Search

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4397 Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4398 Abstract In this chapter the authors explain the value of computed tomography venography (CTV) and magnetic resonance venography (MRV) in the assessment of acute and chronic obstructive venous disease. We summarize the available techniques that have been described in the literature on how to perform CTV or MRV and illustrate their respective values with examples from the literature and our own experience.

The literature of conventional contrast angiography has traditionally focused on arteriography and in fact, many texts make scant reference to venography. Indeed, good-quality conventional venography has long been a challenging procedure for several reasons. First, unlike arteriography, where smaller distal branches are visualized from a central injection in a larger artery, the vein in question or one of its smaller tributaries needs to be directly cannulated for opacification as flow is away from the point of injection towards larger vessels; e.g., a small foot vein must be cannulated in order to study the veins of a lower limb. Second, full evaluation of all the lower limb veins for exclusion of thrombus with conventional venography can actually be quite a complex and technically demanding undertaking, requiring large volumes of contrast medium, careful biplane filming of all veins, and intermittent application of tourniquets [1]. Furthermore, the study of large central veins requires simultaneous bilateral limb injections in order to opacify these capacious low-pressure vessels, for example, bilateral arm injections to show the SVC (◘ Fig. 10.1). Open image in new window Fig. 10.1 Conventional venography with DSA. Bilateral arm injections to demonstrate the central veins in a patient with pacemaker in situ, unsuitable for MRI examination. Note that the axillary and jugular veins etc. are not opacified on this study with preferential cephalic venous inflow