Dynamic contrast-enhanced magnetic resonance angiography for the localization of spinal dural arteriovenous fistulas at 3T.
OBJECTIVE
This study was undertaken to evaluate the accuracy of dynamic contrast-enhanced magnetic resonance angiography (DCE-MRA) in the precise location and demonstration of fistulous points in spinal dural arteriovenous fistulas (SDAVFs).


METHODS
Fifteen patients (14 men, 1 woman; age range: 40-78 years; mean: 55.5 years) harboring SDAVF who underwent preoperative DCE-MRA and spinal digital subtraction angiography (DSA) between January 2012 and January 2015 were evaluated retrospectively. Two reviewers independently evaluated the level and side of the arteriovenous fistula and feeding artery on 3T DCE-MRA and DSA images. The accuracy of DCE-MRA was assessed by comparing its findings with those from DSA and surgery in each case.


RESULTS
All 15 patients underwent DCE-MRA and DSA. DSA was unsuccessful in two patients due to technical difficulties. All cases were explored surgically, guided by the DCE-MRA. Surgery confirmed that 14 AVF sites were located in the thoracic spine, 5 in the lumbar spine, and 1 in the cervical spine. The origin of the fistulas and feeding arteries was accurately shown by DCE-MRA in 11 of the 15 patients. DCE-MRA also detected dilated perimedullary veins in all 15 patients. Overall, DCE-MRA facilitated DSA catheterization in 10 cases. In six patients, the artery of Adamkiewicz could be observed. In 15 out of 20 fistulas (75%), both readers agreed on the location on DCE-MRA images, and the κ coefficient of the interobserver agreement was 0.67 (95% confidence interval [CI], 0.16-0.87). In 13 of 16 shunts (75%), the DCE-MRA consensus findings and DSA findings coincided. The intermodality agreement was 0.77 (95% CI: 0.35-0.92).


CONCLUSIONS
Our DCE-MRA studies benefited from the use of a high-field 3T MR imaging unit and reliably detected and localized the SDAVF and feeding arteries. As experience with this technique grows, it may be possible to replace DSA with DCE-MRA if surgery is the planned treatment.
Department of diagnostic and interventional radiology, Shanghai Jiao Tong university affiliated Sixth People's hospital, Shanghai, China.
G
G
Zhou
Department of diagnostic and interventional radiology, Shanghai Jiao Tong university affiliated Sixth People's hospital, Shanghai, China.
M H
MH
Li
School of radiology, Taishan medical college, Taian, Shandong, China.
C
C
Lu
Department of anesthesiology, The Military general hospital of Beijing PLA, Beijing, China.
Y L
YL
Yin
Department of diagnostic and interventional radiology, Shanghai Jiao Tong university affiliated Sixth People's hospital, Shanghai, China.
Y Q
YQ
Zhu
Department of diagnostic and interventional radiology, Shanghai Jiao Tong university affiliated Sixth People's hospital, Shanghai, China.
X E
XE
Wei
Department of diagnostic and interventional radiology, Shanghai Jiao Tong university affiliated Sixth People's hospital, Shanghai, China.
H T
HT
Lu
Department of hematology, Shanghai Jiao Tong university affiliated Sixth People's hospital, Shanghai, China.
Q Q
QQ
Zheng
Department of neurosurgery, Shanghai Jiao Tong university affiliated Sixth People's hospital, MS, No. 600, Yi Shan road, 200233 Shanghai, China. Electronic address: gaowenweiyx@163.com.
W W
WW
Gao
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging* / Q000473:pathology
D003287:Contrast Media
Accuracy; Angioarchitecture; Digital subtraction angiography; Dynamic contrast-enhanced MR angiography; Spinal dural arteriovenous fistulas