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Upper-Extremity Venography: CO₂ versus Iodinated Contrast Material¹

¹ From the Department of Radiology, University Hospitals Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium. Received April 28, 2005; revision requested June 23; revision received September 7; accepted September 21; final version accepted November 23. Address correspondence to S.H. (e-mail: sam.heye{at}uz.kuleuven.ac.be).

Purpose: To determine prospectively the diagnostic performance of CO₂ venography, by using conventional venography with iodinated contrast material as the reference standard, for the preoperative evaluation of upper-limb and central veins before creation of fistulas for hemodialysis access.

Materials and Methods: The study was approved by the institutional review board, and informed consent was obtained from all patients. Twenty-two patients underwent comparative CO₂ and conventional venography of upper-extremity and central veins. Two independent observers evaluated the opacification of the veins and grade of stenosis, if present. Interobserver agreements were estimated with the Cohen coefficient. Calculations of sensitivity, specificity, and accuracy were used for intertechnique observations.

Results: For CO₂ venography, global interobserver agreement was good, with a value of 0.90 (range, 0.71–1.00; 95% confidence interval: 0.84, 0.95). A value of 0.96 (range, 0.86–1.00; 95% confidence interval: 0.93, 0.99) was calculated for global interobserver agreement for conventional venography. The sensitivity, specificity, and accuracy of CO₂ venography for all vein segments were 97%, 85%, and 95%, respectively.

Conclusion: CO₂ venography had a sensitivity of 97% and a specificity of 85% in the assessment of upper-limb and central vein patency and stenosis, with conventional venography used as the reference standard.

© RSNA, 2006