From the Department of Radiology (X.H., Z.Y., K.L., Z.Z., G.C.), Peking University Shenzhen Hospital, Shenzhen, China.
Paul C. Lauterbur Research Center for Biomedical Imaging (X.H., H.Z.), Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences.
AJNR Am J Neuroradiol. 2024 Mar 7;45(3):351-357. doi: 10.3174/ajnr.A8112.
Accurate pretreatment diagnosis and assessment of spinal vascular malformations using spinal CTA are crucial for patient prognosis, but the postprocessing reconstruction may not be able to fully depict the lesions due to the complexity inherent in spinal anatomy. Our purpose was to explore the application value of the spinal subtraction and bone background fusion CTA (SSBBF-CTA) technique in precisely depicting and localizing spinal vascular malformation lesions.
In this retrospective study, patients (between November 2017 and November 2022) with symptoms similar to those of spinal vascular malformations were divided into diseased (group A) and nondiseased (group B) groups. All patients underwent spinal CTA using Siemens dual-source CT. Multiplanar reconstruction; routine bone subtraction, and SSBBF-CTA images were obtained using the snygo.via and ADW4.6 postprocessing reconstruction workstations. Multiple observers researched the following 3 aspects: 1) preliminary screening capability using original images with multiplanar reconstruction CTA, 2) the accuracy and stability of the SSBBF-CTA postprocessing technique, and 3) diagnostic evaluation of spinal vascular malformations using the 3 types of postprocessing images. Diagnostic performance was analyzed using receiver operating characteristic analysis, while reader or image differences were analyzed using the Wilcoxon signed-rank test or the Kruskal-Wallis rank sum test.
Forty-nine patients (groups A and B: 22 and 27 patients; mean ages, 44.0 [SD, 14.3] years and 44.6 [SD,15.2] years; 13 and 16 men) were evaluated. Junior physicians showed lower diagnostic accuracy and sensitivity using multiplanar reconstruction CTA (85.7% and 77.3%) than senior physicians (93.9% and 90.9%, 98% and 95.5%). Short-term trained juniors achieved SSBBF-CTA image accuracy similar to that of experienced physicians ( > .05). In terms of the visualization and localization of spinal vascular malformation lesions (nidus/fistula, feeding artery, and drainage vein), both multiplanar reconstruction and SSBBF-CTA outperformed routine bone subtraction CTA ( = .000). Compared with multiplanar reconstruction, SSBBF-CTA allowed less experienced physicians to achieve superior diagnostic capabilities (comparable with those of experienced radiologists) more rapidly ( < .05).
The SSBBF-CTA technique exhibited excellent reproducibility and enabled accurate pretreatment diagnosis and assessment of spinal vascular malformations with high diagnostic efficiency, particularly for junior radiologists.
使用脊髓 CTA 对脊髓血管畸形进行准确的术前诊断和评估对患者的预后至关重要，但由于脊髓解剖结构的复杂性，后处理重建可能无法充分显示病变。我们的目的是探讨脊髓减影和骨背景融合 CTA（SSBBF-CTA）技术在精确描绘和定位脊髓血管畸形病变中的应用价值。
本回顾性研究将 2017 年 11 月至 2022 年 11 月间具有类似脊髓血管畸形症状的患者分为病变组（A 组）和非病变组（B 组）。所有患者均使用西门子双源 CT 进行脊髓 CTA 检查。采用多平面重建；常规骨减影，使用 snygo.via 和 ADW4.6 后处理工作站获得 SSBBF-CTA 图像。多名观察者研究了以下 3 个方面：1）多平面重建 CTA 原始图像的初步筛查能力，2）SSBBF-CTA 后处理技术的准确性和稳定性，3）3 种后处理图像对脊髓血管畸形的诊断评估。采用受试者工作特征分析评估诊断性能，采用 Wilcoxon 符号秩检验或 Kruskal-Wallis 秩和检验分析观察者或图像差异。
共评估了 49 名患者（A 组和 B 组分别为 22 名和 27 名患者；平均年龄分别为 44.0[标准差 14.3]岁和 44.6[标准差 15.2]岁；男性分别为 13 名和 16 名）。初级医师使用多平面重建 CTA 的诊断准确性和敏感度均低于高级医师（分别为 85.7%和 77.3%，93.9%和 90.9%，98%和 95.5%）。短期培训的初级医师获得的 SSBBF-CTA 图像准确性与经验丰富的医师相似（>.05）。在显示和定位脊髓血管畸形病变（病灶/瘘管、供血动脉和引流静脉）方面，多平面重建和 SSBBF-CTA 均优于常规骨减影 CTA（=0.000）。与多平面重建相比，SSBBF-CTA 使经验较少的医师能够更快地获得更高的诊断能力（与有经验的放射科医生相当）（<0.05）。
SSBBF-CTA 技术具有良好的可重复性，能够实现脊髓血管畸形的准确术前诊断和评估，具有较高的诊断效率，特别是对初级放射科医生而言。
