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Comparison of hemodialysis arteriovenous fistula blood flow rates measured by Doppler ultrasound and phase-contrast magnetic resonance imaging

Authors :
Prabir Roy-Chaudhury
Daniel B. Pike
Yong He
Scott A. Berceli
Yan-Ting Shiu
Alfred K. Cheung
Source :
Journal of vascular surgery. 68(6)
Publication Year :
2017

Abstract

OBJECTIVE: To compare blood flow rates measured by Doppler ultrasonography (DUS) and phase-contrast magnetic resonance imaging (PC-MRI) in patients having a hemodialysis arteriovenous fistula (AVF) and to identify scenarios in which there was significant discordance between these two approaches. METHODS: Blood flow rates in the proximal artery and draining vein of newly created upper-extremity AVFs were measured and compared using DUS and PC-MRI at 1 day, 6 weeks, and 6 months postoperatively. RESULTS: Blood flow rate in the proximal artery measured by DUS (1155 ± 907 mL/min, mean ± standard deviation) and by MRI (1170 ± 657 mL/min) were not statistically different (P = .812), based on 78 data pairs from 49 patients. Draining vein DUS-flow (1277 ± 995 mL/min) and MRI-flow (1130 ± 655 mL/min) were also not statistically different (P = .071), based on 64 data pairs. In both proximal artery and draining vein, the two methods substantially agreed with each other (Cohen’s kappa: proximal artery = 0.66, draining vein = 0.67) when flow rates were put into four clinically relevant categories (lower than 300, 300-599, 600-1499, and 1500 mL/min or higher). The Bland-Altman analyses of DUS- and MRI-flow identified six and four outliers for proximal artery and draining vein, respectively. Seven outliers had higher DUS- than MRI-flow, with all DUS scan sites having a large lumen and/or significant local curvature; the other three had lower DUS-flow, partly due to an underestimation of lumen diameter by DUS. CONCLUSIONS: DUS- and MRI-flow rates are generally comparable in both proximal artery and draining vein. When using DUS for flow measurements, careful attention to accurate lumen diameter measurements is needed and scan sites with marked curvature should be avoided. Our result may improve the accuracy of DUS-measured AVF blood flow rate.

Details

ISSN :
10976809
Volume :
68
Issue :
6
Database :
OpenAIRE
Journal :
Journal of vascular surgery
Accession number :
edsair.doi.dedup.....974e3852c93b2ecd9e842e75190ceec2