Department of Nephrology, University Hospital Regensburg, Regensburg, Germany.
Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany.
Ultrasound Med Biol. 2021 Jun;47(6):1484-1494. doi: 10.1016/j.ultrasmedbio.2021.02.014. Epub 2021 Mar 20.
Early detection of pathologic variations in an arteriovenous fistula (AVF) is essential for preventing fistula dysfunction in individuals undergoing hemodialysis. This study aimed to evaluate the clinical applicability of 3-D tomographic ultrasound (tUS) for rapid and simple visualization of AVF morphology and pathology. We assessed 53 AVFs in 50 consecutive patients using 3-D tUS including secondary, blinded reading. For all examinations, a high-end ultrasound (US) device was used with linear probe, attached to a tUS system to allow freehand 3-D scanning. Participants were examined by 2-D US and 3-D tUS with different raw data (B-mode, power Doppler, B-flow). Additional angiography was available for 15 participants with scheduled interventions. In all participants, 3-D tUS allowed a 3-D representation of AVFs in angiographic-like images with good image quality. The 2-D US assessment took 7.9 ± 4.0 min. A 3-D power Doppler scan required, on average, 1.4 ± 0.6 min. Diagnostic accuracy of blinded reading for pathologies was high (86.8% for aneurysms and 79.2% for stenoses). Bland-Altman plots showed an excellent correlation of 3-D tUS with 2-D US and angiography. 3-D tUS is an easily and rapidly applicable method for visualizing morphologic and pathologic AVF variations. Color-coded 3-D reconstruction of power Doppler data simplifies detection of perfused aneurysms and stenoses.
早期发现动静脉瘘（AVF）的病理变化对于预防接受血液透析的个体发生瘘功能障碍至关重要。本研究旨在评估三维断层超声（tUS）在快速简便地可视化 AVF 形态和病理方面的临床适用性。我们使用 3-D tUS 评估了 50 例连续患者的 53 个 AVF，包括二次、盲法阅读。所有检查均使用高端超声（US）设备和线性探头，连接到 tUS 系统，以允许自由手 3-D 扫描。参与者接受了 2-D US 和 3-D tUS 检查，使用了不同的原始数据（B 模式、功率多普勒、B 流）。对于 15 名有计划干预的参与者，还可进行额外的血管造影检查。在所有参与者中，3-D tUS 允许以类似于血管造影的图像对 AVF 进行 3-D 表示，具有良好的图像质量。2-D US 评估耗时 7.9 ± 4.0 分钟。平均而言，3-D 功率多普勒扫描需要 1.4 ± 0.6 分钟。盲法阅读对病变的诊断准确性很高（动脉瘤为 86.8%，狭窄为 79.2%）。Bland-Altman 图显示 3-D tUS 与 2-D US 和血管造影具有极好的相关性。彩色编码的 3-D 功率多普勒数据重建简化了灌注动脉瘤和狭窄的检测。
