BACKGROUND Although cardiovascular magnetic resonance venography (CMRV) is generally regarded as the technique of choice for imaging the central veins, conventional CMRV is not ideal. Gadolinium-based contrast agents (GBCA) are less suited to steady state venous imaging than to first pass arterial imaging and they may be contraindicated in patients with renal impairment where evaluation of venous anatomy is frequently required. We aim to evaluate the diagnostic performance of 3-dimensional (3D) ferumoxytol-enhanced CMRV (FE-CMRV) for suspected central venous occlusion in patients with renal failure and to assess its clinical impact on patient management. METHODS In this IRB-approved and HIPAA-compliant study, 52 consecutive adult patients (47 years, IQR 32-61; 29 male) with renal impairment and suspected venous occlusion underwent FE-CMRV, following infusion of ferumoxytol. Breath-held, high resolution, 3D steady state FE-CMRV was performed through the chest, abdomen and pelvis. Two blinded reviewers independently scored twenty-one named venous segments for quality and patency. Correlative catheter venography in 14 patients was used as the reference standard for diagnostic accuracy. Retrospective chart review was conducted to determine clinical impact of FE-CMRV. Interobserver agreement was determined using Gwet's AC1 statistic. RESULTS All patients underwent technically successful FE-CMRV without any adverse events. 99.5% (1033/1038) of venous segments were of diagnostic quality (score ≥ 2/4) with very good interobserver agreement (AC1 = 0.91). Interobserver agreement for venous occlusion was also very good (AC1 = 0.93). The overall accuracy of FE-CMRV compared to catheter venography was perfect (100.0%). No additional imaging was required prior to a clinical management decision in any of the 52 patients. Twenty-four successful and uncomplicated venous interventions were carried out following pre-procedural vascular mapping with FE-CMRV. CONCLUSIONS 3D FE-CMRV is a practical, accurate and robust technique for high-resolution mapping of central thoracic, abdominal and pelvic veins and can be used to inform image-guided therapy. It may play a pivotal role in the care of patients in whom conventional contrast agents may be contraindicated or ineffective.

中文翻译：

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中心静脉闭塞中的高分辨率、3 维 Ferumoxytol 增强心血管磁共振静脉造影。


背景技术虽然心血管磁共振静脉造影（CMRV）通常被认为是中央静脉成像的首选技术，但传统的CMRV并不理想。与首过动脉成像相比，钆基造影剂 (GBCA) 不太适合稳态静脉成像，并且对于经常需要评估静脉解剖结构的肾功能不全患者来说，它们可能是禁忌的。我们的目的是评估 3 维 (3D) 菲鲁莫托增强 CMRV (FE-CMRV) 对肾衰竭患者疑似中心静脉闭塞的诊断性能，并评估其对患者管理的临床影响。方法 在这项 IRB 批准且符合 HIPAA 的研究中，连续 52 名患有肾功能损害且疑似静脉闭塞的成年患者（47 岁，IQR 32-61；29 名男性）在输注 ferumoxytol 后接受了 FE-CMRV。通过胸部、腹部和骨盆进行屏气、高分辨率、3D 稳态 FE-CMRV。两名盲审员独立对 21 个指定静脉段的质量和通畅性进行评分。 14例患者的相关导管静脉造影作为诊断准确性的参考标准。进行回顾性图表审查以确定 FE-CMRV 的临床影响。使用 Gwet 的 AC1 统计数据确定观察者间的一致性。结果 所有患者均接受了技术上成功的 FE-CMRV，没有任何不良事件。 99.5% (1033/1038) 的静脉段具有诊断质量（分数 ≥ 2/4），观察者间一致性非常好（AC1 = 0.91）。静脉闭塞的观察者间一致性也非常好（AC1 = 0.93）。与导管静脉造影相比，FE-CMRV 的总体准确性非常完美 (100.0%)。 在对 52 名患者做出临床管理决定之前，无需进行额外的影像学检查。在使用 FE-CMRV 进行术前血管标测后，进行了 24 例成功且简单的静脉干预措施。结论 3D FE-CMRV 是一种实用、准确且稳健的技术，用于对中央胸静脉、腹部静脉和盆腔静脉进行高分辨率绘图，可用于为图像引导治疗提供信息。它可能在传统造影剂可能禁忌或无效的患者的护理中发挥关键作用。