High-resolution MRI for tip location and complications of transjugular chronic dialysis catheter

Objective: To evaluate the efficacy of high-resolution MRI using the MRCP (HR-MRCP) and T₂WI (HR-T₂WI) sequences for displaying the tip position and complications of transjugular chronic dialysis catheter insertion in the superior vena cava. Methods: 41 consecutive patients with suspicion of catheter dysfunction and complications underwent HR-MRCP and HR-T₂WI after injecting 5 ml of saline into the catheter lumen. Chest X-ray (CXR) was obtained within 1-2 days and the catheter was withdrawn within 3-10 days. The tip point on CXR was used as the gold standard for evaluating the HR-MRI. Results: 38 patients underwent HR-MRI successfully normal outcomes (13) and abnormal findings (25) including fibrin sheaths (22), thrombosis (9) and intraluminal clots (4). There was no significant difference between HR-MRCP and CXR (P = 0.132) in the distance from the top to the tip of the catheter. Normal catheter appearance included the 'double eyes' sign on HR-T₂WI and 'double tracks' sign on HR-MRCP. Fibrin sheaths were displayed as 'thin ring' sign (< 3 mm); thrombosis appeared as patchy hyperintensity or 'thick ring' (> 5 mm) on HR-T₂WI; unilateral intraluminal clot (2) appeared as 'single eye' on HR-T₂WI and 'single track' on HR-MRCP; bilateral intraluminal clot (2) showed absence of the 'double eye' sign on HR-T₂WI and 'double track' sign. After surgical withdrawal of the catheters, 12/22 fibrin sheaths, 4/9 thrombosis, and 4/4 intraluminal clots were confirmed. Conclusion: HR-MRCP and HR-T₂WI are promising methods for visualizing chronic dialysis catheter tip location and complications. (authors)