Tritanon Oranan, Khunvutthidee Sirirat, Kobkitsuksakul Chai, Jindahra Panitha, Panyaping Theeraphol
Division of Diagnostic Neuroradiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand.
Division of Diagnostic Neuroradiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand; Department of Radiology, Neurological Institute of Thailand, 312 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand.
Eur J Radiol. 2023 May;162:110800. doi: 10.1016/j.ejrad.2023.110800. Epub 2023 Mar 26.
This study aimed to evaluate the ability of susceptibility-weighted imaging (SWI) to detect cortical venous reflux (CVR) in patients with intracranial non-cavernous dural arteriovenous fistulas (DAVFs), which can be helpful to differentiate benign and aggressive DAVFs.
Twenty-seven patients (8 women and 19 men) with 33 non-cavernous DAVFs were divided into benign and aggressive groups. Presence of CVR and pseudophlebitic pattern (PPP) and location of fistula on SWI were determined. Digital subtraction angiography was used as the reference standard. Interobserver agreement for the presence of CVR and PPP and location of DAVF on SWI was evaluated using the kappa statistic. Statistical comparisons between the benign and aggressive DAVFs were performed.
Sensitivity, specificity, positive predictive value, and negative predictive value of SWI for detecting CVR was 73.7%, 85.7%, 87.5%, and 70.6%, respectively. Corresponding values for detecting PPP were 95.2%, 83.3%, 95.2%, and 83.3%, respectively. SWI correctly identified DAVF location in 78.9%. Prevalence rates of CVR and PPP on SWI were significantly higher in aggressive DAVFs than benign ones.
SWI exhibited high sensitivity and specificity for detection of CVR, a characteristic used to differentiate benign and aggressive lesions. CVR and PPP on SWI are signs of aggressive DAVFs that guide to perform angiography confirmation and prompt treatment to avoid serious complication.
本研究旨在评估磁敏感加权成像（SWI）检测颅内非海绵状硬脑膜动静脉瘘（DAVF）患者皮质静脉回流（CVR）的能力，这有助于鉴别良性和侵袭性DAVF。
27例（8例女性，19例男性）患有33处非海绵状DAVF的患者被分为良性组和侵袭性组。确定SWI上CVR和假静脉炎样表现（PPP）的存在情况以及瘘口位置。数字减影血管造影用作参考标准。使用kappa统计量评估观察者间对SWI上CVR和PPP的存在情况以及DAVF位置的一致性。对良性和侵袭性DAVF进行统计学比较。
SWI检测CVR的敏感性、特异性、阳性预测值和阴性预测值分别为73.7%、85.7%、87.5%和70.6%。检测PPP的相应值分别为95.2%、83.3%、95.2%和83.3%。SWI正确识别DAVF位置的比例为78.9%。侵袭性DAVF在SWI上CVR和PPP的发生率显著高于良性DAVF。
SWI对CVR的检测具有高敏感性和特异性，CVR是用于鉴别良性和侵袭性病变的特征。SWI上的CVR和PPP是侵袭性DAVF的征象，可指导进行血管造影确认并及时治疗以避免严重并发症。
