R. Nils Planken MD, Presenter: Nothing to Disclose

Jan H. Tordoir MD,PHD, Abstract Co-Author: Nothing to Disclose

Michiel Willem De Haan MD, Abstract Co-Author: Nothing to Disclose

Walter H Backes PhD, Abstract Co-Author: Nothing to Disclose

Jos M.A. van Engelshoven PhD, Abstract Co-Author: Nothing to Disclose

Tim Leiner MD, Abstract Co-Author: Nothing to Disclose

To compare the accuracy of contrast-enhanced (CE) MRA and ultrasonography for selective depiction and diameter measurement of upper extremity arteries and veins prior to arteriovenous fistulae (AVF) placement for hemodialysis.

21 renal failure patients scheduled for AVF placement underwent B-mode ultrasonography and CE-MRA of the upper extremity. Vessel patency was assessed with color-aided duplex ultrasonography (DU) and diameters were measured using B-mode imaging (10 MHz linear probe, Aloka). CE-MRA was done using a 1.5T clinical MR scanner (Intera, Philips Medical Systems) and 0.3 mmol/kg Gd-DTPA (Magnevist, Schering), divided into 4 separate intravenous injections. Contrast was injected in the contralateral hand to depict proximal and distal arteries in the target extremity. For depiction of proximal and distal veins contrast was injected into an ipsilateral hand vein. Distal superficial veins were imaged using a proximal pressure cuff (60 mmHg) for both DU and CE-MRA. CE-MRA diameter measurements were compared with those obtained by preoperative DU. Intra-operative (IO) diameter measurements using coronary artery probes served as standard of reference.

DU overestimated true arterial diameter more than CE-MRA. However, both CE-MRA and DU both overestimated arterial diameters significantly compared to IO measurements (CE-MRA: 4.0 ± 0.8 mm; DU: 4.4 ± 1.2 mm; IO: 3.4 ± 0.6 mm; both P < 0.01). DU significantly underestimated the venous diameter compared to IO measurements (DU: 3.1 ± 1.4 mm; IO: 4.8 ± 1.5 mm, P < 0.001). CE-MRA accurately assessed the venous diameter in comparison to IO measurements (CE-MRA: 4.6 ± 1.3 mm; IO: 4.8 ± 1.5 mm, P = 0.4).

Both CE-MRA and DU slightly overestimated upper extremity arterial diameters. CE-MRA enables accurate determination of true upper extremity venous diameter and is a more accurate technique when compared to DU. Accurate diameter measurements are important in clinical practice because they determine the exact type of AVF in individual patients.

T.L.: Dr. Leiner has received grant support from Amersham Health and Schering

Planken, R, Tordoir, J, De Haan, M, Backes, W, van Engelshoven, J, Leiner, T, Selective MR-Arteriography and Venography Compared to Ultrasonography of the Entire Upper Extremity prior to Arteriovenous Fistula Placement for Hemodialysis.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4414627.html