg venogram - descending 241269003; MRI venography of lower limb 420237007; Popliteal venography 312498005 We describe the CT venographic technique for evaluation of pathologic conditions affecting the veins and the various venous anomalies detected with CT venography in patients with KTS. Copyright © 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. 1A, 1B, 1C, 4A, 4B, and 5A, 5B, 5C). Continuation of the deep femoral vein in the internal iliac vein is rarely encountered (Fig. The indications for surgical management of venous abnormalities include functional disability, cardiac failure, and cosmetic factors [6–8]. This allows identification of DVT in veins usually not opacified on venography and not studied on sonography. Multiple deep or superficial collaterals are commonly encountered. Anomalous lateral veins that originate near the ankle and extend to the infrainguinal or pelvic deep venous system also are found frequently [15]. Descending venography allows … the lower extremity veins with CT venography. The contrast volume used varied between 10 and 20 mL (17.5–35 mg I) for each extremity in children. The most common cause of PE is thrombosis of veins of the lower limbs … We review the practical approach to DVT with CT venography on the basis of our experience with more than 800 combined examinations. Indirect CTV Often combined with CT pulmonary angiography (CTPA) in the acute setting, indirect CTV is performed as a standard, nonoral, post–intravenous contrast-enhanced CT at approximately 120 to 150 seconds after injection of contrast, which is considerably later than portal venous phase. Although all deep veins of the lower extremities can be affected, it has been reported [8, 14] that the popliteal vein is most commonly involved. The length of the extremities can be measured on scout or reconstructed images, and extremity thickness can be evaluated on axial images [14] (Fig. Direct CT venography for evaluation of the lower extremity venous anomalies of Klippel-Trénaunay syndrome. In addition, it is the underlying source of 90% of acute PEs [1] . The femoral vein is second most commonly affected. Venography is an x-ray examination that uses an injection of contrast material to show how blood flows through your veins. • Indirect Venography (recirculation) – 100-150cc contrast needed for adequate venous opacification – Empiric imaging delay • 60 seconds: upper extremity and pelvic veins • 3 to 3.5 min: lower extremity veins – Smart prep off vein of interest Baldt MM, et al. Indirect CTV images do not look like CTA images, but they are almost always diagnostic (jus… Two of these three symptoms are sufficient for the diagnosis of KTS. 1-5 We describe the CT venographic technique for evaluation of pathologic conditions affecting the veins and the various venous anomalies detected with CT venography in patients with KTS. DVT can be easily differentiated from other nonvenous normal or abnormal structures, such as thrombosed native artery; thrombosed arterial bypass; and lymph node, including necrotic or fat-containing adenopathy, muscular hematoma or abscess, popliteal cyst, muscular heterogeneities as seen in the compartment syndrome, normal aponeurosis and tendon, and normal or tumoral sciatic nerve (Figs. Klippel-Trénaunay syndrome (KTS) was first described in 1900. MR venography may yield the same information as CT venography without radiation exposure and contrast administration, but it is time-consuming and the spatial resolution is low. The parameters for CT venography were beam collimation, 20 mm; pitch 1.75; slice thickness 1.25 mm; and reconstruction interval, 1.25 mm. Cadaveric and CT studies show a prevalence of ~25% in the population 7. Despite optimal timing, insufficient venous opacification, particularly at the sural level, can occur in an unpredictable manner (Figs. The venous caliber is larger compared with the corresponding artery for the internal iliac vein, deep femoral vein, and veins below the knee. 3 and 4A, 4B) and have been found in 3–6% of patients [9, 16]. MDCT is helpful for visualizing the full length of extremities and for evaluating length and thickness on one image. Procedure for CT Scan - Lower Limb with Venogram Test You will have to change into a hospital gown and lie down on the X-ray table. 12,13,14,15,16,17,18,19,20). Therefore, MDCT is more useful than conventional venography because it yields transverse images, which show whether a vein accompanies an artery and whether the vein is completely filled.
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