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The value of 3D T2-weighted SPACE sequence in the differential diagnosis of spinal arteriovenous fistula and acute transverse myelitis

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Abstract

Objective

Spinal arteriovenous fistulas (SAVF) was often neglected and misdiagnosed as acute transverse myelitis (ATM) due to its insidious onset and non-specific clinical symptoms. This study aims to investigate the differential diagnostic value of high-resolution T2-weighted volumetric sequence (3D sampling perfection with application-optimized contrasts using different flip-angle evolutions [SPACE]) in patients with SAVF and ATM.

Methods

Retrospectively analyzed the clinical and radiological findings of 32 SDAVF patients and 32 ATM patients treated at our institutions from May 2018 to January 2023. They all underwent conventional spinal MRI and T2-SPACE examination, compared their performance in identifying lesions, to estimate the value of T2 SPACE sequence in the diagnosis of SAVF and ATM patients.

Results

The clue of cauda equina area change (CEAC) in conventional MRI and T2-SPACE sequences is specific for the diagnosis of SAVF. The diagnostic model composed of perimedullary flow voids (PFV) and CEAC has good diagnostic performance (AUCMRI = 0.95; AUCSPACE = 0.935). Compared with conventional MRI, the T2-SPACE sequence has a higher detection rate, sensitivity, and negative predictive value for PFV and CEAC in SAVF patients, but lower specificity and positive predictive value. In T2-SPACE images, there are significant differences in the distribution range, quadrant, and maximum diameter of PFV vessels between SAVF and ATM patients. Moreover, T2-SPACE sequence can determine the site of fistula in most SAVF patients preferably, and the inter-rater agreement was good in the assessment of the fistula.

Conclusion

The CEAC is a new and useful clue for the diagnosis of thoracolumbar SAVF. And T2-SPACE sequence can more intuitively observe the lesions of SAVF, has good differential diagnostic value for SAVF and ATM patients.

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Acknowledgements

First and foremost, I would like to show my deepest gratitude to my supervisor, Professor Xianjun Zeng, a respectable, responsible and resourceful scholar, who has provided me with valuable guidance in every stage of the writing of this thesis. I would also like to thank all the teachers and students, who participated in this study with great cooperation. Last but not least, I’d like to thank my family for their encouragement and support all the time.

Funding

This research was funded by the Clinical Research Center For Medical Imaging In Jiangxi Province (Grant No. 20223BCG74001).

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Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi Institute of Medical Imaging, No. 17, Yongwai Zheng Street, Donghu District, Nanchang City, 330006, Jiangxi Province, China

    Feng Ouyang, Qin Wu, Ye Chen, Mingxue Yin, Jie Liu, Lianjiang Lv, Zihe Xu, Xiaoru Yuan & Xianjun Zeng

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  1. Feng Ouyang
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Contributions

Conceptualization (FO, QW); Data curation (QW, NY); Formal analysis (YC, ZX, MY); Funding acquisition (XZ); Investigation (LL, YC); Methodology (FO, MY); Project administration (FO, QW, MY); Resources (QW, NY); Software (FO, JL); Supervision (XZ, NY); Validation (YC, JL); Visualization (XY, ZX); Roles/Writing—original draft (FO; QW); Writing—review & editing (FO, XZ).

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Correspondence to Xianjun Zeng.

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Ouyang, F., Wu, Q., Chen, Y. et al. The value of 3D T2-weighted SPACE sequence in the differential diagnosis of spinal arteriovenous fistula and acute transverse myelitis. Eur Spine J 32, 4111–4117 (2023). https://doi.org/10.1007/s00586-023-07969-x

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