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RT Journal Article
SR Electronic
T1 Comparative Analysis of Volumetric High-Resolution Heavily T2-Weighted MRI and Time-Resolved Contrast-Enhanced MRA in the Evaluation of Spinal Vascular Malformations
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1601
OP 1606
DO 10.3174/ajnr.A6164
VO 40
IS 9
A1 Kannath, S.K.
A1 Mandapalu, S.
A1 Thomas, B.
A1 Enakshy Rajan, J.
A1 Kesavadas, C.
YR 2019
UL http://www.ajnr.org/content/40/9/1601.abstract
AB 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.ASAanterior spinal arteryPMAVFperimedullary arteriovenous fistulaSCAVMspinal cord arteriovenous malformationSDAVFspinal dural arteriovenous fistulaSVMspinal vascular malformationTRCEtime-resolved contrast-enhancedTRICKStime-resolved imaging of contrast kineticsVHHT2WIvolumetric high-resolution heavily T2-weighted imaging