| Objective:The purpose of this study was to evaluate the feasibility of color doppler ultrasound combined with two-dimensional gray scale Flow imaging(B-Flow)in the diagnosis of autologous arteriovenous internal fistula stenosis in dialysis patients.Methods:From January 2018 to December 2019,we selected the dialysis patients from the hemodialysis center of the Affiliated Hospital of Qingdao University and the 15 th Clinical Medical College of Qingdao University.Ultrasound examination of upper limb vessels due to abnormal physical examination or insufficient dialysis flow,of these,56 patients had a dialysis pump blood flow of less than 200 ml /min and DSA complete examination records were included in the study.Fully apply the coupling agent,and check the anatomical structure of the subclavian artery,axillary artery,brachial artery,radial artery,anastomosis,cephalic vein,middle cubital vein,brachial vein,axillary vein and subclavian vein in order to see if there is any variation.The lumen was observed for thrombus,occlusion,stenosis,plaque,thickening of intima,pseudoaneurysm,venous aneurysmal dilatation,hematoma,etc.The inner diameter and systolic peak velocity(PSV)at the narrowest point of radial artery,distal cephalic vein,middle cephalic vein and distal cephalic vein were measured in B-Flow,2D,CDFI and PDI modes respectively.Measure the inner diameter of the stenosis,PSV and the adjacent area with no obvious stenosis PSV,and calculate the ratio of the two PSV(PSVR).PACS system was used to measure the inner diameter of the five narrowest areas of the fistula in DSA mode.The collected clinical information and examination results were recorded in Excel,and SPSS21.0 software was used for statistical analysis,and a=0.05 was used as the test level for comparison between groups.Kappa was used for consistency test and kappa value was calculated.DSA results were used as the gold standard for diagnosis to evaluate the consistency of B-Flow,2D,CDFI and PDI in the diagnosis of stenosis.The diagnostic efficacy of the indicators was evaluated by the receiver operating curve(ROC),and the diagnostic evaluation results of area under the curve,sensitivity,specificity,diagnostic index and kappa value were obtained.Spearman correlation analysis was used for the correlation analysis between indicators.Diameter values of different measurement methods were compared,and variance F test was used for the comparison between groups.Results:There were 56 cases of AVF,and 63 cases of stenosis were diagnosed by DSA,25 cases were located at the anastomosis,25 cases were located at the distal,middle and proximal sections of the cephalic vein,12 cases and 1 case respectively.B-Flow,2D,CDFI and PDI methods were used to diagnose 61,58,62 and 61 cases of AVF stenosis,respectively.Among the 63 patients,8 had thrombotic stenosis and 55 had non-thrombotic stenosis.In the case of cephalic vein stenosis,the area under the ROC curve of B-Flow method was 0.923,the sensitivity was 97.7%,the specificity was 86.8%,the diagnostic index was 0.845,and the accuracy was 0.952.The area under ROC curve of 2D method was 0.909,the sensitivity was96.7%,the specificity was 84.2%,the diagnostic index was 0.829,and the accuracy was0.946.The area under the ROC curve of CDFI was 0.807,the sensitivity was 93%,the specificity was 68.4%,the diagnostic index was 0.614,and the accuracy was 0.874.The area under the ROC curve of PDI was 0.837,the sensitivity was 93.8%,the specificity was 73.7%,the diagnostic index was 0.675,and the accuracy was 0.892.The area under the ROC curve of B-Flow method was 0.928,the sensitivity was 93.5%,the specificity was 92%,the diagnostic index was 0.855,and the accuracy was 0.929.The area under the ROC of 2D method curve was 0.888,the sensitivity was 93.5%,the specificity was 84%,the diagnostic index was 0.755,and the accuracy was 0.893.The area under the curve of CDFI method is0.787,the sensitivity is 77.4%,the specificity is 80%,the diagnostic index is 0.574,the accuracy is 0.786.The area under the curve of PDI method was 0.783,the sensitivity was80.6%,the specificity was 76%,the diagnostic index was 0.566,and the accuracy was0.786.Compared with DSA,Kappa values of B-Flow,2D,CDFI and PDI in diagnosing cephalic vein stenosis were 0.861,0.842,0.632 and 0.688,respectively.Compared with DSA,Kappa values of B-Flow,2D,CDFI and PDI were 0.855,0.782,0.570 and 0.566,respectively.There was a positive correlation between PSV and DSA in the measurement of stenosis(r: 0.401,P < 0.05),and a positive correlation between PSVR and DSA in the measurement of stenosis(r: 0.390,P < 0.05).There was a positive correlation between PSV and DSA in the measurement of stenosis(r: 0.437,P < 0.05),and a positive correlation between PSVR and DSA in the measurement of stenosis(r: 0.511,P < 0.05).Conclusion:The measurement of AVF narrow inner diameter,B-Flow was better than 2D,CDFI and PDI.Color doppler ultrasound combined with B-Flow has a good effect on the diagnosis of AVF stenosis in dialysis patients,which can be used as the first choice for the diagnosis and follow-up of AVF stenosis. |
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