title: Adjunctive value of intra-arterial cone beam CT angiography relative to DSA in the evaluation of cranial and spinal arteriovenous fistulas.
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.
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Amir R
authors.initials: AR
authors.lastname: Honarmand
authors.affiliation: Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gemmete
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Hurley
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Shaibani
authors.affiliation: Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Chaudhary
authors.affiliation: Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Aditya S
authors.initials: AS
authors.lastname: Pandey
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bendok
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Ansari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods*; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging* / Q000601:surgery; D002533:Cerebral Angiography / Q000379:methods*; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016037:Single-Blind Method; D013116:Spinal Cord / Q000000981:diagnostic imaging*
keywords: Angiography; CT Angiography; Fistula