4D-flow MRI对血液透析患者自体桡动脉-头静脉内瘘的血流可视化及流速定量的初步研究  

Visualization and Quantification of Blood Flow in the Native Radiocephalic Fistula of Hemodialysis Patients by 4D-flow MRI: A Preliminary Study

作　　者：裴贻刚[1] 龙学颖[1] 游潇 廖云杰 王维[3] 肖湘成 钟永 PEI Yigang;LONG Xueying;YOU Xiao(Radiology department,Xiangya Hospital,Central South University,P.R.China)

机构地区：[1]中南大学湘雅医院放射科 [2]中南大学湘雅三医院放射科 [3]中南大学湘雅医院肾内科

出　　处：《临床放射学杂志》2018年第8期1342-1346,共5页Journal of Clinical Radiology

基　　金：国家自然科学基金面上项目资助(编号:81371541);湖南省自然科学基金(编号:2018JJ2656)

摘　　要：目的评估4D-flow MRI对血液透析患者自体桡动脉-头静脉内瘘（RCF）的血流可视化及流速定量的可行性。方法搜集本院2015年9月至2016年4月建立RCF进行血液透析的25名患者。所有患者均接受3次不同速度编码（Venc）的4D-flow MRI扫描,Venc分别为200 cm/s、400 cm/s、600 cm/s。由2名放射科医师共同对4Dflow MRI原始图像进行评估,从中选择最佳的Venc图像进行后处理,并获取RCF的血流流线图,判断有无RCF狭窄、瘤样扩张、湍流;同时选择3个点（分别为吻合口处、距吻合口1 cm处桡动脉侧、距吻合口1 cm处头静脉侧）对血流速度进行定量分析,包括血流峰值（V-peak）及最低血流速度（V-min）,并与多普勒超声（DUS）对照,评估4Dflow MRI对RCF血流流速定量分析的可行性。结果 22例受试者成功完成4D-flow MRI扫描并显示RCF全貌,发现自体RCF狭窄8例,血流湍流9例,静脉瘤样扩张5例。4D-flow与DUS吻合口处V-peak分别为（354.6±133.7）cm/s、（354.8±131.4）cm/s（P=0.96,r=0.97）,V-min分别为（136.3±73.4）cm/s、（138.1±70.6）cm/s（P=0.57,r=0.96）;桡动脉侧距吻合口1cm处V-peak分别为（168.4±41.4）cm/s、（162.3±41.0）cm/s（P=0.19,r=0.76）,V-min分别为（73.7±20.5）cm/s、（74.1±23.7）cm/s（P=0.78,r=0.93）;头静脉侧距吻合口1cm处V-peak分别为（311.6±104.3）cm/s、（309.3±104.9）cm/s（P=0.68,r=0.94）,V-min分别为（147.1±71.8）cm/s、（148.7±68.9）cm/s（P=0.70,r=0.98）.结论 4D-flow能准确显示RCF的血流动力学变化及对血流速度进行定量,为透析患者RCF的评估提供详细血流动力学信息,是一项应用前景良好的技术。Objective To evaluate the feasibility of 4 D-flow MRI in visualizing and quantifying the hemodynamics of the native radiocephalic fistula（ RCF） in hemodialysis patients. Methods ECG gated flow-sensitive 4 D MRIs with velocity encoding of 200 cm/s,400 cm/s and 600 cm/s were performed respectively on a 3. 0 Tesla scanner（ Ingenia,Philips Medical Systems） in 25 consecutive dialysis patients with native RCF for at least 2 months. A 4 D-flow MRI with mostly distinctly presented native RCF from them for each subject was choose to achieve the visualization of blood flow＇s streamline bundles and to evaluate the hemodynamics for the native RCF. The regional peak and mean velocities were quantitatively analyzed at the 3 points of the RCF（ the vascular anastomosis,artery and vein proximate segments at 1 cm from the anastomosis）,which were compared to the referenced standard Doppler ultrasound（ DUS）. Results 22 out of 25 subjects successfully underwent 4 D-flow MRI,including 8 native RCF with stenosis and 9 with turbulent blood flow. 3 D blood flow ＇s streamline bundles of native RCF were obtained on 4 D-flow MRI from dialysis patients＇ wrist,which was more excellent and extended than DUS. At the anastomosis point,there was no significant difference and had excellent agreement for peak velocities（ 354. 6 ± 133. 7 cm/s（ 4 D-flow MRI） 354. 8 ± 131. 4 cm/s（ DUS）,（ P = 0. 96,r = 0. 97） and good agreement for minimum velocities（ 136. 3 ± 73. 4 cm/s（ 4 D-flow MRI） 138. 1 ± 70. 6 cm/s（ DUS）,（ P = 0. 57,r = 0. 96）. At arterial point,there was no significant difference and had good agreement for peak velocities（ 168. 4 ± 41. 4 cm/s（ 4 D-flow MRI）162. 3 ± 41. 0 cm/s（ DUS）,（ P = 0. 19,r = 0. 76） and for minimum velocities（ 73. 7 ± 20. 5 cm/s（ 4 D-flow MRI） 74. 1± 23. 7 cm/s（ DUS）,（ P = 0. 78,r = 0. 93） between 4 D-flow MR and DUS. At vein position,there was no significant difference and good agreement for peak velocities（ 311. 6 ± 104. 3 cm/s（ 4

关 键 词：4D-flow磁共振成像 自体动静脉内瘘 可视化 血流定量 

分 类 号：R445.2[医药卫生—影像医学与核医学] R692.5[医药卫生—诊断学]