Assessment of the Hemodynamics of Autogenous Arteriovenous Fistulas With 4D Phase Contrast‐Based Flow Quantification MRI in Dialysis Patients

Abstract

Background Regular monitoring of autogenous arteriovenous fistulas (AVFs) for hemodialysis patients has importance. Hence, 4D flow MRI may be an alternative for assessing the hemodynamics of AVFs. Purpose To compare the hemodynamics of AVFs using Doppler ultrasound (DUS) and 4D‐MRI in renal dialysis patients. Study Type Case–control study from October 2017 to April 2018. Population Fifty patients (age [range] = 59.52 [39–71] years) with AVFs were included. Field Strength/Sequence Black‐blood MRI and 4D flow MRI at 3.0T and AVF ultrasonography were also performed. Assessment The hemodynamics acquired from 4D flow MRI and ultrasonography by two radiologists were compared. The AVF anatomy was described through an examination of the black‐blood MRI. Statistical Tests The consistency of AVF anatomy and hemodynamics and the consistency of the hemodynamics of AVFs from 4D flow MRI and ultrasound were analyzed by paired t‐tests. The morphological parameters of AVFs acquired from black‐blood MRI were used for a Pearson correlation analysis with the hemodynamic parameters obtained from 4D flow MRI data. Results The consistency of the morphological and hemodynamic parameters measured from MRI by the two radiologists was good (all P < 0.01). The velocities and flow volumes from the 4D flow MRI and vascular ultrasound of AVFs were in moderate agreement (all P < 0.05, r = 0.292–0.569), except for the peak flow velocity at the anastomosis (P = 0.366, r = –0.078). The flow volume and WSS near the anastomotic site were closely related to the morphology of the AVFs (all P < 0.05). The hemodynamics of the complications group were significantly different from those of patients without any complications (normal patients group) (all P < 0.01). Data Conclusion Compared with ultrasonography, 4D flow MRI is a promising technique to noninvasively estimate the AVF hemodynamics of renal dialysis patients. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:1272–1280.

Modified no-touch technique for radio-cephalic arteriovenous fistula increases primary patency and decreases juxta-anastomotic stenosis

“…21 In recent years, some studies have shown that 4D flow MRI is a promising technique for noninvasive estimation of AVF hemodynamics. 22 In this study, 4D-flow MRI was used to visualize and quantify the hemodynamics of AVF created by MNTT. Multidirectional flow, as characterized by medium or high the time-averaged WSS (Figure 3(a) and (b)) was located on the inner wall of the radial artery, the anastomosis floor (except the heel), and on the anterior wall of cephalic vein near the anastomosis floor.…”

Multimodality imaging evaluation of arteriovenous fistulas and grafts: a clinical practice review

“…4D flow is another option available with MRI, which provides the ability to assess flow, pressure, and wall shear stress. Suqin et al showed that 4D flow MRI velocities and flow volumes have moderate agreement with ultrasound values and specific hemodynamic parameters are associated with AVF maturation and complications ( 44 ).…”