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Hu X, Yuan Z, Liang K, Chen M, Zhang Z, Zheng H, Cheng G. Application of Spinal Subtraction and Bone Background Fusion CTA in the Accurate Diagnosis and Evaluation of Spinal Vascular Malformations. AJNR Am J Neuroradiol 2024; 45:351-357. [PMID: 38360787 DOI: 10.3174/ajnr.a8112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/02/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND AND PURPOSE Accurate pretreatment diagnosis and assessment of spinal vascular malformations using spinal CTA are crucial for patient prognosis, but the postprocessing reconstruction may not be able to fully depict the lesions due to the complexity inherent in spinal anatomy. Our purpose was to explore the application value of the spinal subtraction and bone background fusion CTA (SSBBF-CTA) technique in precisely depicting and localizing spinal vascular malformation lesions. MATERIALS AND METHODS In this retrospective study, patients (between November 2017 and November 2022) with symptoms similar to those of spinal vascular malformations were divided into diseased (group A) and nondiseased (group B) groups. All patients underwent spinal CTA using Siemens dual-source CT. Multiplanar reconstruction; routine bone subtraction, and SSBBF-CTA images were obtained using the snygo.via and ADW4.6 postprocessing reconstruction workstations. Multiple observers researched the following 3 aspects: 1) preliminary screening capability using original images with multiplanar reconstruction CTA, 2) the accuracy and stability of the SSBBF-CTA postprocessing technique, and 3) diagnostic evaluation of spinal vascular malformations using the 3 types of postprocessing images. Diagnostic performance was analyzed using receiver operating characteristic analysis, while reader or image differences were analyzed using the Wilcoxon signed-rank test or the Kruskal-Wallis rank sum test. RESULTS Forty-nine patients (groups A and B: 22 and 27 patients; mean ages, 44.0 [SD, 14.3] years and 44.6 [SD,15.2] years; 13 and 16 men) were evaluated. Junior physicians showed lower diagnostic accuracy and sensitivity using multiplanar reconstruction CTA (85.7% and 77.3%) than senior physicians (93.9% and 90.9%, 98% and 95.5%). Short-term trained juniors achieved SSBBF-CTA image accuracy similar to that of experienced physicians (P > .05). In terms of the visualization and localization of spinal vascular malformation lesions (nidus/fistula, feeding artery, and drainage vein), both multiplanar reconstruction and SSBBF-CTA outperformed routine bone subtraction CTA (P = .000). Compared with multiplanar reconstruction, SSBBF-CTA allowed less experienced physicians to achieve superior diagnostic capabilities (comparable with those of experienced radiologists) more rapidly (P < .05). CONCLUSIONS The SSBBF-CTA technique exhibited excellent reproducibility and enabled accurate pretreatment diagnosis and assessment of spinal vascular malformations with high diagnostic efficiency, particularly for junior radiologists.
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Affiliation(s)
- Xuehan Hu
- From the Department of Radiology (X.H., Z.Y., K.L., Z.Z., G.C.), Peking University Shenzhen Hospital, Shenzhen, China
- Paul C. Lauterbur Research Center for Biomedical Imaging (X.H., H.Z.), Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences
| | - Zhidong Yuan
- From the Department of Radiology (X.H., Z.Y., K.L., Z.Z., G.C.), Peking University Shenzhen Hospital, Shenzhen, China
| | - Kaiyin Liang
- From the Department of Radiology (X.H., Z.Y., K.L., Z.Z., G.C.), Peking University Shenzhen Hospital, Shenzhen, China
| | - Min Chen
- Department of Radiology (M.C.), Southern University of Science and Technology Hospital, Shenzhen, China
| | - Zhen Zhang
- From the Department of Radiology (X.H., Z.Y., K.L., Z.Z., G.C.), Peking University Shenzhen Hospital, Shenzhen, China
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging (X.H., H.Z.), Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences
| | - Guanxun Cheng
- From the Department of Radiology (X.H., Z.Y., K.L., Z.Z., G.C.), Peking University Shenzhen Hospital, Shenzhen, China
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Fournel J, Hermier M, Martin A, Gamondès D, Tommasino E, Broussolle T, Morgado A, Baassiri W, Cotton F, Berthezène Y, Bani-Sadr A. It Looks Like a Spinal Cord Tumor but It Is Not. Cancers (Basel) 2024; 16:1004. [PMID: 38473365 DOI: 10.3390/cancers16051004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Differentiating neoplastic from non-neoplastic spinal cord pathologies may be challenging due to overlapping clinical and radiological features. Spinal cord tumors, which comprise only 2-4% of central nervous system tumors, are rarer than non-tumoral myelopathies of inflammatory, vascular, or infectious origins. The risk of neurological deterioration and the high rate of false negatives or misdiagnoses associated with spinal cord biopsies require a cautious approach. Facing a spinal cord lesion, prioritizing more common non-surgical myelopathies in differential diagnoses is essential. A comprehensive radiological diagnostic approach is mandatory to identify spinal cord tumor mimics. The diagnostic process involves a multi-step approach: detecting lesions primarily using MRI techniques, precise localization of lesions, assessing lesion signal intensity characteristics, and searching for potentially associated anomalies at spinal cord and cerebral MRI. This review aims to delineate the radiological diagnostic approach for spinal cord lesions that may mimic tumors and briefly highlight the primary pathologies behind these lesions.
