Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi Institute of Medical Imaging, No. 17, Yongwai Zheng Street, Donghu District, Nanchang City, 330006, Jiangxi Province, China.
Eur Spine J. 2023 Dec;32(12):4111-4117. doi: 10.1007/s00586-023-07969-x. Epub 2023 Oct 7.
Spinal arteriovenous fistulas (SAVF) was often neglected and misdiagnosed as acute transverse myelitis (ATM) due to its insidious onset and non-specific clinical symptoms. This study aims to investigate the differential diagnostic value of high-resolution T2-weighted volumetric sequence (3D sampling perfection with application-optimized contrasts using different flip-angle evolutions [SPACE]) in patients with SAVF and ATM.
Retrospectively analyzed the clinical and radiological findings of 32 SDAVF patients and 32 ATM patients treated at our institutions from May 2018 to January 2023. They all underwent conventional spinal MRI and T2-SPACE examination, compared their performance in identifying lesions, to estimate the value of T2 SPACE sequence in the diagnosis of SAVF and ATM patients.
The clue of cauda equina area change (CEAC) in conventional MRI and T2-SPACE sequences is specific for the diagnosis of SAVF. The diagnostic model composed of perimedullary flow voids (PFV) and CEAC has good diagnostic performance (AUC = 0.95; AUC = 0.935). Compared with conventional MRI, the T2-SPACE sequence has a higher detection rate, sensitivity, and negative predictive value for PFV and CEAC in SAVF patients, but lower specificity and positive predictive value. In T2-SPACE images, there are significant differences in the distribution range, quadrant, and maximum diameter of PFV vessels between SAVF and ATM patients. Moreover, T2-SPACE sequence can determine the site of fistula in most SAVF patients preferably, and the inter-rater agreement was good in the assessment of the fistula.
The CEAC is a new and useful clue for the diagnosis of thoracolumbar SAVF. And T2-SPACE sequence can more intuitively observe the lesions of SAVF, has good differential diagnostic value for SAVF and ATM patients.
由于脊柱动静脉瘘（SAVF）起病隐匿，临床症状不典型，常被忽视和误诊为急性横贯性脊髓炎（ATM）。本研究旨在探讨高分辨率 T2 加权容积序列（3D 采样完美应用优化对比使用不同翻转角演化 [SPACE]）在 SAVF 和 ATM 患者中的鉴别诊断价值。
回顾性分析 2018 年 5 月至 2023 年 1 月在我院治疗的 32 例 SDAVF 患者和 32 例 ATM 患者的临床和影像学资料。所有患者均行常规脊髓 MRI 和 T2-SPACE 检查，比较两种方法识别病变的能力，评估 T2 SPACE 序列在 SAVF 和 ATM 患者诊断中的价值。
常规 MRI 和 T2-SPACE 序列中马尾区变化线索（CEAC）对 SAVF 的诊断具有特异性。由髓周流空（PFV）和 CEAC 组成的诊断模型具有良好的诊断性能（AUC=0.95；AUC=0.935）。与常规 MRI 相比，T2-SPACE 序列对 SAVF 患者 PFV 和 CEAC 的检出率、敏感度和阴性预测值更高，特异性和阳性预测值更低。在 T2-SPACE 图像中，SAVF 和 ATM 患者 PFV 血管的分布范围、象限和最大直径有明显差异。此外，T2-SPACE 序列能较好地确定大多数 SAVF 患者瘘口的位置，且评估瘘口的观察者间一致性良好。
CEAC 是诊断胸腰段 SAVF 的一个新的有用线索。T2-SPACE 序列能更直观地观察 SAVF 的病变，对 SAVF 和 ATM 患者具有良好的鉴别诊断价值。
