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Hemodialysis Access Imaging: Comparison of Flow-interrupted Contrast-enhanced MR Angiography and Digital Subtraction Angiography¹

¹ From the Department of Nephrology (J.H.M.S., W.A.M.A.v.d.M., P.J.B.), Department of Radiology, Image Sciences Institute (C.B., O.E.H.E., C.J.G.B., J.J.Z., W.P.T.M.M.), and Julius Center for Health Sciences and Primary Care (S.K.), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands. Received May 2, 2001; revision requested June 18; final revision received April 5, 2002; accepted May 8. J.H.M.S. supported by grant C.97.1643 from the Dutch Kidney Foundation. Address correspondence to C.J.G.B. (e-mail: c.j.g.bakker@azu.nl).

View larger version (75K): [in a new window]   Figure 1. Contrast-enhanced MR angiographic and DSA images of AVG. A, Coronal maximum intensity projection shows an overview of the graft with both the venous (straight arrow) and arterial (curved arrow) anastomoses. B, Oblique maximum intensity projection of the contrast-enhanced MR angiographic data set and (C) conventional DSA image show a stenosis at the venous anastomosis (arrows). D, Oblique maximum intensity projection of the contrast-enhanced MR angiographic data set and (E) conventional DSA image at the arterial anastomosis (arrows) show a mild stenosis. The contrast-enhanced MR angiogram clearly delineates the narrowing of the venous limb of the graft, the puncture aneurysm at the arterial limb, and the dilated native veins downstream of the anastomosis.

View larger version (110K): [in a new window]   Figure 2. Contrast-enhanced MR angiographic and DSA images of a Brescia-Cimino AVF. The images clearly show the native artery (straight arrows), the side-to-side anastomosis, and the stenosis (curved arrows) in the venous part of the access. A, Coronal maximum intensity projection shows an overview of the fistula. B, Oblique coronal view of the contrast-enhanced MR angiographic data with (C) corresponding conventional DSA image. D, Oblique sagittal view of the contrast-enhanced MR angiographic data with (E) corresponding conventional unsubtracted angiogram.

View larger version (21K): [in a new window]   Figure 3a. Bland and Altman plots of the difference between the maximum stenosis percentage obtained at MR angiography and that obtained at conventional DSA according to the mean stenosis percentage at MR angiography and DSA for (a) observer 1 and (b) observer 2. Mean difference is represented by the solid line; 95% CLs are represented by the dashed lines (mean ± 2 SDs).

View larger version (21K): [in a new window]   Figure 3b. Bland and Altman plots of the difference between the maximum stenosis percentage obtained at MR angiography and that obtained at conventional DSA according to the mean stenosis percentage at MR angiography and DSA for (a) observer 1 and (b) observer 2. Mean difference is represented by the solid line; 95% CLs are represented by the dashed lines (mean ± 2 SDs).