上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2019, Vol. 39 ›› Issue (4): 387-.doi: 10.3969/j.issn.1674-8115.2019.04.010

• 论著·临床研究 • 上一篇    下一篇

四维 MR血流成像在肾透析患者自体动静脉瘘血流动力学研究中的应用价值

李苏芹 1，朱铭力 2，张岚 3，倪其泓 3，唐辉 1，路青 1   

  1. 1. 上海交通大学医学院附属仁济医院放射科，上海 200127；2. 上海交通大学医学院附属仁济医院肾脏科，上海 200127；3. 上海交通大学医学院附属仁济医院血管外科，上海 200127
  • 出版日期:2019-04-28 发布日期:2019-05-23
  • 通讯作者: 路青，电子信箱：drluqingsjtu@163.com。
  • 作者简介:李苏芹（1992—），女，住院医师，硕士生；电子信箱： suqinli@sjtu.edu.cn。
  • 基金资助:
    国家自然科学基金面上项目（ 81271638）；上海市浦江人才计划（ 15PJ1405200）

Application of four-dimensional flow MRI in hemodynamic study of autogenous arteriovenous fistula in renal dialysis patients

LI Su-qin1, ZHU Ming-li2, ZHANG Lan3, NI Qi-hong3, TANG Hui1, LU Qing1   

  1. 1. Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; 2. Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; 3. Department of Vascular Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2019-04-28 Published:2019-05-23
  • Supported by:
    General Program of National Natural Science Foundation of China, 81271638; Shanghai Pujiang Talent Plan, 15PJ1405200

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摘要： 目的 ·探讨利用四维 MR血流成像（ four-dimensional flow MRI，4D flow MRI）评估肾透析患者前臂自体动静脉瘘（autogenous arteriovenous fistula，AVF）血流动力学的可行性。方法 ·选择上海交通大学医学院附属仁济医院肾脏科的血液透析患者 45例，接受前臂 AVF血管超声检查及磁共振成像。利用配对 t检验对 2名放射科医师经 4D flow MRI测量的血流动力学参数的一致性、4D flow MRI与血管超声在 AVF相同层面血流动力学参数的一致性进行分析；利用磁共振黑血序列获取 AVF形态学参数，并就该参数与 4D flow MRI血流动力学参数进行 Pearson相关分析。结果 · 42例患者成功完成了前臂 AVF血管超声检查及磁共振成像。配对 t检验结果显示， 2名放射科医师利用 4D flow MRI测量的血流动力学参数重复性较好（均 P0.000）；除了吻合口峰流速（ r-0.078， P>0.05）外，4D flow MRI与血管超声的血流动力学参数一致性较好（r0.292～ 0.569，均 P<0.05）。经 Pearson相关分析显示，AVF头静脉流量与静动脉管径比、吻合口面积均相关（ r-0.671，r0.482，均 P<0.05）；吻合口附近剪切力与吻合角度、管壁厚度均相关（r0.530，r0.462，均 P<0.05）。结论 ·利用 4D flow MRI可以获取肾透析患者前臂 AVF的血流动力学参数，对进一步研究 AVF功能障碍有一定的参考价值。

关键词: 四维 MR血流成像, 自体动静脉瘘, 血流动力学

Abstract:

Objective · To investigate the feasibility of four-dimensional flow MRI (4D flow MRI) in evaluating the hemodynamics of forearm autologous arteriovenous fistula (AVF) in renal dialysis patients. Methods · Forty-five patients Renal Division of Renji Hospital, Shanghai Jiao Tong University School of Medicine were included. Patients with forearm AVF underwent ultrasonography and MRI. The consistency of 4D flow MRI hemodynamic parameters measuredtwo radiologists and hemodynamic parameters at the same plane of AVF4D flow MRI and ultrasonography were analyzedpaired t test. The morphological parameters of AVF were acquired black blood sequence, and they were used for Pearson correlation analysis with the hemodynamic parameters obtained 4D flow MRI. Results · Forty-two patients completed the forearm AVF ultrasonography and MRI successfully. Paired t test showed that the consistency of 4D flow MRI hemodynamic parameterstwo radiologists was good (all P0.000), and all hemodynamic parameters measured4D flow MRI and ultrasonography were in good agreement (r0.292-0.569, all P<0.05) except for the peak flow velocity at anastomosis (r-0.078, P>0.05). Pearson correlation analysis showed that the cephalic venous flow volume of AVF was correlated with the diameter ratio of the cephalic venous to radial artery and the anastomosis area ( r-0.671, r0.482, both P<0.05), and the wall shear stress (WSS) near the anastomosis was correlated with the anastomosis angle and wall thickness (r0.530, r0.462, both P<0.05). Conclusion · 4D flow MRI can be used to evaluate the hemodynamic parameters of forearm AVF in renal dialysis patients, which can provide a reference for further study of AVF dysfunction. [Key words]four-dimensional flow MRI (4D flow MRI); autologous arteriovenous fistula (AVF); hemodynamics

Key words: four-dimensional flow MRI (4D flow MRI), autologous arteriovenous fistula (AVF), hemodynamics

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