四维MR血流成像在肾透析患者自体动静脉瘘血流动力学研究中的应用价值
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摘要
目的·探讨利用四维MR血流成像(four-dimensional flow MRI,4D flow MRI)评估肾透析患者前臂自体动静脉瘘(autogenous arteriovenous fistula,AVF)血流动力学的可行性。方法·选择上海交通大学医学院附属仁济医院肾脏科的血液透析患者45例,接受前臂AVF血管超声检查及磁共振成像。利用配对t检验对2名放射科医师经4D flow MRI测量的血流动力学参数的一致性、4D flow MRI与血管超声在AVF相同层面血流动力学参数的一致性进行分析;利用磁共振黑血序列获取AVF形态学参数,并就该参数与4D flow MRI血流动力学参数进行Pearson相关分析。结果·42例患者成功完成了前臂AVF血管超声检查及磁共振成像。配对t检验结果显示,2名放射科医师利用4D flow MRI测量的血流动力学参数重复性较好(均P=0.000);除了吻合口峰流速(r=-0.078,P>0.05)外,4D flow MRI与血管超声的血流动力学参数一致性较好(r=0.292～0.569,均P<0.05)。经Pearson相关分析显示,AVF头静脉流量与静动脉管径比、吻合口面积均相关(r=-0.671,r=0.482,均P<0.05);吻合口附近剪切力与吻合角度、管壁厚度均相关(r=0.530,r=0.462,均P<0.05)。结论·利用4D flow MRI可以获取肾透析患者前臂AVF的血流动力学参数,对进一步研究AVF功能障碍有一定的参考价值。
Objective · To investigate the feasibility of four-dimensional flow MRI(4D flow MRI) in evaluating the hemodynamics of forearm autologous arteriovenous fistula(AVF) in renal dialysis patients. Methods · Forty-five patients from Renal Division of Renji Hospital, Shanghai Jiao Tong University School of Medicine were included. Patients with forearm AVF underwent ultrasonography and MRI. The consistency of 4D flow MRI hemodynamic parameters measured by two radiologists and hemodynamic parameters at the same plane of AVF by 4D flow MRI and ultrasonography were analyzed by paired t test. The morphological parameters of AVF were acquired from black blood sequence, and they were used for Pearson correlation analysis with the hemodynamic parameters obtained from 4D flow MRI. Results · Forty-two patients completed the forearm AVF ultrasonography and MRI successfully.Paired t test showed that the consistency of 4D flow MRI hemodynamic parameters by two radiologists was good(all P=0.000), and all hemodynamic parameters measured by 4D flow MRI and ultrasonography were in good agreement(r=0.292-0.569, all P<0.05) except for the peak flow velocity at anastomosis(r=-0.078, P>0.05). Pearson correlation analysis showed that the cephalic venous flow volume of AVF was correlated with the diameter ratio of the cephalic venous to radial artery and the anastomosis area( r=-0.671, r=0.482, both P<0.05), and the wall shear stress(WSS) near the anastomosis was correlated with the anastomosis angle and wall thickness(r=0.530, r=0.462, both P<0.05). Conclusion · 4D flow MRI can be used to evaluate the hemodynamic parameters of forearm AVF in renal dialysis patients, which can provide a reference for further study of AVF dysfunction.
Objective · To investigate the feasibility of four-dimensional flow MRI(4D flow MRI) in evaluating the hemodynamics of forearm autologous arteriovenous fistula(AVF) in renal dialysis patients. Methods · Forty-five patients from Renal Division of Renji Hospital, Shanghai Jiao Tong University School of Medicine were included. Patients with forearm AVF underwent ultrasonography and MRI. The consistency of 4D flow MRI hemodynamic parameters measured by two radiologists and hemodynamic parameters at the same plane of AVF by 4D flow MRI and ultrasonography were analyzed by paired t test. The morphological parameters of AVF were acquired from black blood sequence, and they were used for Pearson correlation analysis with the hemodynamic parameters obtained from 4D flow MRI. Results · Forty-two patients completed the forearm AVF ultrasonography and MRI successfully.Paired t test showed that the consistency of 4D flow MRI hemodynamic parameters by two radiologists was good(all P=0.000), and all hemodynamic parameters measured by 4D flow MRI and ultrasonography were in good agreement(r=0.292-0.569, all P<0.05) except for the peak flow velocity at anastomosis(r=-0.078, P>0.05). Pearson correlation analysis showed that the cephalic venous flow volume of AVF was correlated with the diameter ratio of the cephalic venous to radial artery and the anastomosis area( r=-0.671, r=0.482, both P<0.05), and the wall shear stress(WSS) near the anastomosis was correlated with the anastomosis angle and wall thickness(r=0.530, r=0.462, both P<0.05). Conclusion · 4D flow MRI can be used to evaluate the hemodynamic parameters of forearm AVF in renal dialysis patients, which can provide a reference for further study of AVF dysfunction.
引文
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[16]谢筱彤,刘宏,涂岩,等.动静脉内瘘超声参数与内瘘功能不良的相关性研究[J].肾脏病与透析肾移植杂志,2017,26(5):442-446.
[17]康志敏,洪大情,何强,等.尿毒症患者血管内瘘手术前后的彩超观察[J].四川医学,2010,31(9):1362-1363.
[18]车霞静,倪兆慧,严玉澄,等.血液透析患者的内瘘血流量在预测内瘘预后中的作用[J].中国血液净化,2009,8(12):669-672.
[19]He Y,Terry CM,Nguyen C,et al.Serial analysis of lumen geometry and hemodynamics in human arteriovenous fistula for hemodialysis using magnetic resonance imaging and computational fluid dynamics[J].J Biomech,2013,46(1):165-169.
