CAJ | 학술논문

血液透析导管相关中心静脉狭窄严重影响透析充分性和患者预后，准确诊断中心静脉狭窄具有重要临床意义。笔者回顾国内外对血液透析导管相关中心静脉狭窄诊断的研究，系统地介绍分析数字减影血管造影（DSA）、多普勒超声（DU）、CT和MRI等影像学诊断技术的最新研究进展、优缺点和适用条件。DSA是目前诊断血管通路狭窄的金标准，可以同期行介入治疗，但其为侵入性操作，所需造影剂量较大，不能作为常规筛查手段。DU方便、经济，但不易显示深在的中心静脉，且其准确性很大程度上取决于操作者的技术，适用于中心静脉狭窄的初步筛查。CT血管成像对中心静脉的显示优于超声，可以进行三维高空间分辨率成像，与DSA有很高的相关性。MRI无创、无电离辐射，但是其分辨率不如CT血管造影，有流动相关伪影，对患者的配合程度和体内装置有选择性。不同的影像学技术在检测血液透析导管相关中心静脉狭窄中都有各自独特的优势及不足，多种技术联合应用可以互补。血液透析导管相关中心静脉狭窄的影像学研究还需进一步深入，以更科学地揭示各种诊断方法在不同人群中的诊断价值和各自的适应证。
혈액투석도관상관중심정맥협착엄중영향투석충분성화환자예후，준학진단중심정맥협착구유중요림상의의。필자회고국내외대혈액투석도관상관중심정맥협착진단적연구，계통지개소분석수자감영혈관조영（DSA）、다보륵초성（DU）、CT화MRI등영상학진단기술적최신연구진전、우결점화괄용조건。DSA시목전진단혈관통로협착적금표준，가이동기행개입치료，단기위침입성조작，소수조영제량교대，불능작위상규사사수단。DU방편、경제，단불역현시심재적중심정맥，차기준학성흔대정도상취결우조작자적기술，괄용우중심정맥협착적초보사사。CT혈관성상대중심정맥적현시우우초성，가이진행삼유고공간분변솔성상，여DSA유흔고적상관성。MRI무창、무전리복사，단시기분변솔불여CT혈관조영，유류동상관위영，대환자적배합정도화체내장치유선택성。불동적영상학기술재검측혈액투석도관상관중심정맥협착중도유각자독특적우세급불족，다충기술연합응용가이호보。혈액투석도관상관중심정맥협착적영상학연구환수진일보심입，이경과학지게시각충진단방법재불동인군중적진단개치화각자적괄응증。
As hemodialysis catheter-related central venous stenosis severely influences dialysis adequacy and patients’ prognosis, diagnosing central venous stenosis accurately is of great clinical importance. The authors analyzed the new progresses of imaging diagnosis in patients with hemodialysis catheter-related central venous stenosis. The advantages, disadvantages and applications of digital subtraction angiography (DSA), Doppler ultrasonography (DU), computed tomography (CT) and magnetic resonance imaging (MRI) were discussed. DSA is still the gold standard for assessing central venous stenosis, which could be followed by intravascular intervention if necessary. However, as an invasive procedure requiring a large amount of contrast agent, the application of DSA as a routine screening tool is limited. Though convenient and economical, DU is only regarded as a preliminary screening test, for its accuracy largely depends on the skill of the operator and it is not favorable in demonstrating central veins deep in the thoracic cavity covered by bones and lung lobules. CT angiography (CTA) has a good correlation with DSA in evaluating central venous stenosis with its capacity to provide a high spatial resolution in three-dimensional. MR angiography (MRA) is an alternative method in the assessment of central venous stenosis in hemodialysis patients. The most outstanding point is the avoidance of ionizing radiation and iodinated contrast media. Whereas, MRA has a relatively low resolution compared with CTA and could be influenced by flow-related artifacts. The presence of claustrophobia, pacemaker, and magnetized metal in patients are contraindicated in MRI scanning. As compared with DSA, MRA might over-estimate the level of stenosis. The difference between severe stenosis and total occlusion of the vessels in MRA images could be difficult to interpret and may mislead medical decision. Different imaging modalities have their own advantages and disadvantages which can be complementary to each other in clinic. Further researches are required to reveal the diagnosing value of different imaging methods with respect to various subgroups of dialysis patients and the indications.