Guillevin Remy, Vallee J N, Cormier E, Lo D, Dormont D, Chiras J
Department of Neuroradiology, Pitie-Salpetriere Hospital, Paris, France.
AJNR Am J Neuroradiol. 2005 Apr;26(4):929-35.
This study investigated the role of CT as an early predictor of outcome prognosis after glue embolization of spinal dural arteriovenous fistulas (SDAVF).
Over a 13-year period, 26 patients underwent glue embolization of SDAVF and were retrospectively reviewed. Immediately after embolization, each patient had CT evaluation of cast position. Mean follow-up angiography was 23.4 months (range, 1-87 months; median, 21 months). Both MR images and clinical data (e.g., gait and micturition disabilities according to the Aminoff and Logue disability scale, deep and superficial sensitivity) were analyzed, with a mean follow-up of 37.7 months (range, 12-98 months; median, 28 months). Data were tested by univariate analysis by using Fisher's exact test and the Kruskall Wallis test, depending on the order of the qualitative variables.
Glue was found in the dura mater on CT in 19 (73%) patients. None of these patients had a recanalized fistula on angiography, and the clinical status of all of them improved. Glue was observed in or proximal to the foramen on CT in seven (27%) patients. In five of them, the fistula was recanalized within a mean period of 9 months (range, 3-24 months; median, 6 months) and their clinical status worsened. All five required surgical treatment. On angiography, the absence of fistula recanalization was observed in 21 (81%) patients and correlated with improvements in gait (P = .016), sensitivity (P = .030), and micturition (P = .080). It also correlated with a decrease in the extent of the abnormally high intramedullary T2 signal intensity (P = .002), a decrease in spinal cord diameter (P = .017), and the resolution of prominent perimedullary vessels (P < .001). The presence of glue within the dura mater on CT correlated with the absence of fistula recanalization (P = .045) and with overall improvement in clinical status, including gait and/or sensitivity and/or micturition (P = .042).
CT evaluation of embolization cast position immediately after embolization may constitute an early and reliable tool for predicting permanent fistula occlusion and the prognosis for outcome.
本研究探讨CT作为脊髓硬脊膜动静脉瘘（SDAVF）胶水栓塞术后预后早期预测指标的作用。
在13年期间，对26例行SDAVF胶水栓塞术的患者进行回顾性分析。栓塞术后立即对每位患者进行CT评估栓塞剂位置。平均随访血管造影时间为23.4个月（范围1 - 87个月；中位数21个月）。分析了磁共振成像（MR）图像和临床数据（如根据阿明诺夫和洛格残疾量表评估的步态和排尿功能障碍、深浅感觉），平均随访时间为37.7个月（范围12 - 98个月；中位数28个月）。根据定性变量的顺序，采用Fisher精确检验和Kruskal Wallis检验进行单因素分析。
19例（73%）患者CT显示栓塞剂位于硬脊膜内。这些患者血管造影均未发现瘘管再通，且所有患者临床症状均改善。7例（27%）患者CT显示栓塞剂位于椎间孔内或其近端。其中5例患者瘘管平均在9个月（范围3 - 24个月；中位数6个月）内再通，临床症状恶化。所有5例均需手术治疗。血管造影显示，21例（81%）患者未出现瘘管再通，这与步态改善（P = 0.016）、感觉功能改善（P = 0.030）和排尿功能改善（P = 0.080）相关。还与髓内异常高T2信号强度范围减小（P = 0.002）、脊髓直径减小（P = 0.017）以及脊髓周围明显血管消失（P < 0.001）相关。CT显示硬脊膜内存在栓塞剂与无瘘管再通（P = 0.045）以及包括步态和/或感觉和/或排尿功能在内的临床状态总体改善相关（P = 0.042）。
栓塞术后立即进行CT评估栓塞剂位置可能是预测瘘管永久性闭塞和预后的一种早期且可靠的工具。
