The Position and Role of Four-Dimensional Computed Tomography Angiography in the Diagnosis and Treatment of Spinal Arteriovenous Fistulas

Yamaguchi, Satoshi; Takemoto, Kohei; Takeda, Masaaki; Kajihara, Yosuke; Mitsuhara, Takafumi; Kolakshyapati, Manish; Mukada, Kazutoshi; Kurisu, Kaoru

doi:10.1016/j.wneu.2017.03.100

Cited by 11 publications

(10 citation statements)

References 22 publications

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“…In earlier studies, we demonstrated these differences between 4D-CTA and DSA in patients known to have a dAVF or bAVM [15–18]. Other authors also reported on the use of 4D-CTA in both spinal and cranial arteriovenous shunts [21, 22]. However, in all of these studies, only patients who were already diagnosed with such a lesion were examined.…”

Section: Discussionmentioning

confidence: 75%

High sensitivity and specificity of 4D-CTA in the detection of cranial arteriovenous shunts

et al. 2019

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PurposeIn a prospective cohort study, we evaluated the diagnostic accuracy of time-resolved CT angiography (4D-CTA) compared to digital subtraction angiography (DSA) for detecting cranial arteriovenous shunts.Material and methodsPatients were enrolled if a DSA had been ordered querying either a dural arteriovenous fistula (dAVF) or a cerebral arteriovenous malformation (bAVM). After enrolment, both a DSA and a 4D-CTA were performed. Both studies were evaluated using a standardized form. If a dAVF or bAVM was found, its classification, angioarchitectural details, and treatment options were recorded.ResultsNinety-eight patients were enrolled and 76 full datasets were acquired. DSA demonstrated a shunting lesion in 28 out of 76 cases (prevalence 37%). 4D-CTA demonstrated all but two of these lesions (sensitivity of 93%) and produced one false positive (specificity of 98%). These numbers yielded a positive predictive value (PPV) of 96% and a negative predictive value (NPV) of 96%. Significant doubt regarding the 4D-CTA diagnosis was reported in 6.6% of all cases and both false-negative 4D-CTA results were characterized by such doubt.Conclusions4D-CTA has very high sensitivity and specificity for the detection of intracranial arteriovenous shunts. Based on these results, 4D-CTA may replace DSA imaging as a first modality in the diagnostic workup in a large number of patients suspected of a cranial dAVF or bAVM, especially if there is no doubt regarding the 4D-CTA diagnosis.Key Points • 4D-CTA was shown to have a high diagnostic accuracy and is an appropriate, less invasive replacement for DSA as a diagnostic tool for cranial arteriovenous shunts in the majority of suspected cases. • Doubt regarding the 4D-CTA result should prompt additional DSA imaging, as it is associated with false negatives. • False-positive 4D-CTA results are rare, but do exist.

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Section: Discussionmentioning

confidence: 75%

High sensitivity and specificity of 4D-CTA in the detection of cranial arteriovenous shunts

et al. 2019

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“…The use of sDSA to diagnose a spinal arteriovenous fistula was described in pediatric and adult cases; 13–16 thus, combined radiological diagnostic modalities with sDSA, such as CTA, 3D rotational angiography, and magnetic resonance angiography, have been reported ( Table 1 ). 4 , 13–19 Although a possible reduction of radiation exposure in sDSA using an assistant radiological modality preceding sDSA was mentioned in previous reports, they did not describe the detailed information related to radiation exposure in sDSA such as Air Kerma and dose-area product (total, DSA, and fluoro). Only in the report by Guatam et al was the radiation exposure dosage in pediatric cases described.…”

Section: Discussionmentioning

confidence: 99%

“…Thoracolumbar epidural arteriovenous fistulas are fed by bilateral and multiple segmental arteries. 1 , 7 , 9 Thus, a preoperative detailed vascular anatomical examination is essential to treat complex and difficult arteriovenous fistulas.sDSA is the gold standard for evaluating thoracolumbar epidural arteriovenous fistulas; 1 , 4 , 7 , 9 however, thorough examinations of thoracolumbar arteriovenous fistulas using sDSA require individual catheterization of multiple segmental arteries. 10 Furthermore, fluoroscopy time, radiation exposure, and amount of contrast agent are often increased.…”

