Planken R Nils, Keuter Xavier H, Kessels Alfons G, Hoeks Arnold P, Leiner Tim, Tordoir Jan H
Department of Vascular Surgery, Maastricht University, Maastricht, The Netherlands.
J Vasc Surg. 2006 Aug;44(2):353-8. doi: 10.1016/j.jvs.2006.04.038.
Duplex ultrasonography assessment of superficial forearm veins is frequently used before a hemodialysis arteriovenous fistula (AVF) is created. There is, however, no standardized preoperative duplex ultrasonography protocol. This study assessed B-mode image analysis reproducibility and reproducibility of repeated forearm superficial venous diameter measurements on different days at different venous congestion pressures (VCPs).
Diameters were determined using B-mode ultrasonography in 10 healthy male volunteers on days 1 and 14 at incremental VCP values (10 to 80 mm Hg). Intra- and interobserver agreement was assessed for B-mode image analysis by calculating interclass correlation coefficients (ICC). Reproducibility of repeated diameter measurements (maximum and minimum diameter at days 1 and 14), cross-sectional area size increase, and shape change due to incremental VCPs were determined by calculating ICC values.
Analysis of intraobserver agreement of B-mode image interpretation yielded ICC values of 0.97 (95% confidence interval [CI], 0.94 to 0.99) and 0.97 (95% CI, 0.96 to 0.99) for determination of maximum and minimum diameters, respectively. Interobserver agreement analysis yielded ICC values of 0.95 (95% CI, 0.92 to 0.97) and 0.96 (95% CI, 0.96 to 0.99) for determination of maximum and minimum diameters, respectively. Reproducibility of repeated diameter measurements on days 1 and 14 improved substantially at incremental VCP values, with best reproducibility at VCPs >40 mm Hg. Repeated determination of cross-sectional area size increase and shape change due to VCP increase from 10 to 80 mm Hg yielded ICC values of 0.49 (95% CI, 0.19 to 1.00) and 0.09 (95% CI, 0.00 to 0.92), respectively. Maximum and minimum diameters as well as cross-sectional area size increased significantly (P < .01) due to VCP increase during both sessions. Cross-sectional area shape changed significantly (P < .01) due to VCP increase during both sessions.
Diameter measurements on B-mode images are largely observer independent. Superficial venous cross-sectional area shape is noncircular, and cross-sectional area size depends on VCP. Both maximum and minimum venous diameters should be determined at VCPs >40 mm Hg to attain the best reproducibility. Further studies are needed to determine whether a standardized preoperative vein mapping protocol can reduce AVF nonmaturation rates.
在建立血液透析动静脉内瘘（AVF）之前，经常会使用双功超声检查来评估前臂浅静脉。然而，目前尚无标准化的术前双功超声检查方案。本研究评估了B超图像分析的可重复性以及在不同日期、不同静脉充血压力（VCP）下重复测量前臂浅静脉直径的可重复性。
在10名健康男性志愿者中，于第1天和第14天使用B超在递增的VCP值（10至80 mmHg）下测定静脉直径。通过计算组内相关系数（ICC）来评估观察者内和观察者间对B超图像分析的一致性。通过计算ICC值来确定重复直径测量（第1天和第14天的最大和最小直径）、横截面积大小增加以及因VCP递增导致的形状变化的可重复性。
对于B超图像解释的观察者内一致性分析，测定最大和最小直径时的ICC值分别为0.97（95%置信区间[CI]，0.94至0.99）和0.97（95%CI，0.96至0.99）。观察者间一致性分析，测定最大和最小直径时的ICC值分别为0.95（95%CI，0.92至0.97）和0.96（95%CI，0.96至0.99）。在递增的VCP值下，第1天和第14天重复直径测量的可重复性显著提高，在VCP>40 mmHg时可重复性最佳。对于因VCP从10 mmHg增加到80 mmHg导致的横截面积大小增加和形状变化的重复测定，ICC值分别为0.49（95%CI，0.19至1.00）和0.09（95%CI，0.00至0.92）。在两个时间段内，由于VCP增加，最大和最小直径以及横截面积大小均显著增加（P<0.01）。在两个时间段内，由于VCP增加，横截面积形状也发生了显著变化（P<0.01）。
B超图像上的直径测量在很大程度上与观察者无关。浅静脉横截面积形状并非圆形，且横截面积大小取决于VCP。为获得最佳可重复性，应在VCP>40 mmHg时测定最大和最小静脉直径。需要进一步研究以确定标准化的术前静脉造影方案是否能降低AVF未成熟率。
