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Ferumoxytol MR Angiography versus Duplex US for Vascular Mapping before Arteriovenous Fistula Surgery for Hemodialysis
- Source :
- Radiology. 297(1)
- Publication Year :
- 2020
-
Abstract
- Background Duplex US is performed routinely for vascular mapping prior to arteriovenous fistula (AVF) creation for hemodialysis but cannot demonstrate the central vasculature. Ferumoxytol, an iron oxide nanoparticle, provides an alternative to gadolinium contrast material for MR angiography for safe use in chronic kidney disease (CKD). Purpose To assess the clinical utility of ferumoxytol-enhanced MR angiography compared with duplex US for vascular mapping before upper limb AVF creation in participants with CKD. Materials and Methods In a prospective comparative study (ClinicalTrials.gov: NCT02997046) from December 2016 to August 2018, participants with CKD underwent ferumoxytol-enhanced MR angiography and duplex US. Two independent readers evaluated vessels for diameter, stenosis or occlusion, arterial disease, and central stenosis. Intraclass correlation coefficients (ICCs) and Bland-Altman plots were used to assess intra- and interreader variability. On the basis of accepted standards for AVF creation, an algorithm was developed to predict AVF outcome based on imaging findings. Multivariable regression models used AVF success as the dependent variable and age, sex, and duplex US or ferumoxytol-enhanced MR angiography findings as independent variables. Results Fifty-nine participants with CKD (mean age, 59 years ± 13 [standard deviation]; 30 women) were evaluated. A total of 51 fistulas were created, of which 24 (47%) were successful. Ferumoxytol-enhanced MR angiography showed excellent inter- and intrareader repeatability (ICC, 0.84-0.99) for all variables assessed. In addition to revealing 15 central vasculature stenoses, ferumoxytol-enhanced MR angiography resulted in characterization of 88 of 236 (37%) of the arterial sections examined as unsuitable for AVF creation compared with 61 of 236 (26%) sections with duplex US (
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Arteriovenous fistula
Contrast Media
Magnetic resonance angiography
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Arteriovenous Shunt, Surgical
Renal Dialysis
medicine
Vascular Patency
Humans
Radiology, Nuclear Medicine and imaging
Ultrasonography, Doppler, Duplex
medicine.diagnostic_test
business.industry
Mr angiography
Middle Aged
medicine.disease
Ferrosoferric Oxide
Surgery
Ferumoxytol
Stenosis
Duplex (building)
030220 oncology & carcinogenesis
Female
Hemodialysis
business
Algorithms
Magnetic Resonance Angiography
Subjects
Details
- ISSN :
- 15271315
- Volume :
- 297
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Radiology
- Accession number :
- edsair.doi.dedup.....ca89f8861e12f153cc9110f3fcfe2400