多层螺旋计算机断层血管造影术用于检测前臂血液透析动静脉内瘘狭窄

Multi-slice computed tomographic angiography for stenosis detection in forearm hemodialysis arteriovenous fistulas.

作者信息

Rooijens P P G M, Serafino G P, Vroegindeweij D, Dammers R, Yo T I, De Smet A A E A, Tordoir J H M

机构信息

Department of Surgery, Medical Center Rijnmond Zuid, Rotterdam, The Netherlands.

出版信息

J Vasc Access. 2008 Oct-Dec;9(4):278-84.

PMID:19085898

Abstract

PURPOSE

A method of diagnosing the extent and severity of arteriovenous fistula (AVF) stenoses is multislice computed tomographic angiography (MS-CTA). The aim of this prospective study was to assess the accuracy of MS-CTA for the detection and grading of stenoses in AVF in comparison to digital subtraction angiography (DSA), which was used as the gold standard of reference.

METHODS

Fifteen hemodialysis (HD) patients with dysfunctioning forearm AVF were included. These AVFs were evaluated by both DSA and MS-CTA and were read in a prospective, blinded manner by two radiologists experienced in vascular imaging.

RESULTS

ROC analysis revealed areas under the curve of 0.90+/-0.07 for observer I and 0.87+/-0.08 for observer II at a stenosis cut-off level of >or=50% diameter reduction. The combined results for MS-CTA showed sensitivity, specificity and positive and negative predictive values of 82%, 98%, 82% and 98% for stenoses>or=50% and 71%, 99%, 77% and 98% for stenoses>or=75%. Inter-observer agreement for the detection of stenoses>or=50% diameter reduction was 0.70 and 1.0, for MS-CTA and DSA, respectively.

CONCLUSION

MS-CTA can provide good visualization of forearm HD access AVF and has moderate sensitivity, but high specificity for the detection of flow-limiting stenoses.

摘要

目的

多层螺旋计算机断层血管造影（MS-CTA）是一种诊断动静脉内瘘（AVF）狭窄程度和严重性的方法。本前瞻性研究的目的是评估MS-CTA与作为参考金标准的数字减影血管造影（DSA）相比，在检测AVF狭窄及对其进行分级方面的准确性。

方法

纳入15例前臂AVF功能障碍的血液透析（HD）患者。这些AVF均通过DSA和MS-CTA进行评估，并由两名有血管成像经验的放射科医生以前瞻性、盲法方式进行解读。

结果

在直径减少≥50%的狭窄截断水平下，ROC分析显示观察者I的曲线下面积为0.90±0.07，观察者II为0.87±0.08。MS-CTA的综合结果显示，对于≥50%的狭窄，敏感性、特异性、阳性和阴性预测值分别为82%、98%、82%和98%；对于≥75%的狭窄，分别为71%、99%、77%和98%。对于检测直径减少≥50%的狭窄，MS-CTA和DSA的观察者间一致性分别为0.70和1.0。