[Value of multidetector computed tomography and digital subtraction angiography in assessment of arterio-venous fistula for hemodialysis--own experiences]

Abstract

The aim of the study was to compare the utility of multidetector computed tomography (MDCT) in assessment of arterio-venous fistula (AVF) for hemodialysis (HD) in comparison with the "golden standard" which is digital subtraction angiography (DSA).

Material and methods: The group consisted of 14 pts (9 males and 5 females, mean age 56.8 years +/- 14.3) on HD for 5 to 104 months, clinically suspected for failure of AVF. In all 14 subjects we performed MDCT and DSA of the arterio-venous fistula (AVF). MDCT exams were conducted on a 16 slice LightSpeed16 GE scanner, and on a Marconi Dual MX 8000. We assessed AVF from subclavian artery to the right atrium of the heart. DSA examinations were performed on GE Advantx LCA by Seldinger method. MDCT images were analysed on GE Advantage Workstation 4.1 with different reconstruction techniques: MPR (multiplanar reformation), MIP (maximum intensity projection), VE (virtual endoscopy), VR (volume rendering) and advanced vessel analysis for quantitative assessment of the vasculature.

Results: MDCT showed 31 pathologies of AVF in 13 patients. Only one patient did not have any significant abnormalities. DSA was normal in 5 pts and demonstrated 14 pathologies in further 9 patients. MDCTproved to be more useful than DSA in diagnosis of the following abnormalities: thrombosis, intramural calcifications and thickness of AVF wall (respectively MDCT/DSA--8/1; 2/1; 6/0).

Conclusion: In summary, MDCT is more useful diagnostic method than DSA in assessment of AVF morphology. Its high sensitivity and specificity makes this method especially useful in assessment of complicated AVF.