[20]Dyverfeldt P,Bissell M,Barker AJ,et al.4D flow cardiovascular magnetic resonance consensus statement[J].J Cardiovasc Magn Reson,2015,17:72.
[21]Zhu XJ,Jiang WJ,Liu L,et al.Plaques of nonstenotic basilar arteries with isolated pontine infarction on three-dimensional high isotropic resolution magnetic resonance imaging[J].Chin Med J(Engl),2015,128(11):1433-1437.
[22]冯飞,赵武贻,李中华,等.快速与标准三维时间飞跃法MRA在颅内动脉成像的对比研究[J].磁共振成像,2015,6(6):422-425.
[23]Perazella MA.How should nephrologists approach gadolinium-based contrast imaging in patients with kidney disease?[J].Clin J Am Soc Nephrol,2008,3(3):649-651.
[2]Wang Y,Krishnamoorthy M,Banerjee R,et al.Venous stenosis in a pig arteriovenous fistula model-anatomy,mechanisms and cellular phenotypes[J].Nephrol Dial Transplant,2008,23(2):525-533.
[3]Asif A,Cherla G,Merrill D,et al.Conversion of tunneled hemodialysis catheter-consigned patients to arteriovenous fistula[J].Kidney Int,2005,67(6):2399-2406.
[4]Jia L,Wang L,Wei F,et al.Effects of wall shear stress in venous neointimal hyperplasia of arteriovenous fistulae[J].Nephrology(Carlton),2015,20(5):335-342.
[5]American Institute of Ultrasound in Medicine(AIUM),American College of Radiology(ACR),Society of Radiologists in Ultrasound(SRU).AIUM practice guideline for the performance of peripheral arterial ultrasound examinations using color and spectral Doppler imaging[J].J Ultrasound Med,2014,33(6):1111-1121.
[6]Jaberi A,Muradali D,Marticorena RM,et al.Arteriovenous fistulas for hemodialysis:application of high-frequency US to assess vein wall morphology for cannulation readiness[J].Radiology,2011,261(2):616-624.
[7]Stankovic Z,Allen BD,Garcia J,et al.4D flow imaging with MRI[J].Cardiovasc Diagn Ther,2014,4(2):173-192.
[8]Rose MJ,Jarvis K,Chowdhary V,et al.Efficient method for volumetric assessment of peak blood flow velocity using 4D flow MRI[J].J Magn Reson Imaging,2016,44(6):1673-1682.
[9]van Ooij P,Powell AL,Potters WV,et al.Reproducibility and inter-observer variability of systolic blood flow velocity and 3D wall shear stress derived from4D flow MRI in the healthy aorta[J].J Magn Reson Imaging,2016,43(1):236-248.
[10]Tariq U,Hsiao A,Alley M,et al.Venous and arterial flow quantification are equally accurate and precise with parallel imaging compressed sensing 4Dphase contrast MRI[J].J Magn Reson Imaging,2013,37(6):1419-1426.
[11]Treitl KM,Maurus S,Sommer NN,et al.3D-black-blood 3T-MRI for the diagnosis of thoracic large vessel vasculitis:a feasibility study[J].Eur Radiol,2017,27(5):2119-2128.
[12]Okuchi S,Okada T,Fujimoto K,et al.Visualization of lenticulostriate arteries at 3T:optimization of slice-selective off-resonance sinc pulse-prepared TOF-MRA and its comparison with flow-sensitive black-blood MRA[J].Acad Radiol,2014,21(6):812-816.
[13]Hsiao A,Alley MT,Massaband P,et al.Improved cardiovascular flow quanfitication with time-resolved volumetric phase-contrast MRI[J].Pediatr Radiol,2011,41(6):711-720.
[14]Hwuang E,Vidorreta M,Schwartz N,et al.Assessment of uterine artery geometry and hemodynamics in human pregnancy with 4D flow MRI and its correlation with Doppler ultrasound[J].J Magn Reson Imaging,2019,49(1):59-68.
[15]Hsiao A,Lustig M,Alley MT,et al.Rapid pediatric cardiac assessment of flow and ventricular volume with compressed sensing parallel imaging volumetric cine phase-contrast MRI[J].AJR Am J Roentgenol,2012,198(3):W250-W259.
[16]谢筱彤,刘宏,涂岩,等.动静脉内瘘超声参数与内瘘功能不良的相关性研究[J].肾脏病与透析肾移植杂志,2017,26(5):442-446.
[17]康志敏,洪大情,何强,等.尿毒症患者血管内瘘手术前后的彩超观察[J].四川医学,2010,31(9):1362-1363.
[18]车霞静,倪兆慧,严玉澄,等.血液透析患者的内瘘血流量在预测内瘘预后中的作用[J].中国血液净化,2009,8(12):669-672.
[19]He Y,Terry CM,Nguyen C,et al.Serial analysis of lumen geometry and hemodynamics in human arteriovenous fistula for hemodialysis using magnetic resonance imaging and computational fluid dynamics[J].J Biomech,2013,46(1):165-169.
[20]Dyverfeldt P,Bissell M,Barker AJ,et al.4D flow cardiovascular magnetic resonance consensus statement[J].J Cardiovasc Magn Reson,2015,17:72.
[21]Zhu XJ,Jiang WJ,Liu L,et al.Plaques of nonstenotic basilar arteries with isolated pontine infarction on three-dimensional high isotropic resolution magnetic resonance imaging[J].Chin Med J(Engl),2015,128(11):1433-1437.
[22]冯飞,赵武贻,李中华,等.快速与标准三维时间飞跃法MRA在颅内动脉成像的对比研究[J].磁共振成像,2015,6(6):422-425.
[23]Perazella MA.How should nephrologists approach gadolinium-based contrast imaging in patients with kidney disease?[J].Clin J Am Soc Nephrol,2008,3(3):649-651.
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