Rationale and objectives: Chronic hemodialysis requires a vascular access that provides high blood-flow rates for the extracorporeal recirculation of blood. Synthetic arteriovenous (AV) grafts often fail because of clotting caused by underlying hyperplasia formation. The authors report the use of magnetic resonance (MR) imaging (MRI) without contrast agent to monitor tissue hyperplasia formation as well as luminal area in a porcine model of AV graft stenosis.
Materials and methods: Expanded reinforced polytetrafluoroethylene grafts were surgically placed between the common carotid artery and the external jugular vein, bilaterally, in pigs. Animals underwent MRI in a 3-T scanner at 3, 4, or 6 weeks after graft placement, followed by euthanasia and the collection of grafts and adjacent tissues for histologic analysis. Two animals underwent sequential scanning at 1, 2, 3, 5, and 7 weeks after graft placement, followed by histologic analysis.
Results: Measurements of hyperplasia obtained from the MR images were compared with, and correlated well with, measurements obtained from the histologic cross-sections (r = 0.932, P = .02). The MR images provided a more complete view of the venous hyperplasia throughout the graft compared with histology. The MR images could be examined from multiple angles and were unaffected by histologic preparation artifacts.
Conclusion: Unlike histology, MRI provided longitudinal 3-dimensional views of hyperplasia within the AV grafts. This ability of MRI to more completely identify the geometry of hyperplasia and to quantify the tissue volume in vivo could provide benefits over histologic analysis in assessing the pathology of AV graft failure and the efficacy of antihyperplasia interventions.