Abstract：
OBJECTIVE: To evaluate the diagnostic efficacy of contrast-enhanced ultrasonography (CEUS) for detecting catheter-related right brachiocephalic vein (RBV) and superior vena cava (SVC) obstructions in patients undergoing hemodialysis (HD).
METHODS: From June 1, 2021 to December 31, 2022, we enrolled 80 patients undergoing HD who had used or were using a central venous catheter as vascular access. We evaluated the diagnostic efficacy of conventional ultrasonography and CEUS for identifying RBV and SVC obstructions and compared them with that of digital subtraction angiography (DSA). In the stratified analysis, the SVC was divided into the upper and lower segments. In total, we analyzed 240 central venous segments, including the RBV.
RESULTS: Among the RBV and SVC visualized by DSA, conventional ultrasonography and CEUS could visualize 67.92 and 100% of the vein segments, respectively; however, the lengths and diameters of the RBV and SVC were smaller than those recorded with DSA (P < .001). The diagnostic efficacy of CEUS for detecting catheter-related central venous obstruction was better than that of conventional ultrasonography, with a higher sensitivity (83.95 vs 41.98%), specificity (89.94 vs 53.46%), accuracy (87.92 vs 49.58%), and F1 score (82.42 vs 49.64%). CEUS showed good agreement (κ = 0.732) with DSA. In the stratified analyses, CEUS also showed higher sensitivity (83.93, 83.33, and 84.62%, respectively) and better agreement with DSA (κ = 0.635, 0.655, and 0.673, respectively) than conventional ultrasonography for detecting the RBV and the upper and lower segments of the SVC.
CONCLUSIONS: CEUS had high sensitivity and specificity in diagnosing catheter-related RBV and SVC obstructions.
METHODS: From June 1, 2021 to December 31, 2022, we enrolled 80 patients undergoing HD who had used or were using a central venous catheter as vascular access. We evaluated the diagnostic efficacy of conventional ultrasonography and CEUS for identifying RBV and SVC obstructions and compared them with that of digital subtraction angiography (DSA). In the stratified analysis, the SVC was divided into the upper and lower segments. In total, we analyzed 240 central venous segments, including the RBV.
RESULTS: Among the RBV and SVC visualized by DSA, conventional ultrasonography and CEUS could visualize 67.92 and 100% of the vein segments, respectively; however, the lengths and diameters of the RBV and SVC were smaller than those recorded with DSA (P < .001). The diagnostic efficacy of CEUS for detecting catheter-related central venous obstruction was better than that of conventional ultrasonography, with a higher sensitivity (83.95 vs 41.98%), specificity (89.94 vs 53.46%), accuracy (87.92 vs 49.58%), and F1 score (82.42 vs 49.64%). CEUS showed good agreement (κ = 0.732) with DSA. In the stratified analyses, CEUS also showed higher sensitivity (83.93, 83.33, and 84.62%, respectively) and better agreement with DSA (κ = 0.635, 0.655, and 0.673, respectively) than conventional ultrasonography for detecting the RBV and the upper and lower segments of the SVC.
CONCLUSIONS: CEUS had high sensitivity and specificity in diagnosing catheter-related RBV and SVC obstructions.
摘要：
目的：评价超声造影(CEUS)对血液透析(HD)患者导管相关性右头臂静脉(RBV)和上腔静脉(SVC)阻塞的诊断价值。
方法：从2021年6月1日至2022年12月31日，我们招募了80例使用或正在使用中心静脉导管作为血管通路的HD患者。我们评估了常规超声和CEUS对识别RBV和SVC阻塞的诊断功效，并将其与数字减影血管造影（DSA）进行了比较。在分层分析中，SVC分为上段和下段。总的来说,我们分析了240个中心静脉段,包括RBV。
结果：在DSA可视化的RBV和SVC中，常规超声和超声造影可以显示67.92和100%的静脉段，分别；然而，RBV和SVC的长度和直径小于DSA记录的长度和直径(P<.001)。超声造影对导管相关性中心静脉阻塞的诊断效果优于常规超声,具有更高的灵敏度（83.95比41.98％），特异性（89.94vs53.46%），准确度（87.92vs49.58%），和F1得分（82.42vs49.64％）。CEUS与DSA表现出良好的一致性(κ=0.732)。在分层分析中，CEUS还显示出更高的灵敏度（83.93，83.33和84.62％，分别）与DSA（分别为κ=0.635、0.655和0.673）比常规超声检查更好地检测RBV以及SVC的上段和下段。
结论：CEUS在诊断导管相关性RBV和SVC阻塞方面具有较高的敏感性和特异性。
方法：从2021年6月1日至2022年12月31日，我们招募了80例使用或正在使用中心静脉导管作为血管通路的HD患者。我们评估了常规超声和CEUS对识别RBV和SVC阻塞的诊断功效，并将其与数字减影血管造影（DSA）进行了比较。在分层分析中，SVC分为上段和下段。总的来说,我们分析了240个中心静脉段,包括RBV。
结果：在DSA可视化的RBV和SVC中，常规超声和超声造影可以显示67.92和100%的静脉段，分别；然而，RBV和SVC的长度和直径小于DSA记录的长度和直径(P<.001)。超声造影对导管相关性中心静脉阻塞的诊断效果优于常规超声,具有更高的灵敏度（83.95比41.98％），特异性（89.94vs53.46%），准确度（87.92vs49.58%），和F1得分（82.42vs49.64％）。CEUS与DSA表现出良好的一致性(κ=0.732)。在分层分析中，CEUS还显示出更高的灵敏度（83.93，83.33和84.62％，分别）与DSA（分别为κ=0.635、0.655和0.673）比常规超声检查更好地检测RBV以及SVC的上段和下段。
结论：CEUS在诊断导管相关性RBV和SVC阻塞方面具有较高的敏感性和特异性。
