Diagnostic accuracy of three-dimensional-rotational angiography and heavily T2-weighted volumetric magnetic resonance fusion imaging for the diagnosis of spinal arteriovenous shunts
Diagnostic accuracy of three-dimensional-rotational angiography and heavily T2-weighted volumetric magnetic resonance fusion imaging for the diagnosis of spinal arteriovenous shunts
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DOI：
10.1136/neurintsurg-2020-017252
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发表时间：
2021-03
影响因子：
4.8
通讯作者：
Bikei Ryu;Shinsuke Sato;M. Takase;Tatsuki Mochizuki;S. Shima;Tatsuya Inoue;Y. Okada;Y. Niimi
中科院分区：
文献类型：
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作者：
Bikei Ryu;Shinsuke Sato;M. Takase;Tatsuki Mochizuki;S. Shima;Tatsuya Inoue;Y. Okada;Y. Niimi
脊髓动静脉分流（SAVSs）是罕见的实体，发生在从颅颈交界处到骶骨水平的各个区域。近年来，随着影像技术的进步，对SAVS血管结构的了解和发病机制的阐明已成为可能。然而，融合不同图像模式对SAVS诊断的效用尚未确定。本研究旨在探讨三维旋转血管造影（3D-RA）和3d重t2加权体积磁共振（3D-MR）融合成像是否能提高对savs的诊断准确性。方法回顾性分析12例savs患者的临床资料。7位盲评者评估3D-RA和3D-RA/3D-MR融合图像对SAVS的影响。最终诊断由两名经验丰富的介入神经放射学家进行，并使用κ统计量计算评论者与最终诊断之间的观察者间一致性。比较3D-RA和3D-RA/3D-MR融合图像之间的观察者间一致性，用于诊断SAVS亚型。我们还统计比较了图像质量等级（4级），以描绘血管畸形与周围解剖标志之间的三维关系。结果3D-RA/3D-MR融合图像的观察者间一致性显著（κ=0.7071），高于3D-RA图像的观察者间一致性（κ=0.3534）。3D- ra /3D- mr融合图像的图像质量等级明显优于3D- ra图像（p<0.0001），用于评估所检查的3D关系。结论3D-RA/3D-MR融合图像对SAVS亚型诊断提供了更好的观察者间一致性，可以详细评估分流器周围的SAVS解剖结构。
Background Spinal arteriovenous shunts (SAVSs) are rare entities occurring in various areas, from the craniocervical junction to the sacral level. Recently, better understanding of SAVS angioarchitecture and elucidation of its pathogenesis have become possible with the advancement of imaging techniques. However, the utility of fusing different image modalities for SAVS diagnostics has not been determined. This study aimed to investigate whether three-dimensional-rotational angiography (3D-RA) and 3D-heavily T2-weighted volumetric MR (3D-MR) fusion imaging would improve the diagnostic accuracy for SAVSs. Methods We retrospectively reviewed 12 SAVSs in 12 patients. Assessment of 3D-RA and 3D-RA/3D-MR fusion images for SAVS was performed by seven blinded reviewers. The final diagnosis was performed by two interventional neuroradiologists with extensive experience, and the interobserver agreement between the reviewers and the final diagnosis was calculated using κ statistics. The comparison of the interobserver agreement between 3D-RA and 3D-RA/3D-MR fusion images was performed for the diagnosis of SAVS subtypes. We also statistically compared the image-quality gradings (on a 4-grade scale) to delineate the 3D relationship between vascular malformations and the surrounding anatomical landmarks. Results The interobserver agreement for the 3D-RA/3D-MR fusion images was substantial (κ=0.7071) and higher than that for the 3D-RA images (κ=0.3534). Significantly better image quality grades were assigned to 3D-RA/3D-MR fusion images than to 3D-RA images (p<0.0001) for the evaluation of the examined 3D relationships. Conclusion The 3D-RA/3D-MR fusion images provided better interobserver agreement of SAVS subtype diagnosis, allowing for detailed evaluation of the SAVS anatomical structures surrounding the shunt.