SUN-263 Fluo-3/AM labelling as a sensitive method in the diagnosis of calciphylaxis

Abstract

central venous catheter (CVC). Digital subtraction angiography (DSA) is recognized as the gold standard in diagnosing CVS, while in recent years Multi-detector CT angiography (MDCTA) with 3-dimensional vascular reconstruction has gained progress having the advantage of short scan time, fewer contrast injections, and free rotational projection. MDCTA findings were shown to closely correlate with DSA in benign thoracic central venous obstructions as well as native hemodialysis access dysfunctions. The purpose of this retrospective study was to further evaluate the diagnostic value of MDCTA for catheter related-CVS in hemodialysis patients compared with DSA. Methods: We recruited patients admitted to our hospital between October 1, 2012 and September 31, 2018. During a period of 6 years, hemodialysis patients with suspected catheter related-CVS who received both MDCTA and DSA were retrospectively enrolled. Demographic information and imaging test results were collected. MDCTA was performed using a 64detector CT scanner. Specific identifiers of protected individual health information were removed from the data set. Stenosis was defined as reductions in the diameter of the draining vein over 50% with respect to the adjacent normal segment. For analytic purposes, the highest stenosis grade per vessel segment was taken into account. We calculated the sensitivity and specificity of MDCTA in being able to detect the CVS vs. DSA findings. We compared the sensitivity, specificity, accuracy, diagnostic odds ratio (DOR), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) for MDCTA as an alternative to DSA. Cohen's kappa coefficient (k) was calculated to categorize the degree of inter-test agreement. Results: A total of 1533 vascular segments in 219 patients were analyzed. Among the 280 lesions identified by DSA, 156 were correctly identified by MDCTA. There were 124 false negative diagnoses and 41 false positive diagnoses. MDCTA had a high specificity (96.73%) but a low sensitivity (55.71%). The accuracy, DOR, PPV, NPV, PLR and NLR were 89. 24%, 37.20, 79.19%, 90.72%, 17.03, 0.4578 respectively with a moderate inter-test agreement (k¼0.5930). In stratified analyses of vascular segments, the specificities of MDCTA were 89.93% (superior vena cava), 98.95% (left innominate vein), 95.33% (right innominate vein), 99.53% (left subclavian vein), 97.61% (right subclavian vein), 97.13% (left internal jugular vein) and 95.86% (right internal jugular vein), while the sensitivities were 90.00%, 65.52%, 66.67%, 87.50%, 40.00%, 20.00% and 8.11% accordingly.