title: Application of 4D-CTA using 320-row area detector computed tomography on spinal arteriovenous fistulae: initial experience.
abstract: Time-resolved computed tomography angiography (4D-CTA) using a 320-row area detector CT scanner has recently been applied in the evaluation of cranial vascular disorders. However, application of 4D-CTA to spinal vascular disorder evaluation has never before been described. The authors herein report their initial experience of 4D-CTA in the evaluation of spinal arteriovenous fistulas (AVFs) and compare this novel modality with other imaging modalities. Four consecutive patients with spinal AVF underwent time-resolved contrast-enhanced magnetic resonance angiography (trMRA), 4D-CTA, and selective catheter angiography (CA). In 4D-CTA, volume data was transformed into 3D volume-rendered images and maximum intensity projection. These images were also evaluated by time-resolved serial phases. Then, images of each modality were compared, focusing on the detection of perimedullary draining veins and the prediction of AVF location and drainage flow direction. All modalities successfully detected perimedullary draining veins in all cases. Location of the AVF was detected in all cases by CA. trMRA and 4D-CTA detected the AVF in three out of the four cases. With regard to flow direction, while 4D-CTA successfully depicted ascending or descending drainage flow in the spinal canal, CA failed to detect the flow direction in one case while trMRA failed in two cases. In the case with epidural AVF, 4D-CTA was the only technique to detect the flow direction of perimedullary drainage. Although this is only an initial experience of the application of 4D-CTA to spinal vascular diseases, 4D-CTA was capable of detecting the dynamic vascular flow of spinal AVFs. The authors believe that 4D-CTA can be a useful option in the evaluation of spinal AVFs.
authors.affiliation: Department of Neusorugery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 7348551, Japan. satoya@hiroshima-u.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamaguchi
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takeda
authors.forename: Takafumi
authors.initials: T
authors.lastname: Mitsuhara
authors.forename: Shiro
authors.initials: S
authors.lastname: Kajihara
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Mukada
authors.forename: Kuniki
authors.initials: K
authors.lastname: Eguchi
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Kajihara
authors.forename: Kohei
authors.initials: K
authors.lastname: Takemoto
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Sugiyama
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kurisu
mesh_terms: D000368:Aged; D001164:Arteriovenous Fistula / Q000175:diagnosis*; D057785:Catheters; D002533:Cerebral Angiography / Q000009:adverse effects / Q000379:methods*; D004388:Dura Mater / Q000473:pathology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D013116:Spinal Cord / Q000098:blood supply / Q000473:pathology; D013122:Spinal Diseases / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods*