High sensitivity and specificity of 4D-CTA in the detection of cranial arteriovenous shunts.
Eur Radiol
; 29(11): 5961-5970, 2019 Nov.
Article
en En
| MEDLINE
| ID: mdl-31089848
ABSTRACT
PURPOSE:
In 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 ANDMETHODS:
Patients 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.RESULTS:
Ninety-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.CONCLUSIONS:
4D-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.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Malformaciones Arteriovenosas Intracraneales
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Malformaciones Vasculares del Sistema Nervioso Central
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Angiografía por Tomografía Computarizada
Tipo de estudio:
Clinical_trials
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Diagnostic_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Eur Radiol
Asunto de la revista:
RADIOLOGIA
Año:
2019
Tipo del documento:
Article
País de afiliación:
Países Bajos