Andrew Roper Lewis MD, Presenter: Nothing to Disclose

Daniele Marin MD, Abstract Co-Author: Nothing to Disclose

Holly Lynn Nichols BS, Abstract Co-Author: Nothing to Disclose

Daniel Geersen, Abstract Co-Author: Nothing to Disclose

Cynthia K. Shortell MD, Abstract Co-Author: Nothing to Disclose

Charles Yoon Kim MD, Abstract Co-Author: Research Grant, Bayer Inc Research Grant, Lantheus Medical Imaging, Inc Consultant, Lantheus Medical Imaging, Inc

Duplex ultrasound (U/S) is the gold standard for imaging of venous reflux disease. CT and direct MR venography (MRV) have shown promising results, but are limited in the degree and extent of superficial vein opacification. Gadofosveset, a blood-pool agent, is uniquely well suited for venous imaging. The purpose of this study is to assess the feasibility of MRV of the deep and superficial venous system and to determine its accuracy in detection of perforator veins.

Retrospective review of our imaging database from 9/2010 – 9/2012 yielded 58 patients (40 females, mean age 54) who underwent MRV of the abdomen, pelvis, and lower extremities as well as dedicated U/S evaluation of venous reflux disease of one or both legs. Axial MRV images were acquired during the equilibrium phase, approximately 5 minutes after IV gadofosveset injection. The lower extremity deep, superficial, and perforator veins were divided into 11 segments for evaluation. Two radiologists independently rated the visualization score of each venous segment on a scale of 1-4 with 4 being highest. Signal and contrast-to-noise ratios were calculated for the venous segments. The detection of enlarged perforator veins was assessed and compared to sonography.

Analysis was performed on 80 legs that underwent both MRV and U/S. The mean visualization scores for all analyzed venous segments were excellent (3.8-3.9 on a scale of 1-4). The SNR/CNR values were 280/165 for the femoral vein, 230/144 for the above-knee GSV, 394/237 for the below-knee GSV, 303/177 for the small saphenous vein, and 385/240 for superficial varices. 100% of pathologic perforator veins identified on dedicated U/S were detected on MRV. Additional occult enlarged perforator veins were identified on MRV measuring up to 6mm in diameter.

MRV with gadofosveset allowed excellent visualization of varices, superficial, and perforator veins of the legs with a high SNR and CNR that was not previously possible with other contrast agents. The exceptional sensitivity for detection of perforator veins may enable improved treatment of venous reflux disease. Additional studies are warranted to correlate MRV findings with disease characterization and treatment outcomes.

The excellent imaging quality of the entire venous system of the lower extremities with gadofosveset-enhanced MR venography may enable a new system for evaluation of venous reflux disease.

Lewis, A, Marin, D, Nichols, H, Geersen, D, Shortell, C, Kim, C, Gadofosveset-enhanced MR Venography of the Lower Extremities for Evaluation of Venous Reflux Disease: Feasibility and Comparison of Perforator Vein Imaging with Duplex Ultrasound.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13028887.html