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Original research
Adjunctive value of intra-arterial cone beam CT angiography relative to DSA in the evaluation of cranial and spinal arteriovenous fistulas
  1. Amir R Honarmand1,
  2. Joseph J Gemmete2,3,
  3. Michael C Hurley1,4,
  4. Ali Shaibani1,4,
  5. Neeraj Chaudhary2,3,
  6. Aditya S Pandey2,
  7. Bernard R Bendok1,4,
  8. Sameer A Ansari1,4
  1. 1Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
  3. 3Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
  4. 4Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  1. Correspondence to Sameer A Ansari, MD, PhD Departments of Radiology, Neurology, and Neurological Surgery, Northwestern University, Feinberg School of Medicine, 676 N St Clair, Suite 800, Chicago, IL 60611-2927, USA; s-ansari{at}northwestern.edu

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.

  • Fistula
  • CT Angiography
  • Angiography

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