J Korean Soc Radiol.  2016 Dec;75(6):471-479. 10.3348/jksr.2016.75.6.471.

Venous Reflux on Contrast-Enhanced Head and Neck Magnetic Resonance Angiography: Analysis of Causative Factors

• Shin DJ
• Lee EJ
• Bae JM

• KMID: 2360435
• DOI: http://doi.org/10.3348/jksr.2016.75.6.471

Abstract

PURPOSE
The purpose of this study was to analyze the causative factors of venous reflux on contrast-enhanced head and neck magnetic resonance angiography.
MATERIALS AND METHODS
We retrospectively reviewed 150 patients with right-arm injections and 150 patients with left-arm injections. We included the age, gender, body mass index, history of hypertension, and history of diabetes mellitus in the evaluation of all patients. We measured the shortest width of the left or right brachiocephalic vein (BCV), the diameter of the aortic arch, and the distance between the sternum and vertebral body. The relationship between these factors and the venous reflux was analyzed. In patients with venous reflux, we performed qualitative image scoring for suboptimal images.
RESULTS
In patients with venous reflux, the image quality of the left-arm injection group was significantly inferior to the image quality of the right-arm injection group. The mean age and the male-to-female ratio of patients with venous reflux were significantly higher than those of patients without venous reflux. In patients receiving the left-arm injection, the mean shortest width of the left BCV was significantly narrower in patients with venous reflux than in patients without venous reflux.
CONCLUSION
A left-arm injection should be avoided, especially in elderly patients, to acquire an optimal image.

MeSH Terms

Aged
Aorta, Thoracic
Body Mass Index
Brachiocephalic Veins
Diabetes Mellitus
Head*
Humans
Hypertension
Magnetic Resonance Angiography*
Neck*
Retrospective Studies
Sternum

Figure

• 

  Fig. 1 Two maximum-intensity projection images of contrast-enhanced head and neck magnetic resonance angiography in a 70-year-old male. A. Left-arm study shows venous stasis of contrast media in left subclavian vein (arrowhead) and reflux to cervical venous plexus (arrows). B. A repeated exam after 30 min with contrast injection in the right-arm showing adequate opacification of the arterial system.

• 

  Fig. 2 Contrast-enhanced head and neck MRA of two patients with left-arm injections. A. MIP image of a 78-year-old male shows optimal opacification with no evidence of venous stasis or reflux. B. MIP image of a 92-year-old female shows reflux of contrast to the left internal and external jugular veins (arrows). C. Axial reformatted image of (A) shows the shortest width of the left BCV is 7.1 mm. D. Axial reformatted image of (B) shows the shortest width of the left BCV is 0.3 mm. The left BCV is severely compressed between the sternum and aortic arch. BCV = brachiocephalic vein, MIP = maximum-intensity projection, MRA = magnetic resonance angiography

• 

  Fig. 3 Contrast-enhanced head and neck MRA of two patients with right-arm injections. A. MIP image of a 37-year-old female showing venous stasis in the right subclavian vein (arrow) and the BCV. B. MIP image of a 30-year-old male showing no venous stasis or reflux. C, D. Axial reformatted images of A (C) and B (D) showing no significant difference of the shortest width of the right BCV between the two patients. BCV = brachiocephalic vein, MIP = maximum-intensity projection, MRA = magnetic resonance angiography

• 

  Fig. 4 Box-and-whisker plots showing the distribution of the shortest width of the left or right BCV in patients with or without venous stasis or reflux. The thick horizontal line in the box represents the median value. The upper and lower ends of the box represent the upper and lower quartile values. The whiskers at either end are the maximum and minimum values. The mean shortest width of the left BCV in patients with venous stasis or reflux was significantly narrower than in patients without venous stasis or reflux, although some overlap was observed (p = 0.0001). The mean shortest width of the right BCV did not significantly differ between the patients with venous stasis or reflux and without venous stasis or reflux. BCV = brachiocephalic vein

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