Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of MRI and Brain Informatics, Beijing, China.
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China.
Eur J Radiol. 2023 Apr;161:110755. doi: 10.1016/j.ejrad.2023.110755. Epub 2023 Feb 25.
In comparison with the limited efficacy of conventional MR imaging and the invasiveness of catheter-based digital subtraction angiography (DSA), time-resolved MR angiography (TR-MRA) has been proposed as a promising examination for early diagnosis of spinal arteriovenous shunts (SAVSs). This paper aims to investigate the diagnostic performance of TR-MRA with scan parameters optimized for SAVSs evaluation in a large number of patients.
One hundred patients with suspected SAVSs were enrolled. Each patient underwent preoperative TR-MRA with optimized scan parameters followed by DSA. The presence or absence of SAVS, the types and the angioarchitecture of SAVSs in the TR-MRA images were diagnostically analyzed.
Among the final 97 patients, 80 cases (82.5 %) were diagnosed and classified by TR-MRA as spinal cord arteriovenous shunts (SCAVSs; n = 22), spinal dural arteriovenous shunts (SDAVSs; n = 48), and spinal extradural arteriovenous shunts (SEDAVSs; n = 10). The agreement for classifying SAVSs between TR-MRA and DSA was excellent (κ = 0.91). The sensitivity, specificity, PPV, NPV, and accuracy of TR-MRA for the diagnosis of SAVSs were 100 % (95 % CI, 94.3-100.0 %), 76.5 % (95 % CI, 49.8-92.2 %), 95.2 % (95 % CI, 87.6-98.5 %), 100 % (95 % CI, 71.7-100.0 %), and 95.9 % (95 % CI, 89.9-98.4 %). The accuracy rates of TR-MRA for the detection of feeding arteries were 75.9 %, 91.7 %, and 80.0 % for SCAVSs, SDAVSs, and SEDAVSs respectively.
Time-resolved MR angiography showed excellent diagnostic performance for SAVSs screening. Additionally, this method can classify SAVSs and identify feeding arteries in SDAVSs with high diagnostic accuracy.
与常规磁共振成像的有限疗效和基于导管的数字减影血管造影（DSA）的侵袭性相比，时间分辨磁共振血管造影（TR-MRA）已被提出作为一种有前途的早期诊断脊髓动静脉分流（SAVS）的检查方法。本文旨在研究在大量患者中优化用于 SAVS 评估的扫描参数的 TR-MRA 的诊断性能。
100 例疑似 SAVS 的患者入组。每位患者均行术前 TR-MRA 检查，扫描参数优化，然后行 DSA。对 TR-MRA 图像中 SAVS 的存在、类型和血管结构进行诊断性分析。
在最终的 97 例患者中，80 例（82.5%）通过 TR-MRA 诊断和分类为脊髓动静脉瘘（SCAVS；n=22）、脊髓硬脑膜动静脉瘘（SDAVS；n=48）和脊髓硬膜外动静脉瘘（SEDAVS；n=10）。TR-MRA 与 DSA 对 SAVS 的分类具有极好的一致性（κ=0.91）。TR-MRA 诊断 SAVS 的灵敏度、特异度、PPV、NPV 和准确度分别为 100%（95%CI，94.3-100.0%）、76.5%（95%CI，49.8-92.2%）、95.2%（95%CI，87.6-98.5%）、100%（95%CI，71.7-100.0%）和 95.9%（95%CI，89.9-98.4%）。TR-MRA 检测供血动脉的准确率分别为 SCAVS 为 75.9%、91.7%和 80.0%，SDAVS 为 91.7%和 80.0%，SEDAVS 为 80.0%。
时间分辨磁共振血管造影对 SAVS 筛查具有出色的诊断性能。此外，该方法可以对 SAVS 进行分类，并以较高的诊断准确性识别 SDAVS 中的供血动脉。
