Department of Neusorugery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 7348551, Japan.
Neurosurg Rev. 2013 Apr;36(2):289-96; discussion 296. doi: 10.1007/s10143-012-0440-z. Epub 2012 Nov 30.
Time-resolved computed tomography angiography (4D-CTA) using a 320-row area detector CT scanner has recently been applied in the evaluation of cranial vascular disorders. However, application of 4D-CTA to spinal vascular disorder evaluation has never before been described. The authors herein report their initial experience of 4D-CTA in the evaluation of spinal arteriovenous fistulas (AVFs) and compare this novel modality with other imaging modalities. Four consecutive patients with spinal AVF underwent time-resolved contrast-enhanced magnetic resonance angiography (trMRA), 4D-CTA, and selective catheter angiography (CA). In 4D-CTA, volume data was transformed into 3D volume-rendered images and maximum intensity projection. These images were also evaluated by time-resolved serial phases. Then, images of each modality were compared, focusing on the detection of perimedullary draining veins and the prediction of AVF location and drainage flow direction. All modalities successfully detected perimedullary draining veins in all cases. Location of the AVF was detected in all cases by CA. trMRA and 4D-CTA detected the AVF in three out of the four cases. With regard to flow direction, while 4D-CTA successfully depicted ascending or descending drainage flow in the spinal canal, CA failed to detect the flow direction in one case while trMRA failed in two cases. In the case with epidural AVF, 4D-CTA was the only technique to detect the flow direction of perimedullary drainage. Although this is only an initial experience of the application of 4D-CTA to spinal vascular diseases, 4D-CTA was capable of detecting the dynamic vascular flow of spinal AVFs. The authors believe that 4D-CTA can be a useful option in the evaluation of spinal AVFs.
应用 320 排容积 CT 扫描仪进行时间分辨 CT 血管造影（4D-CTA）最近已被用于评估颅脑血管疾病。然而，将 4D-CTA 应用于脊髓血管疾病的评估尚未有报道。作者在此报告他们在评估脊髓动静脉瘘（AVF）中应用 4D-CTA 的初步经验，并将这种新方法与其他影像学方法进行比较。连续 4 例脊髓 AVF 患者接受时间分辨对比增强磁共振血管造影（trMRA）、4D-CTA 和选择性导管血管造影（CA）检查。在 4D-CTA 中，容积数据被转化为 3D 容积再现图像和最大密度投影。这些图像也通过时间分辨连续相位进行评估。然后，比较了每种方法的图像，重点关注对脊髓周围引流静脉的检测以及对 AVF 位置和引流血流方向的预测。所有方法均成功地在所有病例中检测到脊髓周围引流静脉。CA 成功地在所有病例中检测到 AVF 的位置。trMRA 和 4D-CTA 在 4 例中的 3 例中检测到 AVF。关于血流方向，虽然 4D-CTA 成功地描绘了椎管内上升或下降的引流血流，但 CA 在 1 例中未能检测到血流方向，trMRA 在 2 例中未能检测到血流方向。在硬膜外 AVF 的病例中，4D-CTA 是唯一能够检测脊髓周围引流血流方向的技术。虽然这只是 4D-CTA 应用于脊髓血管疾病的初步经验，但 4D-CTA 能够检测脊髓 AVF 的动态血管血流。作者认为，4D-CTA 可以成为评估脊髓 AVF 的有用选择。
