Time-resolved MR Angiography with Generalized Autocalibrating Partially Parallel Acquisition and Time-resolved Echo-sharing Angiographic Technique for Hemodialysis Arteriovenous Fistulas and Grafts

doi:10.1097/01.RVI.0000220395.05050.77

Journal of Vascular and Interventional Radiology

Volume 17, Issue 6, June 2006, Pages 1003-1009

https://doi.org/10.1097/01.RVI.0000220395.05050.77 Get rights and content

PURPOSE

To evaluate the imaging of hemodialysis arteriovenous (AV) fistulas and grafts with use of magnetic resonance (MR) angiography with generalized autocalibrating partially parallel acquisition (GRAPPA) and time-resolved echosharing angiographic technique (TREAT) and compare the findings with those of digital subtraction angiography (DSA).

MATERIALS AND METHODS

The vascular tree directly related to AV fistulas and grafts was divided into nine segments. Images of each segment obtained on GRAPPA MR angiography were evaluated for the presence of stenosis, occlusion, and any other disease (eg, pseudoaneurysm) by two independent observers and compared with a consensus reading of the same segments on DSA imaging. Sensitivity and specificity were calculated with use of DSA as the gold standard modality, and each image on MR angiography and DSA was rated for quality. Linear-weighted κ scores were calculated as a measure of interobserver variability in the detection of pathologic processes.

RESULTS

A total of 80 segments were evaluated by each observer. For both observers, sensitivity rates for the detection of stenosis, occlusion, and any disease were 100% (95% CI, 52%–100%), 100% (95% CI, 20%–100%), and 100% (95% CI, 60%–100%), respectively. For observer 1, specificity rates for the detection of stenosis, occlusion, and any disease were 96% (95% CI, 88%–99%), 100% (95% CI, 94%–100%), and 96% (95% CI, 88%–99%), respectively. For observer 2, the specificity rates for the detection of stenosis, occlusion, and any disease were 93% (95% CI, 84%–98%), 100% (95% CI, 94%–100%), and 93% (95% CI, 84%–97%), respectively. Linear-weighted κ values for MR angiography and DSA were 0.78 ± 0.084 and 0.62 ± 0.152, respectively.

CONCLUSION

Time-resolved MR angiography with GRAPPA and TREAT offers excellent image quality and provides an accurate and reliable modality for the detection of pathologic processes in hemodialysis AV fistulas and grafts.

Section snippets

Patients

Patients referred to the interventional radiology department for elective DSA evaluation of graft dysfunction were considered candidates for our study. Bases for referral included pain, inability to cannulate AV fistulas, and impeded blood flow during dialysis, in addition to decreased flow rates measured by US and a history of intervention with the need for follow-up. Study inclusion required all corresponding DSA imaging to be completed within 4 weeks of MR angiography. Exclusion criteria

RESULTS

Eleven patients, including eight men and three women, qualified for this study, and their conditions were evaluated with time-resolved MR angiography. The mean age of the patients was 56 years (range, 23–79 y).

Among these patients, 19 vascular segments could not be compared because of a lack of imaging of the particular segment on DSA or MR angiography. A total of 80 segments were therefore analyzed on MR angiography, along with their corresponding DSA images. For MR angiography, the mean

DISCUSSION

Results of the present study indicate that time-resolved MR angiography with GRAPPA and TREAT provides excellent image quality while consistently and accurately demonstrating stenoses and occlusions in AV fistulas and grafts with high sensitivity and specificity and negligible interobserver variability.

Linear-weighted κ scores of 0.78 ± 0.084 and 0.62 ± 0.152 for MR angiography and DSA, respectively, corresponded to good interobserver agreement in the reading of each segment visualized in this

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Predicting hemodialysis access failure with color flow Doppler ultrasound
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Management of suspected hemodialysis graft dysfunction: usefulness of diagnostic US
Radiology
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RN Planken et al.
Stenosis detection in forearm hemodialysis arteriovenous fistulae by multiphase contrast-enhanced magnetic resonance angiography: preliminary experience
J Magn Reson Imaging
(2003)

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: None of the authors have identified a conflict of interest.

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Time-resolved MR Angiography with Generalized Autocalibrating Partially Parallel Acquisition and Time-resolved Echo-sharing Angiographic Technique for Hemodialysis Arteriovenous Fistulas and Grafts

PURPOSE

MATERIALS AND METHODS

RESULTS

CONCLUSION

Section snippets

Patients

RESULTS

DISCUSSION

Kidney Int

Predicting hemodialysis access failure with color flow Doppler ultrasound

Am J Nephrol

Management of suspected hemodialysis graft dysfunction: usefulness of diagnostic US

Radiology

Stenosis detection in forearm hemodialysis arteriovenous fistulae by multiphase contrast-enhanced magnetic resonance angiography: preliminary experience

J Magn Reson Imaging