From the Department of Radiology (S.A.A., M.P.M., G.Z., R.B., N.F.), Stanford University, Stanford, California
Florey Department of Neuroscience and Mental Health (S.A.A., F.C.), University of Melbourne, Melbourne, Victoria, Australia.
AJNR Am J Neuroradiol. 2018 Apr;39(4):669-677. doi: 10.3174/ajnr.A5570. Epub 2018 Mar 15.
Intracranial dural arteriovenous fistulas carry a risk of substantial neurologic complications but can be difficult to detect on structural MR imaging and TOF-MRA. The purpose of this study was to assess the accuracy and added value of 3D pseudocontinuous arterial spin-labeling MR imaging for the detection of these lesions.
This retrospective study included 39 patients with a dural arteriovenous fistula and 117 controls who had undergone both DSA and MR imaging with pseudocontinuous arterial spin-labeling. Two neuroradiologists blinded to the DSA results independently assessed MR imaging with and without pseudocontinuous arterial spin-labeling. They recorded specific signs, including venous arterial spin-labeling signal, and the likelihood of a dural arteriovenous fistula using a 5-point Likert scale. Logistic regression and receiver operating characteristic analyses were performed to determine the accuracy of specific signs and the added value of pseudocontinuous arterial spin-labeling. Interobserver agreement was determined by using κ statistics.
Identification of the venous arterial spin-labeling signal had a high sensitivity (94%) and specificity (88%) for the presence a dural arteriovenous fistula. Receiver operating characteristic analysis showed significant improvement in diagnostic performance with the addition of pseudocontinuous arterial spin-labeling in comparison with structural MR imaging (Δarea under the receiver operating characteristic curve = 0.179) and a trend toward significant improvement in comparison with structural MR imaging with time-of-flight MRA (Δarea under the receiver operating characteristic curve = 0.043). Interobserver agreement for the presence of a dural arteriovenous fistula improved substantially and was almost perfect with the addition of pseudocontinuous arterial spin-labeling (κ = 0.92).
Venous arterial spin-labeling signal has high sensitivity and specificity for the presence of a dural arteriovenous fistula, and the addition of pseudocontinuous arterial spin-labeling increases confidence in the diagnosis of this entity on MR imaging.
颅内硬脑膜动静脉瘘存在发生严重神经并发症的风险，但在结构磁共振成像和时间飞跃磁共振血管成像上可能难以检测到。本研究旨在评估三维伪连续动脉自旋标记磁共振成像检测这些病变的准确性和附加价值。
本回顾性研究纳入了 39 例硬脑膜动静脉瘘患者和 117 例对照者，所有患者均接受了数字减影血管造影和伪连续动脉自旋标记磁共振成像检查。两名神经放射科医师在不知数字减影血管造影结果的情况下，分别独立评估有无伪连续动脉自旋标记的磁共振成像。他们使用 5 分 Likert 量表记录了包括静脉动脉自旋标记信号在内的特定征象，并记录了硬脑膜动静脉瘘的可能性。采用逻辑回归和受试者工作特征曲线分析来确定特定征象的准确性和伪连续动脉自旋标记的附加价值。采用κ 统计量来确定观察者间的一致性。
静脉动脉自旋标记信号的存在对硬脑膜动静脉瘘的诊断具有较高的敏感性（94%）和特异性（88%）。受试者工作特征曲线分析显示，与结构磁共振成像相比，加入伪连续动脉自旋标记后诊断性能有显著提高（受试者工作特征曲线下面积的差值=0.179），与结构磁共振成像联合时间飞跃磁共振血管成像相比，也有改善的趋势（受试者工作特征曲线下面积的差值=0.043）。加入伪连续动脉自旋标记后，硬脑膜动静脉瘘的存在的观察者间一致性有了显著提高，几乎达到了完美（κ=0.92）。
静脉动脉自旋标记信号对硬脑膜动静脉瘘的存在具有较高的敏感性和特异性，而加入伪连续动脉自旋标记则可增加对磁共振成像上该病变的诊断信心。
