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Hu X, Yuan Z, Liang K, Chen M, Zhang Z, Zheng H, Cheng G. Application of Spinal Subtraction and Bone Background Fusion CTA in the Accurate Diagnosis and Evaluation of Spinal Vascular Malformations. AJNR Am J Neuroradiol 2024; 45:351-357. [PMID: 38360787 DOI: 10.3174/ajnr.a8112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/02/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND AND PURPOSE Accurate pretreatment diagnosis and assessment of spinal vascular malformations using spinal CTA are crucial for patient prognosis, but the postprocessing reconstruction may not be able to fully depict the lesions due to the complexity inherent in spinal anatomy. Our purpose was to explore the application value of the spinal subtraction and bone background fusion CTA (SSBBF-CTA) technique in precisely depicting and localizing spinal vascular malformation lesions. MATERIALS AND METHODS In this retrospective study, patients (between November 2017 and November 2022) with symptoms similar to those of spinal vascular malformations were divided into diseased (group A) and nondiseased (group B) groups. All patients underwent spinal CTA using Siemens dual-source CT. Multiplanar reconstruction; routine bone subtraction, and SSBBF-CTA images were obtained using the snygo.via and ADW4.6 postprocessing reconstruction workstations. Multiple observers researched the following 3 aspects: 1) preliminary screening capability using original images with multiplanar reconstruction CTA, 2) the accuracy and stability of the SSBBF-CTA postprocessing technique, and 3) diagnostic evaluation of spinal vascular malformations using the 3 types of postprocessing images. Diagnostic performance was analyzed using receiver operating characteristic analysis, while reader or image differences were analyzed using the Wilcoxon signed-rank test or the Kruskal-Wallis rank sum test. RESULTS Forty-nine patients (groups A and B: 22 and 27 patients; mean ages, 44.0 [SD, 14.3] years and 44.6 [SD,15.2] years; 13 and 16 men) were evaluated. Junior physicians showed lower diagnostic accuracy and sensitivity using multiplanar reconstruction CTA (85.7% and 77.3%) than senior physicians (93.9% and 90.9%, 98% and 95.5%). Short-term trained juniors achieved SSBBF-CTA image accuracy similar to that of experienced physicians (P > .05). In terms of the visualization and localization of spinal vascular malformation lesions (nidus/fistula, feeding artery, and drainage vein), both multiplanar reconstruction and SSBBF-CTA outperformed routine bone subtraction CTA (P = .000). Compared with multiplanar reconstruction, SSBBF-CTA allowed less experienced physicians to achieve superior diagnostic capabilities (comparable with those of experienced radiologists) more rapidly (P < .05). CONCLUSIONS The SSBBF-CTA technique exhibited excellent reproducibility and enabled accurate pretreatment diagnosis and assessment of spinal vascular malformations with high diagnostic efficiency, particularly for junior radiologists.
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Affiliation(s)
- Xuehan Hu
- From the Department of Radiology (X.H., Z.Y., K.L., Z.Z., G.C.), Peking University Shenzhen Hospital, Shenzhen, China
- Paul C. Lauterbur Research Center for Biomedical Imaging (X.H., H.Z.), Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences
| | - Zhidong Yuan
- From the Department of Radiology (X.H., Z.Y., K.L., Z.Z., G.C.), Peking University Shenzhen Hospital, Shenzhen, China
| | - Kaiyin Liang
- From the Department of Radiology (X.H., Z.Y., K.L., Z.Z., G.C.), Peking University Shenzhen Hospital, Shenzhen, China
| | - Min Chen
- Department of Radiology (M.C.), Southern University of Science and Technology Hospital, Shenzhen, China
| | - Zhen Zhang
- From the Department of Radiology (X.H., Z.Y., K.L., Z.Z., G.C.), Peking University Shenzhen Hospital, Shenzhen, China
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging (X.H., H.Z.), Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences
| | - Guanxun Cheng
- From the Department of Radiology (X.H., Z.Y., K.L., Z.Z., G.C.), Peking University Shenzhen Hospital, Shenzhen, China
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Ouyang F, Wu Q, Duan B, Yuan X, Wang B, Chen Y, Yin M, Zeng X. Diagnosis of spinal dural arteriovenous fistula: a multimodal MRI assessment strategy. Clin Radiol 2023; 78:e958-e965. [PMID: 37821323 DOI: 10.1016/j.crad.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 07/11/2023] [Accepted: 08/31/2023] [Indexed: 10/13/2023]
Abstract
