Format

Send to

Choose Destination
See comment in PubMed Commons below
J Neurointerv Surg. 2015 Jul;7(7):517-23. doi: 10.1136/neurintsurg-2014-011139. Epub 2014 May 12.

Adjunctive value of intra-arterial cone beam CT angiography relative to DSA in the evaluation of cranial and spinal arteriovenous fistulas.

Author information

  • 1Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
  • 2Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
  • 3Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
  • 4Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA.

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.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

KEYWORDS:

Angiography; CT Angiography; Fistula

[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire
    Loading ...
    Write to the Help Desk