Detection of spinal dural arteriovenous fistulae with MR imaging and contrast-enhanced MR angiography: sensitivity, specificity, and prediction of vertebral level.
Detection of spinal dural arteriovenous fistulae with MR imaging and contrast-enhanced MR angiography: sensitivity, specificity, and prediction of vertebral level.
复制标题
用 MR 成像和对比增强 MR 血管造影检测脊髓硬脑膜动静脉瘘：敏感性、特异性和椎体水平的预测。
DOI：
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发表时间：
2002
期刊：
影响因子：
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通讯作者：
A. Wakhloo
中科院分区：
文献类型：
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作者：
E. Saraf‐Lavi;B. Bowen;R. Quencer;E. Sklar;A. Holz;S. Falcone;R. Latchaw;R. Duncan;A. Wakhloo
背景和目的
磁共振成像和对比增强磁共振血管造影已被用于检测硬脊膜动静脉瘘（AVF）的证据，但这些技术的敏感性和特异性尚未显示。本研究的目的是确定单独MR成像与MR成像加MR血管造影在确定是否存在硬脑膜AVF方面的敏感性、特异性和准确性，并确定MR血管造影在预测瘘水平方面的准确性。
方法
20例经手术证实的硬脑膜AVF患者（经X线数字减影血管造影诊断）和11例数字减影血管造影结果正常的对照患者接受了常规MR成像加脊柱3D对比增强MR血管造影。由三名对最终诊断不知情的神经放射科医生分两个阶段（第一阶段，仅MR图像;第二阶段，MR图像加MR血管造影）审查图像。
结果
三位评审员检测I期瘘管存在的敏感性、特异性和准确性分别为85%-90%、82%-100%和87%-90%，而II期分别为80%-100%、82%和81%-94%。对于每一位评审员，I期和II期的值之间没有显著差异;然而，在评审员中，经验丰富的神经放射科医生对II期的敏感性显著高于经验不足的神经放射科医生。平均而言，预测正确瘘管水平的真阳性结果百分比从I期的15%增加到II期的50%，而II期预测正确水平+/-一个水平的百分比为73%。硬膜AVF患者的硬膜内血管增加的MR证据显著更多。
结论
在脊柱标准MR成像中增加MR血管造影可提高检测硬脊膜瘘的灵敏度。磁共振血管造影的主要优点是可以更好地定位瘘管的椎体水平，这可能会加快后续的数字减影血管造影研究。
BACKGROUND AND PURPOSE
MR imaging and contrast-enhanced MR angiography have been used to detect evidence of spinal dural arteriovenous fistulae (AVF); however, the sensitivity and specificity of these techniques have not been shown. The purpose of this study was to establish the sensitivity, specificity, and accuracy of MR imaging alone compared with MR imaging plus MR angiography in determining whether dural AVF are present and to establish the accuracy of MR angiography in predicting fistula level.
METHODS
Twenty patients with surgically proven dural AVF (diagnosed with radiographic digital subtraction angiography) and 11 control patients who had normal digital subtraction angiography findings underwent routine MR imaging plus 3D contrast-enhanced MR angiography of the spine. Images were reviewed in two stages (stage I, MR images only; stage II, MR images plus MR angiograms) by three neuroradiologists who were blinded to the final diagnoses.
RESULTS
The sensitivity, specificity, and accuracy of the three reviewers in detecting the presence of fistulae ranged from 85% to 90%, from 82% to 100%, and from 87% to 90%, respectively, for stage I, compared with values of 80% to 100%, 82%, and 81% to 94%, respectively, for stage II. For each reviewer, there was no significant difference between the values for stages I and II; however, among the reviewers, one of the more experienced neuroradiologists had significantly greater sensitivity than a less experienced neuroradiologist for stage II. On average, the percentage of true positive results for which the correct fistula level was predicted increased from 15% for stage I to 50% for stage II, and the correct level +/- one level was predicted in 73% for stage II. MR evidence of increased intradural vascularity was significantly greater in patients with dural AVF.
CONCLUSION
The addition of MR angiography to standard MR imaging of the spine may improve sensitivity in the detection of spinal dural fistulae. The principal benefit of MR angiography is in the improved localization of the vertebral level of the fistula, which potentially expedites the subsequent digital subtraction angiography study.