Diagnostic accuracy and efficiency of combined acquisition of low-dose time-resolved and single-phase high-resolution contrast-enhanced magnetic resonance angiography in a single session for pre-angiographic evaluation of spinal vascular disease

• Published in: PloS one 2019-03, Vol.14 (3), p.e0214289-e0214289
• Main Authors: Shin, Jae Ho, Choi, Yangsean, Park, Borim, Shin, Na-Young, Jang, Jinhee, Choi, Hyun Seok, Jung, So Lyung, Ahn, Kookjin, Kim, Bum-Soo
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Angiography; Angiography, Digital Subtraction; Arteriovenous Malformations - diagnosis; Biology and Life Sciences; Central Nervous System Vascular Malformations - diagnosis; Contrast Media - chemistry; Diagnosis; Diagnostic systems; Disease; Dosage; Evaluation; Feeders; Female; Fistula; Fistulae; High resolution; Hospitals; Humans; Lesions; Localization; Low level; Magnetic resonance; Magnetic resonance angiography; Magnetic Resonance Angiography - methods; Male; Medical diagnosis; Medical imaging; Medical research; Medicine and Health Sciences; Middle Aged; Patients; Research and Analysis Methods; Retrospective Studies; Risk factors; Sensitivity and Specificity; Spinal cord; Spinal Cord - blood supply; Spinal Cord - diagnostic imaging; Vascular diseases; Vascular Diseases - diagnosis; Vascular surgery; Veins & arteries; Vertebrae; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0214289

The purpose of this study was to evaluate the utility and efficacy of combined low-dose, time-resolved (TR) and single-phase high-resolution (HR) contrast-enhanced MRA (CE-MRA) as a pre-angiographic study for spinal vascular disease. Seventeen consecutive patients with suspected spinal vascular disease were retrospectively reviewed. All patients underwent combined low-dose TR CE-MRA and three-dimensional single-phase HR CE-MRA at 3 Tesla, followed by conventional spinal digital subtraction angiography (DSA) within 90 days. Six patients underwent additional spinal MRA and DSA for treatment follow-up. Spinal lesions were analyzed in terms of presence, disease type, laterality, spinal level, and number of arterial feeders. Low-dose TR CE-MRA helped proper localization of subsequent HR CE-MRA in two patients with high or low level of the lesion. For initial detection of spinal vascular disease, sensitivity, specificity and accuracy of CE-MRA were 93.3% (n = 14/15), 100% (n = 3/3), and 94.4% (n = 17/18), respectively. In characterization of dural arteriovenous fistula (AVF), perimedullary AVF, spinal cord arteriovenous malformation (AVM), and extraspinal AVM, CE-MRA correctly characterized in 86.7% (n = 13/15) among the positive findings, and in 88.9% (n = 16/18) among the several patients including negative results. CE-MRA showed matched per-case localization of arterial feeders within 1 vertebral level in 80% (n = 12/15), and matched per-lesion localization in 78.3% (n = 18/23). Combined low-dose TR CE-MRA and single-phase HR CE-MRA at 3 Tesla was an effective and accurate non-invasive tool for the pre-angiographic evaluation of spinal vascular diseases in a single session.