Original Articles
Limitations of magnetic resonance imaging and ultrasound-directed (duplex) scanning in the diagnosis of subclavian vein thrombosis

Presented at the Second Annual American Venous Forum Meeting, Coronado, Calif., Feb. 21 to 23, 1990.
https://doi.org/10.1067/mva.1991.25130Get rights and content

Abstract

To investigate the potential role of magnetic resonance imaging and duplex scanning in the diagnosis of catheter-induced subclavian vein thrombosis, we correlated the results of 43 arm phlebograms with duplex scans; 28 of these phlebograms were also correlated with magnetic resonance imaging scans of the thoracic veins. Eighteen of the 43 phlebograms were normal, and all had normal magnetic resonance imaging and duplex studies. Eleven subclavian veins were totally occluded on phlebography; all had duplex scans, and five were also scanned with magnetic resonance imaging. Duplex scans detected 6 of 11 occlusions, whereas magnetic resonance imaging detected 4 of the 5 occlusions scanned. The five occlusions that were not detected by either magnetic resonance imaging or duplex scans were short segmental occlusions of the medial one third of the left subclavian vein. Of 14 nonocclusive thrombi seen on phlebography, duplex scans correctly identified 8. Magnetic resonance imaging was done on eight nonocclusive thrombi but identified only two. All abnormal findings on duplex scanning and magnetic resonance imaging were confirmed by phlebography. Short occlusions of the proximal portion of the left subclavian vein were often undetected by duplex scanning but occasionally seen with magnetic resonance imaging. Neither modality was sensitive to the presence of nonocclusive mural thrombi. Magnetic resonance imaging is highly reliable in ruling out the presence of a thrombotic process in the subclavian vein, but it may on occasion fail to detect the presence of subclavian thrombi. For this reason, in cases with suspected subclavian vein thrombosis magnetic resonance imaging cannot be used as the only diagnostic modality. Contrast phlebography has to be used for positive exclusion of the possibility of vein thrombosis. (J VASC SURG 1991;13:391-7.)

Section snippets

Patients

The risk factor for subclavian vein thrombosis in all patients was the presence of a silicone rubber catheter placed in the vein.1 All but four examinations were performed as part of a prospective evaluation of thrombotic complications of central venous catheters. The experimental protocol was approved by the Institutional Review Board of the University of Nebraska Medical Center, and written informed consent was obtained from all participants. Participants in this study underwent diagnostic

Results

Forty-three arm phlebograms were obtained with duplex ultrasound examinations shortly thereafter. Twenty-eight of these phlebograms had MRI scans for correlation as well. The results are summarized in Table I and II.

. Comparison of the venogram and duplex scan results in imaging subclavian veins

Empty CellEmpty CellResults of phlebography
Empty CellEmpty CellNormalPartial occlusionComplete occlusion
Normal1865*
Duplex scanPartial occlusion8
Complete occlusion6
Total 43181411
*Occlusion of proximal portion of left subclavian vein.

.

Discussion

Real-time ultrasonography has been found to be useful in the diagnosis of venous thrombosis of the legs.2, 3 When applied to the subclavian veins this technique has been found helpful in a limited number of patients.4, 5, 6, 7 These four reports describe the ultrasound findings of 24 subclavian veins proven phlebography to be totally obstructed by thrombus. Ultrasound findings of only six normal veins on phlebography and no veins only partially occluded by thrombi have been reported.7

References (14)

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Reprint requests: William D. Haire, MD, Department of Internal Medicine, University of Nebraska Medical Center, 42nd and Dewey, Omaha, NE 68105.

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