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Affiliation(s)
- Julien Fournel
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Marc Hermier
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Anna Martin
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Delphine Gamondès
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Emanuele Tommasino
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Théo Broussolle
- Department of Spine and Spinal Cord Neurosurgery, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Alexis Morgado
- Department of Spine and Spinal Cord Neurosurgery, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Wassim Baassiri
- Department of Spine and Spinal Cord Neurosurgery, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Francois Cotton
- CREATIS Laboratory, CNRS UMR 5220, INSERM U1294, Claude Bernard Lyon I University, 7 Avenue Jean Capelle, 69100 Villeurbanne, France
- Department of Radiology, South Lyon Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495 Pierre-Bénite, France
| | - Yves Berthezène
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
- CREATIS Laboratory, CNRS UMR 5220, INSERM U1294, Claude Bernard Lyon I University, 7 Avenue Jean Capelle, 69100 Villeurbanne, France
| | - Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
- CREATIS Laboratory, CNRS UMR 5220, INSERM U1294, Claude Bernard Lyon I University, 7 Avenue Jean Capelle, 69100 Villeurbanne, France
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Clarençon F, Parat D, Shotar E, Premat K, Lenck S, Drir M, Maillart E, Boch AL, Sourour N. 'Balloon pressure technique' for endovascular treatment of spinal cord arteriovenous fistulas: preliminary results in 10 cases. J Neurointerv Surg 2023; 15:276-282. [PMID: 35483910 DOI: 10.1136/neurintsurg-2022-018807] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/14/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Spinal arteriovenous fistulas (SAVFs) are challenging lesions to treat by endovascular means. Our purpose was to report our early experience with dual lumen balloons (DLBs) for embolization of SAVFs using ethylene vinyl alcohol (EVOH) (the so-called 'balloon pressure technique' (BPT)). MATERIALS AND METHODS During the inclusion period, 10 consecutive patients (nine men, mean age 61.6 years) underwent endovascular treatment of a SAVF (seven dural SAVFs and three epidural SAVFs) at a single institution using the BPT. DLBs were used in all cases. In seven cases (70%), a regular DLB was used, while in three cases (30%), low profile DLBs were used. EVOH was used as the liquid embolic agent in all cases. Technical and clinical complications were systematically recorded. Clinical and angiographic outcomes were systematically evaluated more than 3 months after the procedure. RESULTS Complete cure of the SAVF by endovascular means alone was obtained in 80% of cases (8/10). For the two patients with incomplete SAVF occlusion, surgery was successfully performed secondarily. No recurrence was found at the 3 month follow-up in the eight patients for whom complete occlusion was obtained at the end of the embolization procedure. No permanent clinical complication was recorded using the BPT. Clinical improvement was observed in 6/10 (60%) cases. CONCLUSION BPT was a feasible technique, with regular or low profile DLBs, for embolization of SAVFs. Our preliminary results suggest the safety and effectiveness of this technique.
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Affiliation(s)
- Frédéric Clarençon
- Interventional Neuroradiology, APHP-Sorbonne University. Pitié-Salpêtrière Hospital, Paris, France
| | - Damien Parat
- Interventional Neuroradiology, APHP-Sorbonne University. Pitié-Salpêtrière Hospital, Paris, France
| | - Eimad Shotar
- Interventional Neuroradiology, APHP-Sorbonne University. Pitié-Salpêtrière Hospital, Paris, France
| | - Kévin Premat
- Interventional Neuroradiology, APHP-Sorbonne University. Pitié-Salpêtrière Hospital, Paris, France
| | - Stéphanie Lenck
- Interventional Neuroradiology, APHP-Sorbonne University. Pitié-Salpêtrière Hospital, Paris, France
| | - Mehdi Drir
- Anesthesiology, APHP-Sorbonne University. Pitié-Salpêtrière Hospital, Paris, France
| | - Elisabeth Maillart
- Neurology, APHP-Sorbonne University, Pitié-Salpêtrière Hospital, Paris, Île-de-France, France
| | - Anne-Laure Boch
- Neurosurgery, APHP-Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - Nader Sourour
- Interventional Neuroradiology, APHP-Sorbonne University. Pitié-Salpêtrière Hospital, Paris, France
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Premat K, Shotar E, Burns R, Shor N, Eloy G, Cormier É, Drir M, Morardet L, Lenck S, Sourour N, Chiras J, Dormont D, Bonaccorsi R, Clarençon F. Reliability and accuracy of time-resolved contrast-enhanced magnetic resonance angiography in hypervascular spinal metastases prior embolization. Eur Radiol 2021; 31:4690-4699. [PMID: 33449182 DOI: 10.1007/s00330-020-07654-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/01/2020] [Accepted: 12/18/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Preoperative embolization of hypervascular spinal metastases (HSM) is efficient to reduce perioperative bleeding. However, intra-arterial digital subtraction angiography (IA-DSA) must confirm the hypervascular nature and rule out spinal cord arterial feeders. This study aimed to evaluate