Venous reflux on carotid computed tomography angiography: Relationship with left-arm injection

Ying Chi Tseng, Hui-Ling Hsu, Tsong Hai Lee, Chi Jen Chen

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)


OBJECTIVE: We evaluated the relationship between image degradation due to the reflux of contrast agent into the major neck veins and use of a left-arm injection site during computed tomographic (CT) angiography of the carotid arteries. METHODS: A total of 364 patients underwent 4-section carotid CT angiography performed with an injection into the right (n = 183) or left (n = 181) arm. We calculated the volume of refluxed contrast medium and measured the retrosternal distance measured as the shortest distance between the sternum and the arch or its branches. Nine patients underwent follow-up CT angiography weeks later by using the side of injection not used before for comparison. RESULTS: The amount of refluxed contrast medium was greater with left-arm injection than with right-arm injection (P <0.001). With left-arm injection, the volume was significantly correlated with the retrosternal distance (r = -0.514, P <0.001), even after we adjusted for age and sex in the linear regression model (P <0.001). Five of the 9 patients who received injections in both arms had no reflux of contrast medium, whereas 4 patients had obvious reflux after left-arm but not right-arm injection. CONCLUSION: Normal compression of the left brachiocephalic vein due to a developmental decreased retrosternal space may degrade carotid CT angiograms because of reflux of contrast material into the cervical veins. This degradation can be avoided if right-arm injection is used.

Original languageEnglish
Pages (from-to)360-364
Number of pages5
JournalJournal of Computer Assisted Tomography
Issue number3
Publication statusPublished - May 2007
Externally publishedYes


  • Catorid arteries
  • Contrast enhancement
  • CT angiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology


Dive into the research topics of 'Venous reflux on carotid computed tomography angiography: Relationship with left-arm injection'. Together they form a unique fingerprint.

Cite this