Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Spine Tumor Center, National Taiwan University Hospital, Taipei, Taiwan.
Spine Tumor Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Imaging, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
Eur J Radiol. 2024 Sep;178:111639. doi: 10.1016/j.ejrad.2024.111639. Epub 2024 Jul 20.
Computed tomography-digital subtraction angiography (CT-DSA) is a radiological method for assessing spinal metastatic tumor vascularity. The study aimed to investigate the association between CT-DSA results and perioperative outcomes in spinal metastatic surgery.
Patients who underwent spinal metastatic operations with preoperative CT-DSA examinations at any time between January 2018 to December 2022. CT-DSA was classified into five grades ranging from grade 0 to grade 4. Grades 3 and 4 were indicative of hypervascularity. We analyzed the perioperative outcomes of intraoperative blood loss amount, massive hemorrhage (≥2500 ml) occurrence, blood transfusion status, operation time, hospital stay duration, and 30-day and 60-day mortality rates. Logistic regression analyses were conducted to identify factors affecting the likelihood of massive hemorrhage in conjunction with CT-DSA.
Data from 212 operations involving 209 patients were analyzed. In total, 30, 36, 66, 56, and 24 operations had CT-DSA grades from grade 0 to grade 4, respectively. Eighty (38 %) studies were indicative of hypervascularity. CT-DSA grade was positively correlated with the amount of operative blood loss, the occurrence of massive hemorrhage, and the amount of blood in blood transfusion (p < 0.05). However, CT-DSA grades was not significantly associated with operation duration or mortality rate. A multivariable analysis indicated that factors such as hemoglobulin, hypervascular pathology, and spinal instability neoplastic scores were positively correlated with CT-DSA grade. CT-DSA grade (odds ratio: 2.37, p = 0.02), spinal metastatic invasiveness index, and tumor size (≥50 mL) were found to be independent predictors in a multivariable logistic regression analysis where factors associated with massive hemorrhage were included. Hypervascular pathology type was not significantly associated with the likelihood of hemorrhage in the univariable and multivariable analyses.
CT-DSA serves as an effective tool for assessing vascularity, and is associated with intra-operative blood loss and likelihood of experiencing massive hemorrhage. The predictive capability of CT-DSA surpasses that of traditional histopathology classifications, making it a useful method for preoperative planning in spinal metastatic surgeries.
计算机断层扫描数字减影血管造影（CT-DSA）是一种评估脊柱转移瘤血管生成的放射学方法。本研究旨在探讨 CT-DSA 结果与脊柱转移瘤手术围手术期结果之间的关系。
选择 2018 年 1 月至 2022 年 12 月期间任何时间接受脊柱转移手术且术前接受 CT-DSA 检查的患者。将 CT-DSA 分为 0 至 4 级，3 级和 4 级为高血管性。我们分析了术中失血量、大出血（≥2500ml）发生、输血状态、手术时间、住院时间以及 30 天和 60 天死亡率等围手术期结果。采用 Logistic 回归分析确定与 CT-DSA 相结合影响大出血可能性的因素。
共分析了 212 例 209 例患者的手术资料，其中 CT-DSA 分级分别为 0 级 30 例、1 级 36 例、2 级 66 例、3 级 56 例和 4 级 24 例。80 例（38%）为高血管性病变。CT-DSA 分级与手术出血量、大出血发生和输血血量呈正相关（p<0.05）。然而，CT-DSA 分级与手术时间或死亡率无显著相关性。多变量分析表明，血红蛋白、高血管病变和脊柱不稳肿瘤评分等因素与 CT-DSA 分级呈正相关。在多变量 logistic 回归分析中，纳入与大出血相关的因素后，发现 CT-DSA 分级（优势比：2.37，p=0.02）、脊柱转移侵袭指数和肿瘤大小（≥50ml）是独立的预测因子。单变量和多变量分析均表明，高血管病变类型与出血可能性无显著相关性。
CT-DSA 是一种评估血管生成的有效工具，与术中失血量和发生大出血的可能性相关。CT-DSA 的预测能力优于传统的组织病理学分类，是脊柱转移瘤手术术前计划的有用方法。
