Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China.
Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China.
Phlebology. 2021 Apr;36(3):217-225. doi: 10.1177/0268355520955090. Epub 2020 Sep 14.
The objective is to compare Multi-detector CT angiography (MDCTA) and digital subtraction angiography (DSA) in diagnosing hemodialysis catheter related-central venous stenosis (CVS). During a period of 6 years, hemodialysis patients with suspected catheter related-CVS who received both MDCTA and DSA were retrospectively enrolled. We analyzed the sensitivity, specificity, accuracy, Cohen's kappa coefficient (κ) and other diagnostic parameters for MDCTA compared to DSA. A total of 1533 vascular segments in 219 patients were analyzed. Among the 280 lesions identified by DSA, 156 were correctly identified by MDCTA. There were 124 false negative and 41 false positive diagnoses. MDCTA had a high specificity (96.73%) but a low sensitivity (55.71%), with a moderate inter-test agreement (κ = 0.5930). In stratified analyses of vascular segments, the specificities of MDCTA were 89.93% (superior vena cava), 98.95% (left brachiocephalic vein), 95.33% (right brachiocephalic vein), 99.53% (left subclavian vein), 97.61% (right subclavian vein), 97.13% (left internal jugular vein), and 95.86% (right internal jugular vein), while the sensitivities were 90.00%, 65.52%, 66.67%, 87.50%, 40.00%, 20.00% and 8.11%, respectively. Good to excellent inter-test agreement was observed for the superior vena cava (κ = 0.7870), left brachiocephalic vein (κ = 0.7300), right brachiocephalic vein (κ = 0.6610), and left subclavian vein (κ = 0.8700) compared with poor to low agreement for the right subclavian vein (κ = 0.3950), left internal jugular vein (κ = 0.1890), and right internal jugular vein (κ = 0.0500). MDCTA had a high specificity in diagnosing hemodialysis catheter related-CVS. Its sensitivity varied by central venous segments, with better performance in superior vena cava and brachiocephalic veins.
目的是比较多层螺旋 CT 血管造影（MDCTA）和数字减影血管造影（DSA）在诊断血液透析导管相关中心静脉狭窄（CVS）中的作用。在 6 年期间，回顾性纳入了接受 MDCTA 和 DSA 检查的疑似导管相关-CVS 的血液透析患者。我们分析了 MDCTA 与 DSA 相比的敏感性、特异性、准确性、Cohen's kappa 系数（κ）和其他诊断参数。总共分析了 219 名患者的 1533 个血管段。在 DSA 确定的 280 个病变中，MDCTA 正确识别了 156 个。有 124 个假阴性和 41 个假阳性诊断。MDCTA 具有很高的特异性（96.73%）但敏感性低（55.71%），具有中等的检测间一致性（κ=0.5930）。在血管段的分层分析中，MDCTA 的特异性分别为 89.93%（上腔静脉）、98.95%（左侧头臂静脉）、95.33%（右侧头臂静脉）、99.53%（左侧锁骨下静脉）、97.61%（右侧锁骨下静脉）、97.13%（左侧颈内静脉）和 95.86%（右侧颈内静脉），而敏感性分别为 90.00%、65.52%、66.67%、87.50%、40.00%、20.00%和 8.11%。上腔静脉（κ=0.7870）、左侧头臂静脉（κ=0.7300）、右侧头臂静脉（κ=0.6610）和左侧锁骨下静脉（κ=0.8700）的检测间一致性良好到优秀，而右侧锁骨下静脉（κ=0.3950）、左侧颈内静脉（κ=0.1890）和右侧颈内静脉（κ=0.0500）的一致性差到低。MDCTA 在诊断血液透析导管相关-CVS 方面具有很高的特异性。其敏感性因中心静脉段而异，在上腔静脉和头臂静脉中表现更好。
