Dual-Source Computed Tomography Angiography versus Time-Resolved Contrast-Enhanced Magnetic Resonance Angiography for Diagnosis of Spinal Vascular Malformations: A Retrospective Study

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery Pub Date : 2025-03-06 DOI:10.1016/j.wneu.2025.123745

Jinyu Zhu , Wangshu Zhu , Minghua Li , Xiaoer Wei , Zheyi Chen , Yuehua Li

{"title":"Dual-Source Computed Tomography Angiography versus Time-Resolved Contrast-Enhanced Magnetic Resonance Angiography for Diagnosis of Spinal Vascular Malformations: A Retrospective Study","authors":"Jinyu Zhu , Wangshu Zhu , Minghua Li , Xiaoer Wei , Zheyi Chen , Yuehua Li","doi":"10.1016/j.wneu.2025.123745","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the performance of time-resolved angiography with stochastic trajectories (TWIST-MRA) and dual-source CT angiography (CTA), applied independently and in combination, for preoperative assessment of spinal vascular malformation (SVM).</div></div><div><h3>Methods</h3><div>This retrospective study included 77 patients with suspected SVM who underwent TWIST-MRA, CTA, and digital subtraction angiography between September 2019 and December 2022. Precision recall curve analysis was used to assess diagnostic performance. The feeding artery and fistula location were evaluated using radiologist confidence level by CTA and TWIST-MRA.</div></div><div><h3>Results</h3><div>Among the 77 patients, 71 had digital subtraction angiography-confirmed SVM (cervical, n = 7; thoracolumbar, n = 60; deep lumbosacral, n = 4) and 6 did not have SVM. Both TWIST-MRA and CTA showed excellent accuracy (96.1% vs. 94.8%) and sensitivity (98.6% vs. 97.2%) for diagnosis of SVM subtypes. TWIST-MRA performed slightly better than CTA in identifying the feeding artery and fistula (area under the curve-precision recall, 0.958 vs. 0.944); however, sensitivity was not statistically different (<em>P</em> = 0.512). Among SVM patients, the radiologist confidence levels in identifying feeding artery and fistula of SVMs were significantly higher with CTA+TWIST-MRA than with TWIST-MRA alone (<em>P</em> = 0.007). The radiologist confidence levels were significantly higher with CTA alone and CTA+TWIST-MRA compared to TWIST-MRA alone for fistula identification of cervical and deep lumbosacral SVMs (<em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Both TWIST-MRA and CTA are reliable for diagnosing SVM and localizing the feeding artery and fistula. While TWIST-MRA remains the primary technique, the addition of CTA can improve diagnostic confidence. CTA may be considered as an alternative to TWIST-MRA for SVMs in the cervical and lumbosacral regions.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123745"},"PeriodicalIF":1.9000,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1878875025001019","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

To investigate the performance of time-resolved angiography with stochastic trajectories (TWIST-MRA) and dual-source CT angiography (CTA), applied independently and in combination, for preoperative assessment of spinal vascular malformation (SVM).

Methods

This retrospective study included 77 patients with suspected SVM who underwent TWIST-MRA, CTA, and digital subtraction angiography between September 2019 and December 2022. Precision recall curve analysis was used to assess diagnostic performance. The feeding artery and fistula location were evaluated using radiologist confidence level by CTA and TWIST-MRA.

Results

Among the 77 patients, 71 had digital subtraction angiography-confirmed SVM (cervical, n = 7; thoracolumbar, n = 60; deep lumbosacral, n = 4) and 6 did not have SVM. Both TWIST-MRA and CTA showed excellent accuracy (96.1% vs. 94.8%) and sensitivity (98.6% vs. 97.2%) for diagnosis of SVM subtypes. TWIST-MRA performed slightly better than CTA in identifying the feeding artery and fistula (area under the curve-precision recall, 0.958 vs. 0.944); however, sensitivity was not statistically different (P = 0.512). Among SVM patients, the radiologist confidence levels in identifying feeding artery and fistula of SVMs were significantly higher with CTA+TWIST-MRA than with TWIST-MRA alone (P = 0.007). The radiologist confidence levels were significantly higher with CTA alone and CTA+TWIST-MRA compared to TWIST-MRA alone for fistula identification of cervical and deep lumbosacral SVMs (P < 0.001).

Conclusions

Both TWIST-MRA and CTA are reliable for diagnosing SVM and localizing the feeding artery and fistula. While TWIST-MRA remains the primary technique, the addition of CTA can improve diagnostic confidence. CTA may be considered as an alternative to TWIST-MRA for SVMs in the cervical and lumbosacral regions.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS