Document Detail


Stenosis detection in native hemodialysis fistulas with MDCT angiography.
MedLine Citation:
PMID:  19304717     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The objective of our study was to assess the diagnostic value of 64-MDCT angiography in the evaluation of failing hemodialysis arteriovenous fistulas (AVFs) in comparison with conventional digital subtraction angiography (DSA). SUBJECTS AND METHODS: Thirty-six patients (22 men; mean age +/- SD, 65 +/- 15 years) with hemodialysis fistula dysfunction underwent MDCT angiography before DSA. Linear weighted kappa was used to calculate interobserver agreement for stenosis for both MDCT angiography and DSA on a 5-point scale. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the detection of >/= 50% stenosis or occlusion on MDCT angiography was calculated using DSA as the standard of reference. Wilcoxon's signed rank test and Mann-Whitney U test were used to compare differences in image quality between MDCT angiography and DSA and between MDCT angiography with the patient's arm stretched overhead or alongside the body, respectively. RESULTS: Interobserver agreement for detecting stenosis was excellent for both DSA (kappa = 0.86; 95% CI, 0.81-0.91) and MDCT angiography (kappa = 0.82; 95% CI, 0.77-0.87). Accuracy, sensitivity, specificity, PPV, and NPV of MDCT angiography for detecting >/= 50% stenosis or occlusion was 92.0% (95% CI, 86.8-95.3%), 90.2% (77.8-96.3%), 92.8% (85.9-96.6%), 85.2% (72.3-92.9%), and 95.4% (89.0-98.3%), respectively. No significant difference in image quality was seen between MDCT angiography and DSA (p = 0.3008) or between MDCT angiography with the patient's arm stretched overhead or alongside the body (p = 0.2912). CONCLUSION: MDCT angiography is a reproducible and reliable imaging technique for detection of >/= 50% stenosis or occlusion in dysfunctional hemodialysis fistulas.
Authors:
Sam Heye; Geert Maleux; Kathleen Claes; Dirk Kuypers; Raymond Oyen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  AJR. American journal of roentgenology     Volume:  192     ISSN:  1546-3141     ISO Abbreviation:  AJR Am J Roentgenol     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-23     Completed Date:  2009-04-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7708173     Medline TA:  AJR Am J Roentgenol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1079-84     Citation Subset:  AIM; IM    
Affiliation:
Department of Radiology, UZ Leuven, University Hospitals Leuven, Herestraat 49, Leuven, 3000 Vlaams-Brabant 3000, Belgium. sam.heye@uzleuven.be
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Angiography / methods*
Angiography, Digital Subtraction
Arteriovenous Shunt, Surgical*
Contrast Media / administration & dosage
Female
Graft Occlusion, Vascular / radiography*
Humans
Iopamidol / administration & dosage,  analogs & derivatives
Male
Middle Aged
Predictive Value of Tests
Radiographic Image Interpretation, Computer-Assisted
Renal Dialysis*
Sensitivity and Specificity
Statistics, Nonparametric
Tomography, X-Ray Computed*
Chemical
Reg. No./Substance:
0/Contrast Media; 62883-00-5/Iopamidol; 78649-41-9/iomeprol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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