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AJNR Am J Neuroradiol. 2019 Sep;40(9):1601-1606. doi: 10.3174/ajnr.A6164. Epub 2019 Aug 22.

Comparative Analysis of Volumetric High-Resolution Heavily T2-Weighted MRI and Time-Resolved Contrast-Enhanced MRA in the Evaluation of Spinal Vascular Malformations.

Author information

1
From the Department of Imaging Sciences and Interventional Radiology (S.K.K., B.T., J.E.R., C.K.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India drsanthoshkannath@gmail.com.
2
Department of Radiology (S.M.), NRI Medical College, Chinakakani, Guntur, Andra Pradesh, India.
3
From the Department of Imaging Sciences and Interventional Radiology (S.K.K., B.T., J.E.R., C.K.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.

Abstract

BACKGROUND AND PURPOSE:

Volumetric high-resolution heavily T2-weighted imaging or time-resolved contrast-enhanced MRA is used in the detection and characterization of spinal vascular malformations, though inherent trade-offs can affect their overall sensitivity and accuracy. We compared the efficacy of volumetric high-resolution heavily T2-weighted and time-resolved contrast-enhanced images in spinal vascular malformation diagnosis and feeder characterization and assessed whether a combined evaluation improved the overall accuracy of diagnosis.

MATERIALS AND METHODS:

Twenty-eight patients with spinal vascular malformations (spinal dural arteriovenous fistula, spinal cord arteriovenous malformation, and perimedullary arteriovenous fistula) were prospectively enrolled. MR images were separately analyzed by 2 neuroradiologists blinded to the final diagnosis.

RESULTS:

Both sequences demonstrated 100% sensitivity and 93.5% accuracy for the detection of spinal vascular malformations. Volumetric high-resolution heavily T2-weighted imaging was superior to time-resolved contrast-enhanced MR imaging for identification of spinal cord arteriovenous malformations (100% versus 90% sensitivity and 96.7% versus 93.5% accuracy), however, for the diagnosis of perimedullary arteriovenous fistula, time resolved contrast enhanced MRI was found to perform better than the volumetric T2 sequence (80% versus 60% sensitivity and 96.7% versus 93.5% accuracy). Both sequences showed equal sensitivity (100%) and accuracy (87%) for spinal dural arteriovenous fistulas. Combined evaluation improved the overall accuracy across all types of spinal vascular malformation. Volumetric high-resolution heavily T2-weighted imaging was superior or equal to time-resolved contrast-enhanced MR imaging for feeder identification of spinal dural arteriovenous fistulas for both observers (90.9% and 72.7% versus 72.7%), which improved to 90.9% when the sequences were combined. Time-resolved contrast-enhanced MR imaging performed better for major and total feeder identification of spinal cord arteriovenous malformation (80% versus 60%) and perimedullary arteriovenous fistula (80% versus 60%-80%).

CONCLUSIONS:

Combined volumetric high-resolution heavily T2-weighted imaging and time-resolved contrast-enhanced MR imaging can improve the sensitivity and accuracy of spinal vascular malformation diagnosis, classification, and feeder characterization.

PMID:
31439626
DOI:
10.3174/ajnr.A6164

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