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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. Eur Spine J 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] [What about the content of this article? (0)] [Affiliation(s)] [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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