3T 磁共振血管成像（4D MR Angiography）与数字减影血管造影（DSA）在栓塞治疗脑硬脑膜动静脉瘘（dural arteriovenous fistula）后的随访中的比较：一项双中心研究。
Assessment of 4D MR Angiography at 3T Compared with DSA for the Follow-up of Embolized Brain Dural Arteriovenous Fistula: A Dual-Center Study.
机构信息
From the Department of Neuroradiology (B.D., F.E., J.-Y.G., J.-C.F.), Centre Hospitalier Universitaire Rennes, Rennes, France
Department of Medical Imaging (B.D., J.O., J.-C.G.), Centre Hospitalier Universitaire La Cavale Blanche, Brest, France.
出版信息
AJNR Am J Neuroradiol. 2021 Jan;42(2):340-346. doi: 10.3174/ajnr.A6903. Epub 2020 Dec 17.
BACKGROUND AND PURPOSE
4D contrast-enhanced MRA in the follow-up of treated dural arteriovenous fistulas has rarely been evaluated. Our aim was to evaluate its diagnostic performance at 3T in the follow-up of embolized dural arteriovenous fistulas using DSA as the standard of reference.
MATERIALS AND METHODS
Patients treated for dural arteriovenous fistulas in 2 centers between 2008 and 2019 were included if they met the following criteria: 1) dural arteriovenous fistula embolization, and 2) follow-up imaging with <6 months between DSA and 4D contrast-enhanced MRA. Two readers reviewed the 4D contrast-enhanced MRA images, first independently, then in consensus to detect any residual/recurrent dural arteriovenous fistula and to grade cases according to the Cognard classification system. Interobserver and intermodality agreement for the detection of a residual dural arteriovenous fistula and stratification of bleeding risk (0-I-IIa; IIb-IIa+b-III-IV-V) was calculated using κ coefficients.
RESULTS
A total of 51 pairs of examinations for 44 patients (median age, 65 years; range, 25-81 years) were analyzed. Interobserver agreement for the detection and stratification of bleeding risk was, respectively, κ = 0.8 (95% CI, 0.6-1) and κ = 0.8 (95% CI, 0.5-1). After consensus review, the sensitivity and specificity of 4D contrast-enhanced MRA for the detection of residual/recurrent dural arteriovenous fistula was 63.6% (95% CI, 40.7%-82.8%) and 96.6% (95% CI, 82.2%-99.9%), respectively. The positive and negative predictive values of 4D contrast-enhanced MRA were 93.3% (95% CI, 68.1%-99.8%) and 77.8% (95% CI, 60.8%-89.9%). Intermodality agreement for the detection and stratification of bleeding risk was good, with κ = 0.60 (95% CI, 0.3-0.8).
CONCLUSIONS
4D contrast-enhanced MRA at 3T is of interest in the follow-up of treated dural arteriovenous fistulas but lacks the sensitivity to replace arteriography.
背景与目的
4D 对比增强磁共振血管成像（MRA）在治疗后硬脑膜动静脉瘘（dural arteriovenous fistula，DAVF）的随访中很少被评估。我们的目的是使用数字减影血管造影（DSA）作为参考标准，在 3T 上评估其在栓塞性硬脑膜动静脉瘘随访中的诊断性能。
材料与方法
在 2008 年至 2019 年期间，在 2 个中心接受治疗的硬脑膜动静脉瘘患者，如果符合以下标准，则被纳入研究：1）硬脑膜动静脉瘘栓塞治疗；2）DSA 检查后 <6 个月进行影像学随访。2 位读者首先独立，然后共识地对 4D 对比增强 MRA 图像进行评估，以检测任何残留/复发性硬脑膜动静脉瘘，并根据 Cognard 分类系统对病例进行分级。使用κ系数计算检测残留硬脑膜动静脉瘘和分层出血风险（0-I-IIa；IIb-IIa+b-III-IV-V）的观察者间和模式间一致性。
结果
共分析了 44 例患者的 51 对检查（中位年龄 65 岁；范围 25-81 岁）。检测和分层出血风险的观察者间一致性分别为κ=0.8（95%置信区间，0.6-1）和κ=0.8（95%置信区间，0.5-1）。共识后，4D 对比增强 MRA 检测残留/复发性硬脑膜动静脉瘘的灵敏度和特异度分别为 63.6%（95%置信区间，40.7%-82.8%）和 96.6%（95%置信区间，82.2%-99.9%）。4D 对比增强 MRA 的阳性和阴性预测值分别为 93.3%（95%置信区间，68.1%-99.8%）和 77.8%（95%置信区间，60.8%-89.9%）。检测和分层出血风险的模式间一致性良好，κ=0.60（95%置信区间，0.3-0.8）。
结论
3T 下的 4D 对比增强 MRA 对治疗后硬脑膜动静脉瘘的随访具有一定的应用价值，但缺乏替代血管造影的敏感性。
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