Four-dimensional digital subtraction angiography for exploration of spinal cord vascular malformations: preliminary experience.


Journal

Journal of neurointerventional surgery
ISSN: 1759-8486
Titre abrégé: J Neurointerv Surg
Pays: England
ID NLM: 101517079

Informations de publication

Date de publication:
Jan 2021
Historique:
received: 14 02 2020
revised: 07 05 2020
accepted: 12 05 2020
pubmed: 27 6 2020
medline: 10 3 2021
entrez: 27 6 2020
Statut: ppublish

Résumé

The precise understanding of the angioarchitecture of spinal vascular malformations (SVMs) is often difficult to reach with conventional digital subtraction angiography (DSA). The purpose of our study was to evaluate the potential of four-dimensional DSA (4D-DSA) (Siemens Healthcare) in the exploration of SVMs. We retrospectively studied all patients who underwent spinal DSA, including 4D-DSA acquisition, from July 2018 to June 2019 at a single institution. All spinal DSA acquisitions were performed under general anesthesia. 4D-DSA acquisitions were acquired with the protocol '12 s DSA Dyna4D Neuro'. 12 mL of iodixanol 320 mg iodine/mL were injected via a 5 F catheter (1 mL/s during the 12 s 4D-DSA acquisition). Inter-rater (three independent reviewers) and intermodality agreements were assessed. Nine consecutive patients (six men, three women, mean age 55.3±19.8 years) with 10 SVMs (spinal dural arteriovenous fistulas n=3, spinal epidural arteriovenous fistulas n=2, spinal pial arteriovenous fistulas n=2, and spinal arteriovenous malformations n=2; one patient had two synchronous pial fistulas) had spinal DSA, including 4D-DSA acquisition. Inter-rater agreement was good and moderate for the venous drainage pattern and the SVM subtype, respectively. In 9 of 10 cases, the quality of the acquisition was graded as good. Satisfactory concordance between 4D-DSA and the selective microcatheterization was observed in 90% of cases for the location of the shunt point. 4D-DSA acquisition may be helpful for a better understanding of the angioarchitecture of SVMs. Larger series are warranted to confirm these preliminary results.

Sections du résumé

BACKGROUND BACKGROUND
The precise understanding of the angioarchitecture of spinal vascular malformations (SVMs) is often difficult to reach with conventional digital subtraction angiography (DSA). The purpose of our study was to evaluate the potential of four-dimensional DSA (4D-DSA) (Siemens Healthcare) in the exploration of SVMs.
METHODS METHODS
We retrospectively studied all patients who underwent spinal DSA, including 4D-DSA acquisition, from July 2018 to June 2019 at a single institution. All spinal DSA acquisitions were performed under general anesthesia. 4D-DSA acquisitions were acquired with the protocol '12 s DSA Dyna4D Neuro'. 12 mL of iodixanol 320 mg iodine/mL were injected via a 5 F catheter (1 mL/s during the 12 s 4D-DSA acquisition). Inter-rater (three independent reviewers) and intermodality agreements were assessed.
RESULTS RESULTS
Nine consecutive patients (six men, three women, mean age 55.3±19.8 years) with 10 SVMs (spinal dural arteriovenous fistulas n=3, spinal epidural arteriovenous fistulas n=2, spinal pial arteriovenous fistulas n=2, and spinal arteriovenous malformations n=2; one patient had two synchronous pial fistulas) had spinal DSA, including 4D-DSA acquisition. Inter-rater agreement was good and moderate for the venous drainage pattern and the SVM subtype, respectively. In 9 of 10 cases, the quality of the acquisition was graded as good. Satisfactory concordance between 4D-DSA and the selective microcatheterization was observed in 90% of cases for the location of the shunt point.
CONCLUSION CONCLUSIONS
4D-DSA acquisition may be helpful for a better understanding of the angioarchitecture of SVMs. Larger series are warranted to confirm these preliminary results.

Identifiants

pubmed: 32586909
pii: neurintsurg-2020-015909
doi: 10.1136/neurintsurg-2020-015909
doi:

Substances chimiques

Contrast Media 0
Triiodobenzoic Acids 0
iodixanol HW8W27HTXX

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

69-74

Informations de copyright

© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Déclaration de conflit d'intérêts

Competing interests: FC reports payment for readings from Medtronic, Guerbet, Balt Extrusion, and Penumbra (not related to the study), and core lab from Codman Neurovascular and Microvention (not related to the study). N-AS is a consultant for Medtronic, Balt Extrusion, and Microvention, and has stock/stock options in Medina.

Auteurs

Frédéric Clarençon (F)

Sorbonne Université, Paris, Île-de-France, France fredclare5@gmail.com.
Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France.

Stéphanie Lenck (S)

Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France.

Eimad Shotar (E)

Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France.

Anne-Laure Boch (AL)

Neurosurgery, Hôpital Universitaire Pitié-Salpêtrière, Paris, Île-de-France, France.

Etienne Lefevre (E)

Sorbonne Université, Paris, Île-de-France, France.
Neurosurgery, Hôpital Universitaire Pitié-Salpêtrière, Paris, Île-de-France, France.

Kevin Premat (K)

Sorbonne Université, Paris, Île-de-France, France.
Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France.

Maria Del Mar Amador (MDM)

Neurology, Hôpital Universitaire Pitié-Salpêtrière, Paris, Île-de-France, France.

Nader-Antoine Sourour (NA)

Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France.

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Classifications MeSH