Jin W T, Zhang G F, Liu H C, Zhang H, Li B, Zhu X Q
Department of Radiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Department of Radiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Clin Radiol. 2015 Aug;70(8):852-7. doi: 10.1016/j.crad.2015.04.005. Epub 2015 May 12.
To assess the diagnostic value of non-contrast-enhanced magnetic resonance angiography (NCE-MRA), using time-of-flight and black-blood MRA, in the evaluation of arteriovenous fistulas in haemodialysis patients in comparison to multidetector computed tomography angiography (MDCTA).
NCE-MRA and MDCTA were performed on the same day in 21 patients on maintenance haemodialysis with dysfunctional arteriovenous fistulas. The fistulas included three segments: arterial inflow, anastomosis, and venous outflow. Two experienced observers, who were blinded to the results of the NCE-MRA, recorded in consensus the significant stenoses (≥50%) seen on CTA. Two other experienced observers, unaware of the results of CTA, independently recorded significant stenoses (≥50%) in the NCE-MRA. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of NCE-MRA were calculated, with MDCTA as the standard reference.
Sixty-three vascular segments in the 21 patients were clearly displayed. For the two observers of NCE-MRA, the accuracy was 98% and 95.4%; sensitivity 96.4% and 96.4%; specificity 97.1% and 94.3%; positive predictive value 96.4% and 93.1%; and, negative predictive value 97.1% and 97.1%. Inter-/intra-observer agreement for detecting stenosis was excellent for NCE-MRA, with a weighted kappa of 0.968 (95% confidence interval [CI], 0.874-1) and 0.936 (95% CI, 0.848-1).
Non-contrast-enhanced MRA, using time-of-flight and black-blood MRA, is a reproducible and reliable imaging technique for detecting ≥50% stenosis in dysfunctional haemodialysis arteriovenous fistulas.
与多排螺旋计算机断层血管造影（MDCTA）相比，评估采用飞行时间法和黑血磁共振血管造影（NCE-MRA）的非增强磁共振血管造影在评估血液透析患者动静脉内瘘方面的诊断价值。
对21例维持性血液透析且动静脉内瘘功能不良的患者在同一天进行NCE-MRA和MDCTA检查。内瘘包括三个部分：动脉流入段、吻合口和静脉流出段。两名对NCE-MRA结果不知情的经验丰富的观察者一致记录CTA上显示的显著狭窄（≥50%）。另外两名不知道CTA结果的经验丰富的观察者独立记录NCE-MRA中的显著狭窄（≥50%）。以MDCTA作为标准参考，计算NCE-MRA的敏感性、特异性、阳性预测值、阴性预测值和准确性。
21例患者的63个血管段显示清晰。对于NCE-MRA的两名观察者，准确性分别为98%和95.4%；敏感性分别为96.4%和96.4%；特异性分别为97.1%和94.3%；阳性预测值分别为96.4%和93.1%；阴性预测值分别为97.1%和97.1%。NCE-MRA在检测狭窄方面的观察者间/观察者内一致性极佳，加权kappa值分别为0.968（95%置信区间[CI]，0.874 - 1）和0.936（95%CI，0.848 - 1）。
采用飞行时间法和黑血磁共振血管造影的非增强磁共振血管造影是一种可重复且可靠的成像技术，用于检测功能不良的血液透析动静脉内瘘中≥50%的狭窄。
