Li Whenzheng, Li Fang, Wang He, Long Xueying, Ghimire Obin, Pei Yigang, Xiao Xiangcheng, Ning Jianping
Department of Radiology, Xiangya Hospital, Central South University, Changsha Philips Healthcare, Buiding, Shanghai Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China.
Medicine (Baltimore). 2017 Jun;96(26):e7135. doi: 10.1097/MD.0000000000007135.
Catheter-related thrombotic complications(TCs) can occur during the long term use of a chronic dialysis catheter (CDC), including fibrin sheath (FS), mural thrombosis (MT), venous thrombosis (VT), and intraluminal clots (IC), which has not been reported with MRI. The aim of our study was to evaluate the determination of catheter tip position (TP) and resolution of TCs in patients with transjugular CDC scheduled into the superior vena cava using high resolution magnetic resonance cholangiopancreatography (HR-MRCP) and T2-weighted imaging (HR-T2WI).
The study protocol was approved by the local Research Ethics Committee. Informed consent was obtained from all patients. In total, 41 consecutively enrolled transjugular CDC patients with suspected catheter dysfunction were scanned with HRMRCP and HR-T2WI. The distance from the top to the tip of the catheter and the presence and nature of catheter TCs were assessed by 2 experienced radiologists. Chest x-ray was taken within 1 to 2 days and CDC was withdrawn within 3 to 10 days from those patients with TCs identified by HR-MRI.
A total of 38 subjects successfully underwent HR-MRI, including 13 normal and 25 with TCs (fibrin sheath [FS]: n = 21, mural thrombosis [MT]: n = 7, venous thrombosis [VT]: n = 3, intraluminal clots [IC]: n = 4). There was no significant difference between HR-MRCP and chest x-ray in catheter TP determination (P = .124). Normal catheter appeared as "double eyes" on HR-T2WI and "double tracks" on HR-MRCP. TCs appeared as follows: FS displayed as a "thin ring" (<1mm) around the catheter, MT as patchy hyperintensity and VT as a "thick ring" (>5mm) on HR-T2WI. Unilateral IC appeared as a "single eye" on HR-T2WI and a "single track" on HR-MRCP (n = 3). Bilateral IC appeared as neither "eye" nor "track" (n = 1). Catheter withdrawal confirmed FS (n = 16), MT (n = 6), VT (n = 1), and IC (n = 4).
HR-MRCP and HR-T2WI are promising methods for visualizing TP and TCs in CDC patients, and are helpful in adjusting the treatment plan and avoiding the risk of pulmonary embolism.
长期使用慢性透析导管（CDC）时可能会发生与导管相关的血栓形成并发症（TCs），包括纤维蛋白鞘（FS）、壁血栓形成（MT）、静脉血栓形成（VT）和管腔内血栓（IC），而MRI尚未对这些情况进行报道。我们研究的目的是使用高分辨率磁共振胰胆管造影（HR-MRCP）和T2加权成像（HR-T2WI）评估经颈静脉置入上腔静脉的CDC患者的导管尖端位置（TP）以及TCs的情况。
本研究方案已获当地研究伦理委员会批准。所有患者均签署了知情同意书。共有41例连续入选的怀疑导管功能障碍的经颈静脉CDC患者接受了HR-MRCP和HR-T2WI扫描。2名经验丰富的放射科医生评估了从导管顶部到尖端的距离以及导管TCs的存在情况和性质。在1至2天内进行胸部X线检查，并在通过HR-MRI确定有TCs的患者中，于3至10天内拔除CDC。
共有38名受试者成功接受了HR-MRI检查，其中13名正常，25名有TCs（纤维蛋白鞘[FS]：n = 21，壁血栓形成[MT]：n = 7，静脉血栓形成[VT]：n = 3，管腔内血栓[IC]：n = 4）。在导管TP测定方面，HR-MRCP与胸部X线检查之间无显著差异（P = 0.124）。正常导管在HR-T2WI上表现为“双眼”，在HR-MRCP上表现为“双轨”。TCs表现如下：FS在HR-T2WI上显示为导管周围的“细环”（<1mm），MT表现为斑片状高信号，VT表现为“厚环”（>5mm）。单侧IC在HR-T2WI上表现为“单眼”，在HR-MRCP上表现为“单轨”（n = 3）。双侧IC在HR-T2WI上既不表现为“眼”也不表现为“轨”（n = 1）。拔除导管证实了FS（n = 16）、MT（n = 6）、VT（n = 1）和IC（n = 4）。
HR-MRCP和HR-T2WI是用于观察CDC患者TP和TCs的有前景的方法，有助于调整治疗方案并避免肺栓塞风险。
