Stenosis Characterization and Identification for Dialysis Vascular Access.
Stenosis Characterization and Identification for Dialysis Vascular Access.
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DOI：
10.1109/spmb.2018.8615597
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发表时间：
2018-12-01
期刊：
影响因子：
--
通讯作者：
Majerus, S J A
中科院分区：
文献类型：
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作者：
Chin, S;Panda, B;Majerus, S J A
血管通路功能障碍是血液透析患者住院的主要原因，也是该患者群体中医疗费用最多的原因。血管通道流动通常因血管狭窄而受阻。目前包括影像学检查狭窄的筛查方法对于常规护理点来说过于昂贵。对有血管通路功能障碍风险的患者进行无创、实时筛查，可以潜在地识别高危患者，降低紧急手术干预的可能性。Bruits（狭窄处湍流血流产生的声音）可以由熟练的临床工作人员使用传统听诊器来解释。为了提高检测的灵敏度，利用无创的听觉记录对血流声进行数字分析是一种很有前途的血管通道狭窄分类方法。在这里，我们展示了PAGs的听觉和频谱特征，这些特征可以估计狭窄的位置和程度（DOS）。采用数字记录听诊器对9例不同DOS和血流动力学流速的狭窄幻听进行录音分析，提取分类特征。采用自回归建模和离散小波变换对多分辨率信号进行分解，得到14个特征，其中大部分特征与DOS呈线性相关。我们的初步结果表明，广泛使用的听觉谱质心是一种简单的计算特征的方法，可以估计血管通路狭窄的位置和严重程度。
Vascular access dysfunction is the leading cause of hospitalization for hemodialysis patients and accounts for the most medical costs in this patient population. Vascular access flow is commonly hindered by blood vessel narrowing (stenosis). Current screening methods involving imaging to detect stenosis are too costly for routine use at the point of care. Noninvasive, real-time screening of patients at risk of vascular access dysfunction could potentially identify high-risk patients and reduce the likelihood of emergency surgical interventions. Bruits (sounds produced by turbulent blood flow near stenoses) can be interpreted by skilled clinical staff using conventional stethoscopes. To improve the sensitivity of detection, digital analysis of blood flow sounds (phonoangiograms or PAGs) is a promising approach for classifying vascular access stenosis using non-invasive auditory recordings. Here, we demonstrate auditory and spectral features of PAGs which estimate both the location and degree of stenosis (DOS). Auditory recordings from nine stenosis phantoms with variable DOS and hemodynamic flow rate were obtained using a digital recording stethoscope and analyzed to extract classification features. Autoregressive modeling and discrete wavelet transforms were used for multiresolution signal decomposition to produce 14 distinct features, most of which were linearly correlated with DOS. Our initial results suggest that the widely-used auditory spectral centroid is a simple way to calculate features which can estimate both the location and severity of vascular access stenosis.