Direct contrast enhanced MR in the study of central venous accesses in children receiving total parenteral nutrition.

ABSTRACT

PURPOSE: To present direct contrast-enhanced Magnetic Resonance Venography, a recently developed method for the study of central venous accesses. MATERIALS AND METHODS: Six patients (4 males and 2 females; age range 15-18 years) with severe intestinal failure treated with indwelling central venous catheter since childhood were studied by MR-angiography. The examination was carried out with a 1.5 Philips Gyroscan Intera magnet, sequences during the simultaneous injection of about 60 ml/limb paramagnetic contrast material, Gd-DTPA, diluted with saline solution at a ratio of 112. The images were processed with maximum intensity coronal projections and compared with the phlebographic images obtained earlier. RESULTS: In 4 cases the method demonstrated superior vena cava occlusion, in 2 cases inferior vena cava occlusion. The examination was well tolerated by all patients and image quality was very similar to that of the gold-standard study, conventional phlebography. CONCLUSIONS: We believe direct contrast-enhanced MR-venography to be a minimally invasive, panoramic and diagnostically reliable method, which should be considered the first choice in the study of central venous accesses of patients receiving total parenteral nutrition for the medical treatment of intestinal failure. The method does not expose the patients to ionizing radiation or require iodinated contrast material, and is relatively short with a room time of about 30-40 minutes.