title: Magnetic resonance angiographic assessment of upper extremity vessels prior to vascular access surgery: feasibility and accuracy.
abstract: A contrast-enhanced magnetic resonance angiography (CE-MRA) protocol for selective imaging of the entire upper extremity arterial and venous tree in a single exam has been developed. Twenty-five end-stage renal disease (ESRD) patients underwent CE-MRA and duplex ultrasonography (DUS) of the upper extremity prior to hemodialysis vascular access creation. Accuracy of CE-MRA arterial and venous diameter measurements were compared with DUS and intraoperative (IO) diameter measurements, the standard of reference. Upper extremity vasculature depiction was feasible with CE-MRA. CE-MRA forearm and upper arm arterial diameters were 2.94 +/- 0.67 mm and 4.05 +/- 0.84 mm, respectively. DUS arterial diameters were 2.80 +/- 0.48 mm and 4.38 +/- 1.24 mm; IO diameters were 3.00 +/- 0.35 mm and 3.55 +/- 0.51 mm. Forearm arterial diameters were accurately determined with both techniques. Both techniques overestimated upper arm arterial diameters significantly. Venous diameters were accurately determined with CE-MRA but not with DUS (forearm: CE-MRA: 2.64 +/- 0.61 mm; DUS: 2.50 +/- 0.44 mm, and IO: 3.40 +/- 0.22 mm; upper arm: CE-MRA: 4.09 +/- 0.71 mm; DUS: 3.02 +/- 1.65 mm, and IO: 4.30 +/- 0.78 mm). CE-MRA enables selective imaging of upper extremity vasculature in patients requiring hemodialysis access. Forearm arterial diameters can be assessed accurately by CE-MRA. Both CE-MRA and DUS slightly overestimate upper arm arterial diameters. In comparison to DUS, CE-MRA enables a more accurate determination of upper extremity venous diameters.
authors.affiliation: Department of Vascular Surgery, Maastricht University Hospital, Peter Debijelaan 25, 6202 AZ Maastricht, The Netherlands. nilsplanken@gmail.com
authors.forename: Nils R
authors.initials: NR
authors.lastname: Planken
authors.forename: Jan H
authors.initials: JH
authors.lastname: Tordoir
authors.forename: Lucien E
authors.initials: LE
authors.lastname: Duijm
authors.forename: Harrie C
authors.initials: HC
authors.lastname: van den Bosch
authors.forename: Frank M
authors.initials: FM
authors.lastname: van der Sande
authors.forename: Jeroen P
authors.initials: JP
authors.lastname: Kooman
authors.forename: Michiel W
authors.initials: MW
authors.lastname: de Haan
authors.forename: Tim
authors.initials: T
authors.lastname: Leiner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000098:blood supply* / Q000000981:diagnostic imaging; D001166:Arteriovenous Shunt, Surgical; D003287:Contrast Media / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007676:Kidney Failure, Chronic / Q000628:therapy; D018810:Magnetic Resonance Angiography / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods; D018709:Statistics, Nonparametric; D018616:Ultrasonography, Doppler, Duplex
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA