Adjunctive value of intra-arterial cone beam CT angiography relative to DSA in the evaluation of cranial and spinal arteriovenous fistulas.
J Neurointerv Surg
; 7(7): 517-23, 2015 Jul.
Article
em En
| MEDLINE
| ID: mdl-24821841
ABSTRACT
OBJECTIVE:
To assess the adjunctive diagnostic value of intra-arterial cone-beam CT angiography (IA-CBCTA) relative to digital subtraction angiography (DSA) in the anatomic identification/localization of intracranial/spinal arteriovenous fistulas (AVFs) and utility for surgical/endovascular treatment planning.METHODS:
Retrospectively, two blinded observers scored DSA and IA-CBCTA images of 32 patients with intracranial/spinal AVFs based on a qualitative scale. The following parameters were scored arterial feeders, venous drainers and course, fistula site, and adjacent anatomic landmarks for cross-sectional localization. The total score was defined as the overall diagnostic value. Differences between IA-CBCTA and DSA scores were defined as the IA-CBCTA efficacy value. Observers described the treatment strategy at the end of DSA and IA-CBCTA grading, respectively. Mann-Whitney U test, Wilcoxon's signed rank test, and Kendall's tau (τ) coefficient were used for statistical analysis.RESULTS:
Interobserver agreement of overall diagnostic value for IA-CBCTA was good (τ=0.59, p=0.001) with no significant variance between the two observers' IA-CBCTA efficacy values (p=0.2). Significantly higher scores were assigned to IA-CBCTA for overall diagnostic value (both observers p<0.0001), delineation of fistula site (observer 1 p<0.0001, observer 2 p=0.0003), and adjacent anatomic landmarks (both observers p<0.0001). Observers found IA-CBCTA helpful, enabling a more confident treatment approach in 30 and 29 cases for observer 1 and observer 2, respectively. Both observers altered the treatment plan in two cases based on IA-CBCTA findings.CONCLUSIONS:
IA-CBCTA as an adjunctive technique to DSA improves the anatomic delineation of AVFs, particularly for the fistula site and cross-sectional localization, and has the potential to improve treatment planning.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Medula Espinal
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Angiografia Cerebral
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Angiografia Digital
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Malformações Arteriovenosas Intracranianas
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Fístula Arteriovenosa
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Tomografia Computadorizada de Feixe Cônico
Tipo de estudo:
Observational_studies
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Prevalence_studies
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Prognostic_studies
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Qualitative_research
/
Risk_factors_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2015
Tipo de documento:
Article