Skip to main content

Preoperative assessment of thymic veins on multidetector row CT: optimization of contrast material volume

Abstract

Purpose

Preoperative localization of the thymic veins is considered important to prevent intraoperative severe bleeding prior to video-assisted thoracoscopic thymectomy. The purpose of this study was to determine the optimal dose of contrast material for preoperative CT imaging for the detection of thymic veins on the basis of patient weight.

Materials and methods

The records of 31 patients who underwent thymectomy were examined retrospectively. All patients were scanned using an eight-channel multidetector-row computed tomography (CT) scanner at 1.25 mm collimation and a 0.625-mm reconstruction interval. CT scans were obtained after injection of 300 mg I/ml nonionic contrast material at a rate of 2 ml/s. A 90-ml contrast bolus was used for the first 16 consecutive patients (group I), and a 150-ml bolus was used for the following 15 patients (group II). The scan delay was 60 s and 90 s in groups I and II respectively. Two independent radiologists who were blinded to the surgical results evaluated the number of thymic veins observed on preoperative CT, which was later correlated with the actual number of thymic veins clipped during surgery. The responses were analyzed with respect to contrast amount by single bolus and per kilogram of body weight.

Results

Thymic veins were correctly detected in 9 of 16 (56%) patients in group I and 14 of 15 (93%) patients in group II. Thymic vein detection was significantly better in patients who received the ≥2.0 ml/kg contrast medim compared to those who received the 1.00–1.99 ml/kg medium (P < 0.05).

Conclusion

An intravenous contrast material volume of 2 ml/kg (300 mg I/ml) is appropriate for the identification of thymic veins on prethymectomy CT.

This is a preview of subscription content, access via your institution.

References

  1. S Akamine T Takahashi T Oka K Kishimoto H Ayabe (1999) ArticleTitleThymic cystectomy through subxyphoid by video-assisted thoracic surgery Ann Thorac Surg 68 IssueID6 2339–41 Occurrence Handle10617034 Occurrence Handle10.1016/S0003-4975(99)01164-9 Occurrence Handle1:STN:280:DC%2BD3c%2Fotlehtg%3D%3D

    PubMed  Article  CAS  Google Scholar 

  2. H Shiono A Inoue N Tomiyama N Shigemura K Ideguchi M Inoue et al. (2006) ArticleTitleSafer video-assisted thoracoscopic thymectomy after location of thymic veins with multidetector computed tomography Surg Endosc 20 IssueID9 1419–22 Occurrence Handle16736308 Occurrence Handle10.1007/s00464-005-0659-7 Occurrence Handle1:STN:280:DC%2BD28rmtlCksw%3D%3D

    PubMed  Article  CAS  Google Scholar 

  3. I Okuda T Kokubo T Kohno H Yamase K Shibuya (2005) ArticleTitleImaging aid for thoracoscopic thymectomy; thymic vein visualization Kyobu Geka [Jpn 58 IssueID10 887–92 Occurrence Handle1:STN:280:DC%2BD2Mvps1altA%3D%3D

    CAS  Google Scholar 

  4. JC Scatarige KM Horton LE Ratner EK Fishman (2001) ArticleTitleLeft adrenal vein localization by 3D real-time volume-rendering CTA before laparoscopic nephrectomy in living renal donors Abdom Imaging 26 IssueID5 553–6 Occurrence Handle11503098 Occurrence Handle10.1007/s002610000205 Occurrence Handle1:STN:280:DC%2BD3Mvls1Khtw%3D%3D

    PubMed  Article  CAS  Google Scholar 

  5. HC Kim JW Chung CJ Yoon W Lee HJ Jae YI Kim et al. (2004) ArticleTitleCollateral pathways in thoracic central venous obstruction: three-dimensional display using direct spiral computed tomography venography J Comput Assist Tomogr 28 IssueID1 24–33 Occurrence Handle14716228 Occurrence Handle10.1097/00004728-200401000-00004

    PubMed  Article  Google Scholar 

  6. LP Lawler FM Corl EK Fishman (2002) ArticleTitleMulti-detector row and volume-rendered CT of the normal and accessory flow pathways of the thoracic systemic and pulmonary veins Radiographics 22 Spec No S45–60 Occurrence Handle12376600

    PubMed  Google Scholar 

  7. C Herzog S Dogan T Diebold MF Khan H Ackermann S Schaller et al. (2003) ArticleTitleMulti-detector row CT versus coronary angiography: preoperative evaluation before totally endoscopic coronary artery bypass grafting Radiology 229 IssueID1 200–8 Occurrence Handle14519876 Occurrence Handle10.1148/radiol.2291020630

    PubMed  Article  Google Scholar 

  8. S Kawamoto LP Lawler EK Fishman (2005) ArticleTitleEvaluation of the renal venous system on late arterial and venous phase images with MDCT angiography in potential living laparoscopic renal donors AJR Am J Roentgenol 184 IssueID2 539–45 Occurrence Handle15671376