Section: Discussionmentioning

confidence: 99%

Interactive spinal computed tomography angiography–guided spinal digital subtraction angiography and embolization for thoracolumbar epidural arteriovenous fistulas: illustrative case

Hashikata

Maki

Ishibashi

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Spinal digital subtraction angiography (sDSA) is the gold standard for examining spinal arteriovenous fistulas; however, thorough sDSA evaluations of spinal arteriovenous fistulas require a long procedure, which may increase the radiation exposure time. OBSERVATIONS A 72-year-old man presented with progressive myelopathy due to a spinal epidural arteriovenous fistula. Spinal computed tomography angiography (sCTA) showed an epidural arteriovenous fistula fed by the left L3 segmental artery. To prepare for sDSA, the sCTA images were modified to mark the segmental artery bifurcations from T5 to L5 with multicolored markers. These modified sCTA images were loaded onto the multiwindow DSA display. The sCTA images were interactively modulated during sDSA. This sCTA-guided sDSA identified 18 segmental arteries within 47 minutes. The total radiation exposure was 1,292 mGy. Subsequently, transarterial embolization resolved the epidural arteriovenous fistula with clinical improvement. LESSONS Three-dimensional sCTA can provide detailed anatomical information before sDSA. Modified sCTA images with segmental artery bifurcation marking can provide interactive guidance on multipanel DSA displays. sCTA-guided sDSA is useful for accurate catheterization and reduction of procedure time.

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“…Additionally, the analysis of the Dyna-CT 3D volume that can be extracted from the 4D-DSA may be helpful for the neurosurgeons to analyze the relationships between the shunt point and the spine bone landmarks. 14 Other time resolved imaging techniques have been proposed for the exploration of SVMs such as 4D CT angiography (CTA) 15 or time-resolved MR angiography (MRA). 16 17 These techniques are non-invasive; their goal is mostly to confirm the presence of a SVM and to locate approximately the shunt point.…”

Section: Discussionmentioning

confidence: 99%

Four-dimensional digital subtraction angiography for exploration of spinal cord vascular malformations: preliminary experience

Clarençon

Lenck

Shotar

et al. 2020

J NeuroIntervent Surg

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BackgroundThe precise understanding of the angioarchitecture of spinal vascular malformations (SVMs) is often difficult to reach with conventional digital subtraction angiography (DSA). The purpose of our study was to evaluate the potential of four-dimensional DSA (4D-DSA) (Siemens Healthcare) in the exploration of SVMs.MethodsWe retrospectively studied all patients who underwent spinal DSA, including 4D-DSA acquisition, from July 2018 to June 2019 at a single institution. All spinal DSA acquisitions were performed under general anesthesia. 4D-DSA acquisitions were acquired with the protocol '12 s DSA Dyna4D Neuro'. 12 mL of iodixanol 320 mg iodine/mL were injected via a 5 F catheter (1 mL/s during the 12 s 4D-DSA acquisition). Inter-rater (three independent reviewers) and intermodality agreements were assessed.ResultsNine consecutive patients (six men, three women, mean age 55.3±19.8 years) with 10 SVMs (spinal dural arteriovenous fistulas n=3, spinal epidural arteriovenous fistulas n=2, spinal pial arteriovenous fistulas n=2, and spinal arteriovenous malformations n=2; one patient had two synchronous pial fistulas) had spinal DSA, including 4D-DSA acquisition. Inter-rater agreement was good and moderate for the venous drainage pattern and the SVM subtype, respectively. In 9 of 10 cases, the quality of the acquisition was graded as good. Satisfactory concordance between 4D-DSA and the selective microcatheterization was observed in 90% of cases for the location of the shunt point.Conclusion4D-DSA acquisition may be helpful for a better understanding of the angioarchitecture of SVMs. Larger series are warranted to confirm these preliminary results.

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The Position and Role of Four-Dimensional Computed Tomography Angiography in the Diagnosis and Treatment of Spinal Arteriovenous Fistulas

Cited by 11 publications

References 22 publications

High sensitivity and specificity of 4D-CTA in the detection of cranial arteriovenous shunts

High sensitivity and specificity of 4D-CTA in the detection of cranial arteriovenous shunts

Interactive spinal computed tomography angiography–guided spinal digital subtraction angiography and embolization for thoracolumbar epidural arteriovenous fistulas: illustrative case

Four-dimensional digital subtraction angiography for exploration of spinal cord vascular malformations: preliminary experience

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