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Title: Stenosis detection in native hemodialysis fistulas with MDCT angiography
Authors: Heye, Sam ×
Maleux, Geert
Claes, Kathleen
Kuypers, Dirk
Oyen, Raymond #
Issue Date: Apr-2009
Publisher: American Roentgen Ray Society
Series Title: American Journal of Roentgenology vol:192 issue:4 pages:1079-84
Abstract: OBJECTIVE: The objective of our study was to assess the diagnostic value of 64-MDCT angiography in the evaluation of failing hemodialysis arteriovenous fistulas (AVFs) in comparison with conventional digital subtraction angiography (DSA). SUBJECTS AND METHODS: Thirty-six patients (22 men; mean age +/- SD, 65 +/- 15 years) with hemodialysis fistula dysfunction underwent MDCT angiography before DSA. Linear weighted kappa was used to calculate interobserver agreement for stenosis for both MDCT angiography and DSA on a 5-point scale. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the detection of >/= 50% stenosis or occlusion on MDCT angiography was calculated using DSA as the standard of reference. Wilcoxon's signed rank test and Mann-Whitney U test were used to compare differences in image quality between MDCT angiography and DSA and between MDCT angiography with the patient's arm stretched overhead or alongside the body, respectively. RESULTS: Interobserver agreement for detecting stenosis was excellent for both DSA (kappa = 0.86; 95% CI, 0.81-0.91) and MDCT angiography (kappa = 0.82; 95% CI, 0.77-0.87). Accuracy, sensitivity, specificity, PPV, and NPV of MDCT angiography for detecting >/= 50% stenosis or occlusion was 92.0% (95% CI, 86.8-95.3%), 90.2% (77.8-96.3%), 92.8% (85.9-96.6%), 85.2% (72.3-92.9%), and 95.4% (89.0-98.3%), respectively. No significant difference in image quality was seen between MDCT angiography and DSA (p = 0.3008) or between MDCT angiography with the patient's arm stretched overhead or alongside the body (p = 0.2912). CONCLUSION: MDCT angiography is a reproducible and reliable imaging technique for detection of >/= 50% stenosis or occlusion in dysfunctional hemodialysis fistulas.
URI: 
ISSN: 0361-803X
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Laboratory of Nephrology
Radiology
× corresponding author
# (joint) last author

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