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Application of 4D-CTA using 320-row area detector computed tomography on spinal arteriovenous fistulae: initial experience

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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.

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Authors and Affiliations

  1. Department of Neusorugery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 7348551, Japan

    Satoshi Yamaguchi, Masaaki Takeda, Takafumi Mitsuhara, Kuniki Eguchi, Kazuhiko Sugiyama & Kaoru Kurisu

  2. Department of Neurosurgery, Itsukaichi Memorial Hospital, Hiroshima, Japan

    Shiro Kajihara, Kazutoshi Mukada & Yosuke Kajihara

  3. Technical Division of Diagnostic Imaging, Itsukaichi Memorial Hospital, Hiroshima, Japan

    Kohei Takemoto

Authors
  1. Satoshi Yamaguchi
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  2. Masaaki Takeda
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  3. Takafumi Mitsuhara
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  4. Shiro Kajihara
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  5. Kazutoshi Mukada
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  9. Kazuhiko Sugiyama
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  10. Kaoru Kurisu
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Correspondence to Satoshi Yamaguchi.

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Comments

Peter Willems, Leiden, The Netherlands

Arteriovenous fistulas (AVFs) may be challenging lesions to diagnose. Their key finding is the early opacification of veins after contrast injection, which requires time-resolved imaging. The gold standard for this is catheter-based angiography (CA). Unfortunately, CA is time-consuming, requires trained personnel, and is associated with the procedural risks of an intra-arterial catheterization. The development of another modality without these downsides would be of value, even if it would not replace catheter angiography as the gold standard. For this, one would need to be aware of the diagnostic value of such a new modality to allow decision making based on its results. In cranial lesions, both time-resolved MRA (trMRA) and time-resolved CTA (4D-CTA) have been shown to reveal fistulas and arteriovenous malformations (AVMs) and their diagnostic value is currently under investigation. However, this report is the first to demonstrate an attempt to use 4D-CTA in spinal lesions. This shift of attention from cranial to spinal is not a trivial one. The CT scanner in this report only covers 16 cm per study, which is sufficient for the entire cranium but not for the entire spinal column. Furthermore, issues arise with regard to contrast bolus timing, patient positioning, and patient movement. Finally, spinal fistulas and the vessels involved are often much smaller than their cranial counterparts. Consequently, the authors are to be commended with the successful diagnosis of a small number of spinal arteriovenous shunting lesions, using their novel protocols. On the other hand, it is important to be aware that these results do not imply that any and every shunt will be diagnosed with 4D-CTA. Further (prospective) research will be necessary to determine the true diagnostic value of this modality. Those results would allow us to determine when 4D-CTA, rather than CA, is indicated and what the consequences should be of its findings.

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Yamaguchi, S., Takeda, M., Mitsuhara, T. et al. Application of 4D-CTA using 320-row area detector computed tomography on spinal arteriovenous fistulae: initial experience. Neurosurg Rev 36, 289–296 (2013). https://doi.org/10.1007/s10143-012-0440-z

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  • DOI: https://doi.org/10.1007/s10143-012-0440-z

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