AIM To identify more specific screening indicators at magnetic resonance imaging (MRI) for the diagnosis of spinal dural arteriovenous fistulas (SDAVFs) and to determine an efficient diagnostic strategy. MATERIALS AND METHODS This retrospective study analysed clinical and imaging data of patients diagnosed with SDAVF and alternative myelopathy who underwent conventional MRI examinations. Additionally, three-dimensional (3D) T2-weighted sampling perfection with application-optimised contrasts using different flip-angle evolutions (3D-T2-SPACE) and contrast-enhanced magnetic resonance angiography (CE-MRA) data from patients with SDAVF were compared with digital subtraction angiography (DSA) data. RESULTS The age of onset, perimedullary flow voids (PFV), distribution of lesions, syringomyelia, degree of spinal oedema, and cauda equina disorder (CED) were factors that showed statistically significance in the identification of SDAVF with alternative myelopathy. After controlling for age, gender, PFV, degree of spinal cord swelling, and syringomyelia, the multivariable ordinal logistic regression model showed that the CED sign (OR = 32.46; 95% confidence interval [CI]: 2.47-427.15; p=0.008) was an independent predictor for SDAVF. The diagnostic model constructed using the PFV and CED signs had better diagnostic performance, with an area under the curve of 0.957 (p<0.001), maximum Youden index of 0.844, sensitivity of 92.9%, and specificity of 91.5%. Both 3D-T2-SPACE (77.8%) and CE-MRA (83.3%) sequences had good localisation values for SDAVF. Combining the two imaging examinations had better diagnostic accuracy than that of DSA. CONCLUSION CED and PFV on conventional MRI were specific indicators for the diagnosis of SDAVF. To compensate for the lack of fistula localisation on conventional MRI, 3D-T2-SPACE and CE-MRA can be used. Together they complement each other and have good diagnostic potential.
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Affiliation(s)
- F Ouyang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Q Wu
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - B Duan
- Class 211, Innovation Experiment, Nanchang University, 330031 Nanchang, Jiangxi, China
| | - X Yuan
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - B Wang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Y Chen
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - M Yin
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - X Zeng
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China.
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Ouyang F, Wu Q, Chen Y, Yin M, Liu J, Lv L, Xu Z, Yuan X, Zeng X. The value of 3D T2-weighted SPACE sequence in the differential diagnosis of spinal arteriovenous fistula and acute transverse myelitis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4111-4117. [PMID: 37804454 DOI: 10.1007/s00586-023-07969-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 09/14/2023] [Accepted: 09/23/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE Spinal arteriovenous fistulas (SAVF) was often neglected and misdiagnosed as acute transverse myelitis (ATM) due to its insidious onset and non-specific clinical symptoms. This study aims to investigate the differential diagnostic value of high-resolution T2-weighted volumetric sequence (3D sampling perfection with application-optimized contrasts using different flip-angle evolutions [SPACE]) in patients with SAVF and ATM. METHODS Retrospectively analyzed the clinical and radiological findings of 32 SDAVF patients and 32 ATM patients treated at our institutions from May 2018 to January 2023. They all underwent conventional spinal MRI and T2-SPACE examination, compared their performance in identifying lesions, to estimate the value of T2 SPACE sequence in the diagnosis of SAVF and ATM patients. RESULTS The clue of cauda equina area change (CEAC) in conventional MRI and T2-SPACE sequences is specific for the diagnosis of SAVF. The diagnostic model composed of perimedullary flow voids (PFV) and CEAC has good diagnostic performance (AUCMRI = 0.95; AUCSPACE = 0.935). Compared with conventional MRI, the T2-SPACE sequence has a higher detection rate, sensitivity, and negative predictive value for PFV and CEAC in SAVF patients, but lower specificity and positive predictive value. In T2-SPACE images, there are significant differences in the distribution range, quadrant, and maximum diameter of PFV vessels between SAVF and ATM patients. Moreover, T2-SPACE sequence can determine the site of fistula in most SAVF patients preferably, and the inter-rater agreement was good in the assessment of the fistula. CONCLUSION The CEAC is a new and useful clue for the diagnosis of thoracolumbar SAVF. And T2-SPACE sequence can more intuitively observe the lesions of SAVF, has good differential diagnostic value for SAVF and ATM patients.
