Impact of non-contrast enhanced volumetric MRI-based feeder localization in the treatment of spinal dural arteriovenous fistula

Kannath, Santhosh Kumar; Sarma, P. Sankara; Rajan, Jayadevan Enakshy

doi:10.1136/neurintsurg-2016-012497

Cited by 8 publications

(3 citation statements)

References 19 publications

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“…Thus, although both VHHT2WI and TRCE MR imaging are excellent tools to evaluate suspected SVMs, due to inherent technical limitations of each of these sequences, whether it is possible to replace a diagnostic spinal angiography or plan limited angiography with therapeutic intent is unclear. 10,11,17 In our study, we found that VHHT2WI and TRCE MR imaging had high sensitivity and accuracy in the diagnosis of SVM, concurrent with other reported studies in the literature. [10][11][12][13][14][15] Although the diagnosis of SDAVF could be confidently made using either sequence, a false-positive diagnosis was a concern for both.…”

Section: Discussionsupporting

confidence: 89%

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Comparative Analysis of Volumetric High-Resolution Heavily T2-Weighted MRI and Time-Resolved Contrast-Enhanced MRA in the Evaluation of Spinal Vascular Malformations

Kannath

Mandapalu

Rajan

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Volumetric high-resolution heavily T2-weighted imaging or time-resolved contrast-enhanced MRA is used in the detection and characterization of spinal vascular malformations, though inherent trade-offs can affect their overall sensitivity and accuracy. We compared the efficacy of volumetric high-resolution heavily T2-weighted and time-resolved contrast-enhanced images in spinal vascular malformation diagnosis and feeder characterization and assessed whether a combined evaluation improved the overall accuracy of diagnosis. MATERIALS AND METHODS: Twenty-eight patients with spinal vascular malformations (spinal dural arteriovenous fistula, spinal cord arteriovenous malformation, and perimedullary arteriovenous fistula) were prospectively enrolled. MR images were separately analyzed by 2 neuroradiologists blinded to the final diagnosis. RESULTS: Both sequences demonstrated 100% sensitivity and 93.5% accuracy for the detection of spinal vascular malformations. Volumetric high-resolution heavily T2-weighted imaging was superior to time-resolved contrast-enhanced MR imaging for identification of spinal cord arteriovenous malformations (100% versus 90% sensitivity and 96.7% versus 93.5% accuracy), however, for the diagnosis of perimedullary arteriovenous fistula, time resolved contrast enhanced MRI was found to perform better than the volumetric T2 sequence (80% versus 60% sensitivity and 96.7% versus 93.5% accuracy). Both sequences showed equal sensitivity (100%) and accuracy (87%) for spinal dural arteriovenous fistulas. Combined evaluation improved the overall accuracy across all types of spinal vascular malformation. Volumetric high-resolution heavily T2-weighted imaging was superior or equal to time-resolved contrast-enhanced MR imaging for feeder identification of spinal dural arteriovenous fistulas for both observers (90.9% and 72.7% versus 72.7%), which improved to 90.9% when the sequences were combined. Time-resolved contrast-enhanced MR imaging performed better for major and total feeder identification of spinal cord arteriovenous malformation (80% versus 60%) and perimedullary arteriovenous fistula (80% versus 60%-80%). CONCLUSIONS: Combined volumetric high-resolution heavily T2-weighted imaging and time-resolved contrast-enhanced MR imaging can improve the sensitivity and accuracy of spinal vascular malformation diagnosis, classification, and feeder characterization. ABBREVIATIONS: ASA ϭ anterior spinal artery; PMAVF ϭ perimedullary arteriovenous fistula; SCAVM ϭ spinal cord arteriovenous malformation; SDAVF ϭ spinal dural arteriovenous fistula; SVM ϭ spinal vascular malformation; TRCE ϭ time-resolved contrast-enhanced; TRICKS ϭ time-resolved imaging of contrast kinetics; VHHT2WI ϭ volumetric high-resolution heavily T2-weighted imaging

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Section: Discussionsupporting

confidence: 89%

“…This approach will have the advantage of reduction in procedural time and the risks of spinal DSA, radiation exposure, and contrast load along with an overall reduced hospital stay. 17 Our study has several strengths. The study design was prospective, blinded, and performed on a 3T MR imaging machine.…”

Section: Discussionmentioning

confidence: 96%

Comparative Analysis of Volumetric High-Resolution Heavily T2-Weighted MRI and Time-Resolved Contrast-Enhanced MRA in the Evaluation of Spinal Vascular Malformations

Kannath

Mandapalu

Rajan

et al. 2019

AJNR Am J Neuroradiol

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“…As far as diagnosis is concerned, MRA could be of value if it is performed before DSA as this examination allows us to focus the DSA study on the suspected fistula metamers, 13 saving time, reducing exposure to radiation for both the patient and the radiologist, and reducing the probability of possible complication related to angiography. The diagnostic accuracy and the estimation of its level is lower for cases of epidural AVFs as claimed by Koizumi et al 14 Furthermore, the MRA can be very helpful in finding the correct diagnosis in elderly patients with tortuous vessels, or in the case of feeding arteries coming from the iliac arteries.…”

Section: Discussionmentioning

confidence: 99%

Time-Resolved Magnetic Resonance Angiography for Follow-Up of Treated Dural and Epidural Spinal Arteriovenous Fistula

Vercelli

Venturi

Minardi

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background Spinal arteriovenous fistulas (AVFs) are uncommon vascular malformations of spinal dural and epidural vessels. Actually digital subtraction angiography (DSA) is the gold standard for diagnosis and follow-up. The aim of this study is to demonstrate the validity of the multiphasic magnetic resonance angiography (MRA) to identify recurrent/residual AVFs or their correct surgical and/or endovascular closure. Methods A retrospective cases series with perimedullary venous plexus congestion due to spinal dural or epidural AVF was performed at our center from April 2014 to September 2019. After 1 month from treatment, the patients were subjected to time-resolved MRA and DSA to demonstrate recurrence or correct closure of AVFs. Results We collected a series of 26 matched time-resolved MRA and DSA in 20 patients who underwent an endovascular and/or surgical procedure. In our series, we reported five cases of recurrence. Time-resolved MRA detected six cases of recurrence, with 100% sensitivity and 95% specificity (p < 0.001). We used DSA as the standard reference. Conclusion Time-resolved MRA is a valid tool in posttreatment follow-up to detect recurrent or residual AVFs. It has high sensitivity and specificity and may replace DSA.

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Diagnosis of spinal dural arteriovenous fistula using 3D T2-weighted imaging

et al. 2017

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Impact of non-contrast enhanced volumetric MRI-based feeder localization in the treatment of spinal dural arteriovenous fistula

Cited by 8 publications

References 19 publications

Comparative Analysis of Volumetric High-Resolution Heavily T2-Weighted MRI and Time-Resolved Contrast-Enhanced MRA in the Evaluation of Spinal Vascular Malformations

Comparative Analysis of Volumetric High-Resolution Heavily T2-Weighted MRI and Time-Resolved Contrast-Enhanced MRA in the Evaluation of Spinal Vascular Malformations

Time-Resolved Magnetic Resonance Angiography for Follow-Up of Treated Dural and Epidural Spinal Arteriovenous Fistula

Diagnosis of spinal dural arteriovenous fistula using 3D T2-weighted imaging

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