Usefulness of arterial spin labeling in the postoperative evaluation for dural arteriovenous fistula

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-07-28 DOI:10.1016/j.clineuro.2025.109082

Shota Yoshimura, Yoichi Morofuji, Kazuaki Okamura, Yuki Matsunaga, Takayuki Matsuo

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引用次数: 0

Abstract

Purpose

Arterial spin labeling (ASL) has shown promise in diagnosing, classifying, and evaluating cortical venous reflux in dural arteriovenous fistulas (DAVFs). However, its utility in the postoperative assessment of DAVFs remains underexplored due to limited clinical data. This study aimed to evaluate the diagnostic performance of ASL in the postoperative setting.

Methods

In this single-center retrospective study, 48 patients with DAVF who underwent perioperative digital subtraction angiography (DSA) and pseudocontinuous ASL between January 2012 and June 2018 were included. ASL images were assessed for abnormal signal in cerebral venous drainage (CVD) areas or the superior ophthalmic vein (SOV) by two independent neurointerventionalists blinded to the DSA findings. Diagnostic performance metrics for ASL were calculated, and interobserver agreement was evaluated using Cohen’s kappa (κ).

Results

Postoperative ASL demonstrated a sensitivity of 87.5 % (95 % CI, 81.0 %–94.0 %), specificity of 100 % (95 % CI, 100 %), and overall diagnostic accuracy of 95.8 % (95 % CI, 90.2 %–101.5 %). The positive predictive value was 100 % and the negative predictive value was 94.1 % (95 % CI, 86.2 %–102.0 %). The positive likelihood ratio was infinite, while the negative likelihood ratio was 12.5 (95 % CI, 3.4–45.7). Interobserver reliability was substantial, with κ = 0.70.

Conclusion

ASL is a reliable noninvasive tool for postoperative surveillance of DAVF. Given its excellent specificity and high overall accuracy, ASL can serve as a valuable adjunct to DSA in the perioperative management of DAVF patients, although caution is warranted due to occasional false negatives.

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动脉自旋标记在硬脑膜动静脉瘘术后评价中的应用价值

目的材料自旋标记（ASL）在硬脑膜动静脉瘘（DAVFs）的诊断、分类和评估皮质静脉回流方面显示出前景。然而，由于临床数据有限，其在davf术后评估中的应用仍未得到充分探讨。本研究旨在评估ASL在术后的诊断性能。方法本研究为单中心回顾性研究，纳入2012年1月至2018年6月期间接受围手术期数字减影血管造影（DSA）和假连续ASL的48例DAVF患者。由两名独立的神经介入医师对DSA结果进行盲视，评估ASL图像中是否有脑静脉引流区（CVD）或眼上静脉（SOV）的异常信号。计算ASL的诊断性能指标，并使用Cohen 's kappa （κ）评估观察者间的一致性。ResultsPostoperative手语了灵敏度87.5 %(95 % CI, 81.0 % -94.0 %),100年特异性 %(95 % CI 100 %),和整体的诊断精度95.8 %(95 % CI, 90.2 % -101.5 %)。阳性预测值为100 %，阴性预测值为94.1 %（95 % CI, 86.2 % -102.0 %）。正似然比为无限大，负似然比为12.5（95 % CI, 3.4-45.7）。观察者间信度显著，κ = 0.70。结论asl是一种可靠的无创DAVF术后监测工具。由于ASL具有出色的特异性和较高的整体准确性，因此在DAVF患者的围手术期管理中，ASL可以作为DSA的有价值的辅助手段，尽管由于偶尔出现假阴性，需要谨慎。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.