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Affiliation(s)
- Feng Ouyang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi Institute of Medical Imaging, No. 17, Yongwai Zheng Street, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - Qin Wu
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi Institute of Medical Imaging, No. 17, Yongwai Zheng Street, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - Ye Chen
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi Institute of Medical Imaging, No. 17, Yongwai Zheng Street, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - Mingxue Yin
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi Institute of Medical Imaging, No. 17, Yongwai Zheng Street, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - Jie Liu
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi Institute of Medical Imaging, No. 17, Yongwai Zheng Street, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - Lianjiang Lv
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi Institute of Medical Imaging, No. 17, Yongwai Zheng Street, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - Zihe Xu
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi Institute of Medical Imaging, No. 17, Yongwai Zheng Street, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - Xiaoru Yuan
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi Institute of Medical Imaging, No. 17, Yongwai Zheng Street, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - Xianjun Zeng
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi Institute of Medical Imaging, No. 17, Yongwai Zheng Street, Donghu District, Nanchang City, 330006, Jiangxi Province, China.
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Yoshida K, Niimi Y, Kamamoto D, Fukumura M, Imai R, Nagoshi N, Akiyama T. Targeted embolisation for coexisting conus medullaris arteriovenous malformation and cauda equina arteriovenous fistulas with a varix on a shared drainer †. Br J Neurosurg 2023; 37:1200-1205. [PMID: 33034527 DOI: 10.1080/02688697.2020.1830948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The coexistence of vascular malformations in the conus medullaris and cauda equina has been rarely reported, and the complex angioarchitecture in multiple arteriovenous lesions remains poorly understood. CASE DESCRIPTION A 17-year-old woman presented with a sudden-onset, stepwise worsening of weakness and pain in the bilateral legs. Angiography revealed conus medullaris arteriovenous malformation and cauda equina arteriovenous fistulas. One of the drainers was shared between the coexisting lesions and harboured a varix. Targeted embolisation of a fistulous point in the conus lesion was performed with precaution to prevent occluding the common drainage route, which led to symptom improvement with angiographical diminishment of the varix. CONCLUSIONS Recognising that communications between drainers can be observed in multiple spinal arteriovenous lesions is important in facilitating a safe embolisation. Cautious assessment of angiogram with fusion images of cone-beam computed tomography and volumetric T2 magnetic resonance imaging can help in establishing the diagnosis and treatment strategy.
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Affiliation(s)
- Keisuke Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan
| | - Dai Kamamoto
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Mariko Fukumura
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Ryotaro Imai
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
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Ryu B, Sato S, Takase M, Mochizuki T, Shima S, Inoue T, Okada Y, Niimi Y. Diagnostic accuracy of three-dimensional-rotational angiography and heavily T2-weighted volumetric magnetic resonance fusion imaging for the diagnosis of spinal arteriovenous shunts. J Neurointerv Surg 2021; 14:neurintsurg-2020-017252. [PMID: 33674393 PMCID: PMC8785054 DOI: 10.1136/neurintsurg-2020-017252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Spinal arteriovenous shunts (SAVSs) are rare entities occurring in various areas, from the craniocervical junction to the sacral level. Recently, better understanding of SAVS angioarchitecture and elucidation of its pathogenesis have become possible with the advancement of imaging techniques. However, the utility of fusing different image modalities for SAVS diagnostics has not been determined. This study aimed to investigate whether three-dimensional-rotational angiography (3D-RA) and 3D-heavily T2-weighted volumetric MR (3D-MR) fusion imaging would improve the diagnostic accuracy for SAVSs. METHODS We retrospectively reviewed 12 SAVSs in 12 patients. Assessment of 3D-RA and 3D-RA/3D-MR fusion images for SAVS was performed by seven blinded reviewers. The final diagnosis was performed by two interventional neuroradiologists with extensive experience, and the interobserver agreement between the reviewers and the final diagnosis was calculated using κ statistics. The comparison of the interobserver agreement between 3D-RA and 3D-RA/3D-MR fusion images was performed for the diagnosis of SAVS subtypes. We also statistically compared the image-quality gradings (on a 4-grade scale) to delineate the 3D relationship between vascular malformations and the surrounding anatomical landmarks. RESULTS The interobserver agreement for the 3D-RA/3D-MR fusion images was substantial (κ=0.7071) and higher than that for the 3D-RA images (κ=0.3534). Significantly better image quality grades were assigned to 3D-RA/3D-MR fusion images than to 3D-RA images (p<0.0001) for the evaluation of the examined 3D relationships. CONCLUSION The 3D-RA/3D-MR fusion images provided better interobserver agreement of SAVS subtype diagnosis, allowing for detailed evaluation of the SAVS anatomical structures surrounding the shunt.
