Abstract
ObjectiveTo compare non-contrast enhanced MRI with ultrasound (US) for measurement of arm blood vessel geometries and flow velocities in volunteers and patients with end-stage renal disease.Materials and methodsSubjects were scanned using US (reference standard), and MRI 2D time-of-flight (ToF), 2D phase contrast (PC), and 3D multi-echo data image combination (MEDIC). Patients were also scanned after arteriovenous fistula (AVF) surgery.ResultsFor mean vessel diameters (radial and brachial arteries; cephalic vein) MEDIC measurements were similar to US (p > 0.05). However, ToF underestimated the mean diameter of the cephalic vein relative to US (p < 0.05). For arterial velocity measurements, the mean values derived by PC-MR and US were similar (p > 0.05). Post-operatively, the intra-luminal signal intensity was hypo-intense at the anastomosis site using ToF and MEDIC. At the same site the outer boundary of the vessel was consistently lost on ToF, but remained clearly delineated on the MEDIC images.DiscussionWith the exception of ToF, the MRI data demonstrated excellent agreement with US for measurements of vessel geometry and flow velocity. Further, the ability to clearly delineate the post-surgery vessel edges with MEDIC MRI suggests that the technique may be useful for surveillance after AVF creation or for patient-specific modelling studies.
Highlights
End-stage renal disease (ESRD) affects an estimated two million people worldwide and is increasing at a rate of around 3% per year [1]
All 16 participants were scanned successfully using both US and Magnetic resonance imaging (MRI), initial observation of the images revealed that the following exclusions were required: ToF: one dataset (PRF5)—unreadable due to participant movement; multi-echo data image combination (MEDIC): one dataset (HV4)—unreadable due to participant movement; phase contrast (PC)-MRI: two datasets (PRF4, HV2)—arterial velocity encoding (VENC) sub-optimal; US: one dataset (HV6)—file data corrupted during storage
Participant PRF6 developed a post-surgical infection at the anastomosis site, but with no long-term complications
Summary
End-stage renal disease (ESRD) affects an estimated two million people worldwide and is increasing at a rate of around 3% per year [1]. Patients with ESRD require some form of renal replacement therapy (RRT). Haemodialysis (HD) is the most common form of RRT; the provision of optimal vascular access, essential for successful HD, has long remained a challenge. The arteriovenous fistula (AVF) first described by Brescia and Cimino in 1966 [2], revolutionised vascular access, allowing repeated access to high volume blood flow by forming a surgical anastomosis between the radial artery and cephalic vein. Blood flow through the venous vessel instantly increases. The venous and arterial segments of a recently created AVF should dilate in response to the increased blood flow through the newly established low resistance pathway [3]
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