Mathias Meyer, Presenter: Nothing to Disclose

Holger Haubenreisser, Abstract Co-Author: Nothing to Disclose

Sonja Sudarski MD, Abstract Co-Author: Nothing to Disclose

Stefan Oswald Schoenberg MD, PhD, Abstract Co-Author: Institutional research agreement, Siemens AG

Thomas Henzler MD, Abstract Co-Author: Nothing to Disclose

To prospectively evaluate the feasibility and potential impact on therapy management of dynamic computed tomography angiography (dCTA) in patients with forearm arterio-venous fistula (AVF).

Fifteen patients with malfunctioning forearm AVFs were examined with ultrasound and a dCTA protocol on a 3rd generation dual-source CT using the following scan parameters: 21 phases; 2.5s/phase, 80kV, 100mAs, volume of contrast medium 45mL, flow rate 5.0mL/s. Forearm AVFs were classified into high-flow shunts, stenotic shunts (>50%) or non-stenotic shunts (<50%) by two radiologist. Further, therapy management was evaluated using only ultrasound examination and again by using dCTA in a consensus read by a radiologist and a vascular surgeon. Contrast arrival times and HU values were evaluated by placing regions-of-interest in arterial, venous and muscle structures of the arm.

All imaging studies were completed without any complications and contrast enhancement was rated as sufficient in all patients. Eight patients were scanned with their arms above their head and the other 7 patients with their arms aligned next to their body. Six patients were classified as having high-shunt flow and 6 were classified as having stenotic AVF grafts. The highest mean AVF enhancement was achieved 17 seconds after contrast media application (mean 412±84 HU). Utilizing the information from the dCTA protocol lead to a change in therapy management in5 patients when compared to ultrasound alone.

Dynamic CTA provides adequate AVF contrast enhancement as well as valuable additional clinical information, improving diagnostic confidence and leading to changes in therapy management when compared to ultrasound alone.

3rd generation dual-scource CT enables dCTA which is especially important as dCTA allows -next to stenotic lesion evaluation- also the evaluation of abnormalities like high-flow shunts.

Meyer, M, Haubenreisser, H, Sudarski, S, Schoenberg, S, Henzler, T, Dynamic CT Angiography of Arterio-venous Fistulas: Feasibility and Impact on Therapy Management in Comparison to Ultrasound.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011177.html