Visualization of deep veins and detection of deep vein thrombosis (DVT) with balanced turbo field echo (b‐TFE) and contrast‐enhanced T1 fast field echo (CE‐FFE) using a blood pool agent (BPA)

Abstract

Purpose: To assess image quality, vessel visualization, preliminary diagnostic properties, and interobserver variability of a novel balanced turbo field echo (b-TFE) sequence and contrast-enhanced T1 fast field echo (CE-FFE) sequence with blood pool agent (BPA). Materials and Methods:A total of 15 healthy volunteers and six patients with ultrasound-verified proximal deep vein thrombosis (DVT) were examined from the inferior vena cava (IVC) to the proximal calf veins.Results: The great majority of deep veins were completely visualized on both sequences. In healthy volunteers the IVC was completely visualized in five b-TFE and 11 CE-FFE scans, and partially in seven b-TFE and four CE-FFE scans (P ¼ 0.008). Poorest image quality was in the pelvis. Contrast-to-noise ratio (CNR) was higher on b-TFE compared to CE-FFE, with significant difference in calf images (P ¼ 0.036). Sensitivity was 100% for proximal DVT with both methods. Specificity was 70% (CE-FFE) and 80% (b-TFE) for proximal femoral DVT; 100% in distal femoral. Interobserver reliability was kappa 1.0 (b-TFE), 0.9 (CE-FFE) for proximal, and overall poor for distal DVT.Conclusion: Contrast-enhancement did not add valuable information in visualizing deep veins of the lower limbs compared to b-TFE, though the IVC was slightly better visualized. Diagnostic properties and interobserver reliability of both sequences were good for proximal DVT and poor for distal DVT.

Safety and technique of ferumoxytol administration for MRI

“…Noncontrast MRA and venography techniques should be considered as alternatives in these settings, balancing the speed, resolution, and reliability of the various approaches. Additionally, several groups have described the use of ferumoxytol for the imaging of deep vein thrombosis and pulmonary thromboembolism , as well as pediatric cardiovascular imaging . Quantitative first‐pass perfusion MRI has also been described , along with blood signal suppression for lymphangiography .…”

Rapid MR venography in children using a blood pool contrast agent and multi-station fat-water-separated volumetric imaging

“…While ultrasound is commonly used to evaluate the extremities, it is of limited sensitivity in the assessment of pelvic veins [1, 2]. Methods utilizing iodinated contrast for venography are not optimal in the pediatric population because of the exposure to ionizing radiation.…”

“…Ultrasound is operator- and patient-dependent, and has suboptimal sensitivity when evaluating the pelvic veins [2]. Both CT venography and catheter-based contrast venography rely on ionizing radiation, use iodinated contrast with its risk of contrast nephropathy, and are limited by rapid clearance of contrast from the blood pool [1].…”

Blood pool contrast agents for venous magnetic resonance imaging

“…Instead, ultrasound (US) has now become the modality of choice in clinical practice for the evaluation of deep vein thrombosis (DVT), with advantages in cost effectiveness, noninvasiveness, and portability in critically ill patients (1). However, key limitations of US exist, and include decreased sensitivity due to body habitus or edema, individual operator dependence (2), and difficulty in evaluation of calf veins and recurrent or chronic DVT (3). Ultrasound is also technically unable to evaluate the abdominopelvic deep venous system or the pulmonary arterial system (4), limiting its use in the workup of patients with venous thromboembolism at other sites.…”