Reflux of CT contrast into the IVC: Defining boundaries between pathologic and iatrogenic reflux

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dc.contributor.authorFudge, Thomas
dc.date.accessioned2015-06-01T19:19:53Z
dc.date.available2015-06-01T19:19:53Z
dc.date.issued2014-06-01
dc.description.abstractBackground: Reflux of intravenous contrast into the inferior vena cava (IVC) or hepatic veins seen on contrast enhanced computed tomography (CT) studies has been linked to right-sided heart disease including tricuspid regurgitation (TR), pulmonary hypertension, and right ventricular systolic dysfunction (RVSD). Current CT protocols call for increasingly faster contrast injection rates, which have led to relatively frequent visualization of the reflux sign. Objective: Assess the clinical role of reflux at high contrast injection rates while correcting for right ventricular function obtained by pocket-sized echocardiography (PSE). Methods: Patients having undergone contrast enhanced CT examination at rates of 3-6 ml/sec were recruited to undergo a limited PSE examination. Presence and severity of IVC reflux on CT, was compared to right ventricular fractional area change (< 35% = RVSD), TR, IVC diameter and IVC collapse during sniff test. Results: 86 patients underwent PSE. IVC reflux incidence was 79% (68/86), with 38 patients exhibiting reflux to the suprahepatic level, and 30 having significant reflux (hepatic level). There were no statistically significant differences between varying injection rates and RVSD. There was a significant difference favoring greater reflux with RVSD when injection rates were combined (P = 0.0393). In those with significant reflux, higher injection rates were linked to higher Hounsfield units within the hepatic veins for both normal and RVD, but the population size was too small to draw significance. Conclusion: Although population numbers were too low for statistical significance, we believe that faster injection rates play a major role in the incidence and severity of IVC reflux. Further research is needed to understand the clinical significance of this sign.en_US
dc.identifier.urihttp://hdl.handle.net/1993/30543
dc.language.isoengen_US
dc.rightsopen accessen_US
dc.subjectreflux of CTen_US
dc.subjectIVCen_US
dc.titleReflux of CT contrast into the IVC: Defining boundaries between pathologic and iatrogenic refluxen_US
dc.typeOtheren_US
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