    PubMed  Google Scholar 

  9. S Kawamoto RA Montgomery LP Lawler KM Horton EK Fishman (2003) ArticleTitleMultidetector CT angiography for preoperative evaluation of living laparoscopic kidney donors AJR Am J Roentgenol 180 IssueID6 1633–8 Occurrence Handle12760934

    PubMed  Google Scholar 

  10. DV Sahani N Rastogi AC Greenfield SP Kalva D Ko S Saini et al. (2005) ArticleTitleMulti-detector row CT in evaluation of 94 living renal donors by readers with varied experience Radiology 235 IssueID3 905–10 Occurrence Handle15833989 Occurrence Handle10.1148/radiol.2353040496

    PubMed  Article  Google Scholar 

  11. M Savcenko GK Wendt SL Prince MJ Mack (2002) ArticleTitleVideo-assisted thymectomy for myasthenia gravis: an update of a single institution experience Eur J Cardiothorac Surg 22 IssueID6 978–83 Occurrence Handle12467823 Occurrence Handle10.1016/S1010-7940(02)00593-6

    PubMed  Article  Google Scholar 

  12. HY Yune EC Klatte (1970) ArticleTitleThymic venography Radiology 96 IssueID3 521–6 Occurrence Handle5456307 Occurrence Handle1:STN:280:DyaE3c3otlymuw%3D%3D

    PubMed  CAS  Google Scholar 

  13. JD Godwin JT Chen (1986) ArticleTitleThoracic venous anatomy AJR Am J Roentgenol 147 IssueID4 674–84 Occurrence Handle3489364 Occurrence Handle1:STN:280:DyaL28zhvFOltA%3D%3D

    PubMed  CAS  Google Scholar 

  14. R Uflacker (1997) Atlas of vascular anatomy: an angiographic approach CW Mitchell (Eds) Veins of the head and neck, veins of the thorax Williams & Wilkins Baltimore 81–212

    Google Scholar 

  15. L Kreel (1967) ArticleTitleSelective thymic venography: new method for visualization of the thymus BMJ 1 IssueID537 406–7 Occurrence Handle6017507 Occurrence Handle1:STN:280:DyaF2s%2FovVOjuw%3D%3D Occurrence Handle10.1136/bmj.1.5537.406

    PubMed  CAS  Article  Google Scholar 

  16. L Novellino M Longoni L Spinelli M Andretta M Cozzi G Faillace et al. (1994) ArticleTitle“Extended” thymectomy, without sternotomy, performed by cervicotomy and thoracoscopic technique in the treatment of myasthenia gravis Int Surg 79 IssueID4 378–81 Occurrence Handle7713713 Occurrence Handle1:STN:280:DyaK2M3ivFeltg%3D%3D

    PubMed  CAS  Google Scholar 

  17. A Jaretzki Suffix3rd (2003) ArticleTitleThymectomy for myasthenia gravis: analysis of controversies—patient management Neurologist 9 IssueID2 77–92 Occurrence Handle12808370 Occurrence Handle10.1097/01.nrl.0000051446.03160.2e

    PubMed  Article  Google Scholar 

  18. G Rademacher D Stengel S Siegmann J Petersein S Mutze (2002) ArticleTitleOptimization of contrast agent volume for helical CT in the diagnostic assessment of patients with severe and multiple injuries J Comput Assist Tomogr 26 IssueID1 113–8 Occurrence Handle11801913 Occurrence Handle10.1097/00004728-200201000-00017

    PubMed  Article  Google Scholar 

  19. KT Bae JP Heiken JA Brink (1998) ArticleTitleAortic and hepatic contrast medium enhancement at CT. Part II. Effect of reduced cardiac output in a porcine model Radiology 207 IssueID3 657–62 Occurrence Handle9609887 Occurrence Handle1:STN:280:DyaK1c3nt1yjtQ%3D%3D

    PubMed  CAS  Google Scholar 

  20. E Boijsen SR Reuter (1966) ArticleTitleSubclavian and internal mammary angiography in the evaluation of anterior mediastinal masses Am J Roentgenol Radium Ther Nucl Med 98 IssueID2 447–50 Occurrence Handle5925117 Occurrence Handle1:STN:280:DyaF2s%2Fks1WitA%3D%3D

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Noriyuki Tomiyama.

About this article

Cite this article

Natsag, J., Tomiyama, N., Inoue, A. et al. Preoperative assessment of thymic veins on multidetector row CT: optimization of contrast material volume. Radiat Med 25, 202–210 (2007). https://doi.org/10.1007/s11604-007-0125-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11604-007-0125-7

Key words

  • Thymic vein
  • Thymectomy
  • Video-assisted thoracoscopic surgery
  • Thymic tumor