Diagnostic Accuracy of 4D-MRA for the Detection and Localization of Spinal Dural Arteriovenous Fistulas: A Systematic Review and Meta-Analysis

• Published in: World neurosurgery 2025-01, Vol.193, p.184-190
• Main Authors: Raymaekers, Vincent, Rodríguez-Hernández, Ana, Pegge, Sjoert A.H., Menovsky, Tomas, Meijer, Frederick J.A., Boogaarts, Jeroen H.D.
• Format: Article
• Language: English
• Subjects: 4D-MRA; Angiography; Arteriovenous fistula; Spine
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2024.10.087

The gold standard for the diagnosis and detailed evaluation of spinal dural arteriovenous fistula (SDAVF) is a digital subtraction angiography (DSA). However, this procedure is time-consuming and effortful. A time-resolved contrast enhanced 4D magnetic resonance angiography (4D-MRA) can be used to increase the diagnostic accuracy of spinal magnetic resonance imaging for the detection and localization of a SDAVF. The goal of this study is to assess the diagnostic accuracy of 4D-MRA for the detection and localization of a SDAVF in comparison to DSA based on a systematic review of the literature. We performed a systematic review and meta-analysis on the diagnostic accuracy of 4D-MRA compared to DSA. Literature was reviewed from the PubMed, Cochrane, and EMBASE databases. In comparison with DSA, the pooled sensitivity of MRA was 98.2% (95% confidence interval [CI] 91.5%–99.6%), with a pooled specificity of 88.2% (95% CI 57.5%–97.6%) for the diagnosis of SDAVFs. The side and level of the SDAVFs were correct in 91% (95% CI: 86%–94%) and 76% (95% CI: 71%–80%), respectively. Current literature indicates that 4D-MRA has a high sensitivity and specificity for the detection and localization of a SDAVF. It can serve to guide DSA to shorten the procedural time, reduce the risk of complications, and decrease patient discomfort.