使用自定义采集协议和成像方法对透析通路中的血流进行定量评估：一项临床验证研究。

Quantification of Blood Flow in Dialysis Access Using Custom-Acquisition Protocol and Imaging Methods: A Clinical Validation Study.

机构信息

Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH; Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195.

Section of Vascular and Interventional Radiology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195.

出版信息

J Vasc Interv Radiol. 2019 Jul;30(7):1062-1068.e2. doi: 10.1016/j.jvir.2018.10.023. Epub 2019 Mar 27.

DOI:10.1016/j.jvir.2018.10.023

PMID:30928484

Abstract

PURPOSE

To determine access blood flow (ABF) rate using 2D image sequences acquired with digital subtraction angiography (DSA) and fluoroscopy.

MATERIALS AND METHODS

A total of 23 patients with known or suspected malfunctioning accesses were imaged using 2 filming modes: DSA at 3 or 6 frames/s (F/s), and fluoroscopy at 10 or 15 pulses/s (P/s). ABF rates were quantified using a bolus tracking method based on cross-correlation algorithm and compared with catheter-based thermal dilution (TD) flow measurements. The indicator-dilution curves were fitted with a gamma-variate (GV) curve fitting model to assess the effect on accuracy. Radiation doses were calculated to examine any increased susceptibility to tissue reactions and stochastic effects.

RESULTS

For DSA images, the absolute percent deviations (mean ± standard error of mean) in computed flow vs TD flow measurements at 3 F/s and 6 F/s were 34% ± 4.5% and 20% ± 4.7%, respectively, without curve fitting, and 31% ± 3.3% and 20% ± 4.1%, respectively, with curve fitting. For fluoroscopic images, the deviations at 10 P/s and 15 P/s were 44% ± 7.3% and 68% ± 10.7%, respectively, without curve fitting and 36% ± 6.4% and 48% ± 7.1%, respectively, with curve fitting. The mean peak skin dose and effective dose at 6 F/s were 3.28 mGy and 75 μSv, respectively.

CONCLUSIONS

Digital subtraction angiography images obtained at 6 F/s offered the highest accuracy for dialysis access blood flow quantification.

摘要

目的

使用数字减影血管造影（DSA）和透视获得的 2 维图像序列来确定入路血流（ABF）速率。

材料与方法

共对 23 例已知或疑似入路功能障碍的患者进行了 2 种摄像模式的成像：3 帧/秒（F/s）或 6 帧/秒（F/s）的 DSA，以及 10 脉冲/秒（P/s）或 15 脉冲/秒（P/s）的透视。使用基于互相关算法的示踪剂跟踪方法定量 ABF 速率，并将其与基于导管的热稀释（TD）流量测量进行比较。使用伽马变量（GV）曲线拟合模型拟合指示剂稀释曲线，以评估其对准确性的影响。计算辐射剂量以检查对组织反应和随机效应的敏感性增加。

结果

对于 DSA 图像，在未进行曲线拟合时，3 F/s 和 6 F/s 计算流量与 TD 流量测量值的绝对百分比偏差（平均值±平均值的标准误差）分别为 34%±4.5%和 20%±4.7%，而进行曲线拟合时则分别为 31%±3.3%和 20%±4.1%。对于透视图像，在 10 P/s 和 15 P/s 时，无曲线拟合的偏差分别为 44%±7.3%和 68%±10.7%，而有曲线拟合的偏差分别为 36%±6.4%和 48%±7.1%。6 F/s 时的平均皮肤峰值剂量和有效剂量分别为 3.28 mGy 和 75 μSv。