Assessment of the Hemodynamics of Autogenous Arteriovenous Fistulas With 4D Phase Contrast‐Based Flow Quantification MRI in Dialysis Patients

BackgroundRegular monitoring of autogenous arteriovenous fistulas (AVFs) for hemodialysis patients has importance. Hence, 4D flow MRI may be an alternative for assessing the hemodynamics of AVFs.PurposeTo compare the hemodynamics of AVFs using Doppler ultrasound (DUS) and 4D‐MRI in renal dialysis patients.Study TypeCase–control study from October 2017 to April 2018.PopulationFifty patients (age [range] = 59.52 [39–71] years) with AVFs were included.Field Strength/SequenceBlack‐blood MRI and 4D flow MRI at 3.0T and AVF ultrasonography were also performed.AssessmentThe hemodynamics acquired from 4D flow MRI and ultrasonography by two radiologists were compared. The AVF anatomy was described through an examination of the black‐blood MRI.Statistical TestsThe consistency of AVF anatomy and hemodynamics and the consistency of the hemodynamics of AVFs from 4D flow MRI and ultrasound were analyzed by paired t‐tests. The morphological parameters of AVFs acquired from black‐blood MRI were used for a Pearson correlation analysis with the hemodynamic parameters obtained from 4D flow MRI data.ResultsThe consistency of the morphological and hemodynamic parameters measured from MRI by the two radiologists was good (all P < 0.01). The velocities and flow volumes from the 4D flow MRI and vascular ultrasound of AVFs were in moderate agreement (all P < 0.05, r = 0.292–0.569), except for the peak flow velocity at the anastomosis (P = 0.366, r = –0.078). The flow volume and WSS near the anastomotic site were closely related to the morphology of the AVFs (all P < 0.05). The hemodynamics of the complications group were significantly different from those of patients without any complications (normal patients group) (all P < 0.01).Data ConclusionCompared with ultrasonography, 4D flow MRI is a promising technique to noninvasively estimate the AVF hemodynamics of renal dialysis patients.Level of Evidence: 3Technical Efficacy: Stage 2J. Magn. Reson. Imaging 2020;51:1272–1280.