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Affiliation(s)
- Bikei Ryu
- Neuroendovascular Therapy, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan .,Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.,Neurosurgery, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Shinsuke Sato
- Neuroendovascular Therapy, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan.,Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.,Neurosurgery, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Masayuki Takase
- Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Tatsuki Mochizuki
- Neurosurgery, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Shogo Shima
- Neurosurgery, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Tatsuya Inoue
- Neurosurgery, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Yoshikazu Okada
- Neurosurgery, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Yasunari Niimi
- Neuroendovascular Therapy, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
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Kannath SK, Mandapalu S, Thomas B, Enakshy Rajan J, Kesavadas C. Comparative Analysis of Volumetric High-Resolution Heavily T2-Weighted MRI and Time-Resolved Contrast-Enhanced MRA in the Evaluation of Spinal Vascular Malformations. AJNR Am J Neuroradiol 2019; 40:1601-1606. [PMID: 31439626 DOI: 10.3174/ajnr.a6164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/01/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Volumetric high-resolution heavily T2-weighted imaging or time-resolved contrast-enhanced MRA is used in the detection and characterization of spinal vascular malformations, though inherent trade-offs can affect their overall sensitivity and accuracy. We compared the efficacy of volumetric high-resolution heavily T2-weighted and time-resolved contrast-enhanced images in spinal vascular malformation diagnosis and feeder characterization and assessed whether a combined evaluation improved the overall accuracy of diagnosis. MATERIALS AND METHODS Twenty-eight patients with spinal vascular malformations (spinal dural arteriovenous fistula, spinal cord arteriovenous malformation, and perimedullary arteriovenous fistula) were prospectively enrolled. MR images were separately analyzed by 2 neuroradiologists blinded to the final diagnosis. RESULTS Both sequences demonstrated 100% sensitivity and 93.5% accuracy for the detection of spinal vascular malformations. Volumetric high-resolution heavily T2-weighted imaging was superior to time-resolved contrast-enhanced MR imaging for identification of spinal cord arteriovenous malformations (100% versus 90% sensitivity and 96.7% versus 93.5% accuracy), however, for the diagnosis of perimedullary arteriovenous fistula, time resolved contrast enhanced MRI was found to perform better than the volumetric T2 sequence (80% versus 60% sensitivity and 96.7% versus 93.5% accuracy). Both sequences showed equal sensitivity (100%) and accuracy (87%) for spinal dural arteriovenous fistulas. Combined evaluation improved the overall accuracy across all types of spinal vascular malformation. Volumetric high-resolution heavily T2-weighted imaging was superior or equal to time-resolved contrast-enhanced MR imaging for feeder identification of spinal dural arteriovenous fistulas for both observers (90.9% and 72.7% versus 72.7%), which improved to 90.9% when the sequences were combined. Time-resolved contrast-enhanced MR imaging performed better for major and total feeder identification of spinal cord arteriovenous malformation (80% versus 60%) and perimedullary arteriovenous fistula (80% versus 60%-80%). CONCLUSIONS Combined volumetric high-resolution heavily T2-weighted imaging and time-resolved contrast-enhanced MR imaging can improve the sensitivity and accuracy of spinal vascular malformation diagnosis, classification, and feeder characterization.
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Affiliation(s)
- S K Kannath
- From the Department of Imaging Sciences and Interventional Radiology (S.K.K., B.T., J.E.R., C.K.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - S Mandapalu
- Department of Radiology (S.M.), NRI Medical College, Chinakakani, Guntur, Andra Pradesh, India
| | - B Thomas
- From the Department of Imaging Sciences and Interventional Radiology (S.K.K., B.T., J.E.R., C.K.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - J Enakshy Rajan
- From the Department of Imaging Sciences and Interventional Radiology (S.K.K., B.T., J.E.R., C.K.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - C Kesavadas
- From the Department of Imaging Sciences and Interventional Radiology (S.K.K., B.T., J.E.R., C.K.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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