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Diagnostic accuracy of CTA and MRI/MRA in the evaluation of the cortical venous reflux in the intracranial dural arteriovenous fistula DAVF

  • Diagnostic Neuroradiology
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Abstract

Purpose

Computed tomography angiography (CTA) and magnetic resonance imaging/angiography (MRI/MRA) are used for the diagnosis of intracranial dural arteriovenous fistulas (DAVFs). The purpose of this study was to compare the diagnostic accuracy of CTA and magnetic resonance imaging/angiography (MRI/MRA) for detection of cortical venous reflux (CVR) in intracranial DAVFs.

Methods

The records of patients with angiography-confirmed intracranial DAVFs who also received CTA and MRI/MRA from January 2008 to July 2016 were reviewed. CTA and MRI/MRA were reviewed for signs of CVR, and the diagnostic accuracy of individual signs was evaluated by receiver operating curve (ROC) analysis.

Results

A total 108 patients were included in this study. CTA signs of CVR included abnormal dilatation, early enhancement, and the presence of a medullary or pial vein. MRI/MRA signs of CVR included abnormal dilatation, early enhancement, flow-related enhancement, flow void, and medullary or pial venous collaterals. The sensitivity of individual CTA signs ranged from 62 to 96%, and specificities from 79 to 94%. The sensitivities of individual MRI/MRA signs ranged from 58 to 83%, and specificities from 77 to 93%. The area under ROC curve (AUC) of CTA and MRI/MRA were 0.91 and 0.87, respectively (P = 0.04 in direct comparison). In subgroup analysis, CTA had better diagnostic accuracy for higher grade disease (P = 0.05) and non-aggressive manifestation (P = 0.04).

Conclusions

Both CTA and MRI/MRA have good diagnostic accuracy for detection of CVR in patients with intracranial DAVFs. There is modest evidence that CTA is better than MRI/MRA.

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Authors and Affiliations

  1. Department of Medical Imaging and Radiology, Hospital and Medical College, National Taiwan University, Taipei, Taiwan

    Yen-Heng Lin, Yu-Fen Wang, Hon-Man Liu, Chung-Wei Lee & Ya-Fang Chen

  2. Department of Medical Imaging, National Taiwan University Hospital, Yun-Lin branch, Douliu City, Taiwan

    Yen-Heng Lin & Hong-Jen Hsieh

  3. Department of Medical Imaging and Radiology, Hospital and Medical College, Fu Jen Catholic University, New Taipei City, Taiwan

    Hon-Man Liu

  4. Department of Medical Imaging, Fu Jen Catholic University Hospital, 69, Guizi Rd., Taishan Dist., New Taipei City, 24352, Taiwan

    Hon-Man Liu

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  1. Yen-Heng Lin
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Correspondence to Hon-Man Liu.

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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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For this type of retrospective study formal consent is not required.

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Lin, YH., Wang, YF., Liu, HM. et al. Diagnostic accuracy of CTA and MRI/MRA in the evaluation of the cortical venous reflux in the intracranial dural arteriovenous fistula DAVF. Neuroradiology 60, 7–15 (2018). https://doi.org/10.1007/s00234-017-1948-2

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