Abstract Archives of the RSNA, 2012
Whal Lee MD, PhD, Presenter: Nothing to Disclose
1) Set up the protocol and parameters for CT and contrast media injection for evaluation of the venous system of the lower extremities. 2) Describe the three dimensional reconstruction techniques for varicose vein of the lower extremities. 3) Know the advantages, drawbacks and limitations of CT venography in evaluation of the varicose vein of the lower extremities. 4) Know the unusual causes of the varicose vein of the lower extremities and their CT findings.
Varicose veins are present in 10–40% of people aged 30 to 70 years-old. Regardless of the epidemiology and pathophysiology, the pathogenesis of varicose veins in the lower extremities is mainly venous valvular dysfunction. From a radiological point of view, the most important aspect is to determine the primary cause of venous insufficiency by demonstrating veins with valvular incompetence in the lower limb varicosities and analyzing overall characteristics of the varicosities from the presented valvular dysfuctions in the patient.
Doppler ultrasound is a traditional and most useful modality to employ with the ability to demonstrate venous hemodynamic reflux. In varicose veins with complex morphology or unusual manifestations, the use of Doppler ultrasound combined with CT venography can assist radiologists to figure out the characteristics and the causes of varicosities.
The technique of CT venography for evaluation of varicose vein is not complicated but has unique features. First of all, the patient’s legs should not contact CT table, because the pressure from the leg itself can collapse the varicose vein of the dependant portion. The degree of the enhancement depends on the total amount of contrast media and 2ml/kg of contrast media is recommended. The scan timing is 3 min after contrast media injection.
There were a a sapheno-femoral, sapheno-popliteal junction and usual perforator insufficiency in the causes of varicose veins. Sometimes, a varicose vein is arising from unexpected anatomical cause and in these cases the CT venography could demonstrate the overview of the varicose veins. Complementary CT venography is useful to evaluate a precise cause of varicose veins especially in the patients with unusual cause of varicose veins.
A radiologist should be familiar with the comprehensive list of primary causes of varicose veins in the lower extremities and recognize the complementary role of CT venography in their evaluation.
CT Venography of Varicose Veins. Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/9000716.html