the reliability and accuracy of time-resolved contrast-enhanced magnetic resonance angiography (TR-CE-MRA) in assessing HSM prior to embolization. METHODS All consecutive patients referred for preoperative embolization of an HSM were prospectively included. TR-CE-MRA sequences and selective IA-DSA were performed prior to embolization. Two readers independently reviewed imaging data to grade tumor vascularity (using a 3-grade and a dichotomized "yes vs no" scale) and identify the arterial supply of the spinal cord. Interobserver and intermodality agreements were estimated using kappa statistics. RESULTS Thirty patients included between 2016 and 2019 were assessed for 55 levels. Interobserver agreement was moderate (κ = 0.52; 95% CI [0.09-0.81]) for TR-CE-MRA. Intermodality agreement between TR-CE-MRA and IA-DSA was good (κ = 0.74; 95% CI [0.37-1.00]). TR-CE-MRA had a sensitivity of 97.9%, a specificity of 71.4%, a positive predictive value of 95.9%, a negative predictive value of 83.3%, and an overall accuracy of 94.6%, for differentiating hypervascular from non-hypervascular SM. The arterial supply of the spine was assessable in 2/30 (6.7%) cases with no interobserver agreement (κ < 0). CONCLUSIONS TR-CE-MRA can reliably differentiate hypervascular from non-hypervascular SM and thereby avoid futile IA-DSAs. However, TR-CE-MRA was not able to evaluate the vascular supply of the spinal cord at the target levels, thus limiting its scope as a pretherapeutic assessment tool. KEY POINTS • TR-CE-MRA aids in distinguishing hypervascular from non-hypervascular spinal metastases. • TR-CE-MRA could avoid one-quarter of patients referred for HSM embolization to undergo futile conventional angiography. • TR-CE-MRA's spatial resolution is insufficient to replace IA-DSA in the pretherapeutic assessment of the spinal cord vascular anatomy.
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Affiliation(s)
- Kévin Premat
- Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Department of Neuroradiology, F75013, Paris, France.
| | - Eimad Shotar
- Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Department of Neuroradiology, F75013, Paris, France
| | - Robert Burns
- Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Department of Neuroradiology, F75013, Paris, France
| | - Natalia Shor
- Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Department of Neuroradiology, F75013, Paris, France
| | - Gauthier Eloy
- Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Department of Orthopaedic Surgery, F75013, Paris, France
| | - Évelyne Cormier
- Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Department of Neuroradiology, F75013, Paris, France
| | - Mehdi Drir
- Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Department of Anaesthesiology, F75013, Paris, France
| | - Laetitia Morardet
- Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Department of Oncology, F75013, Paris, France
| | - Stéphanie Lenck
- Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Department of Neuroradiology, F75013, Paris, France
| | - Nader Sourour
- Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Department of Neuroradiology, F75013, Paris, France
| | - Jacques Chiras
- Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Department of Neuroradiology, F75013, Paris, France
| | - Didier Dormont
- Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Department of Neuroradiology, F75013, Paris, France
| | - Raphaël Bonaccorsi
- Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Department of Orthopaedic Surgery, F75013, Paris, France
| | - Frédéric Clarençon
- Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Department of Neuroradiology, F75013, Paris, France
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Spinal dural fistula evaluation using 4-Dimensional intra-aortic spinal CTAngiography in a hybrid angiography suite. J Neuroradiol 2021; 48:492-494. [PMID: 33418055 DOI: 10.1016/j.neurad.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/23/2022]
Abstract
Intra-aortic CT Angiography (IA-CTA) is a relatively new technique that shows promise in efficient diagnosis and evaluation of the angioarchitecture of spinal dural arteriovenous fistulae(sdAVF). The authors document the first reported use of a 4D-CT and C-arm fluoroscope in a hybrid interventional suite to evaluate a sdAVF. Time resolved IA-CTA is clinically feasible in the evaluation of sdAVF, has higher temporal resolution as compared to standard IA-CTA and reduced contrast load, radiation dose and potential for procedural complications as compared to standard spinal angiography.
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6
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Clarençon F, Lenck S, Shotar E, Boch AL, Lefevre E, Premat K, Amador MDM, Sourour NA. Four-dimensional digital subtraction angiography for exploration of spinal cord vascular malformations: preliminary experience. J Neurointerv Surg 2020; 13:69-74. [PMID: 32586909 DOI: 10.1136/neurintsurg-2020-015909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 11/03/2022]
Abstract
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 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 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 4D-DSA acquisition may be helpful for a better understanding of the angioarchitecture of SVMs. Larger series are warranted to confirm these preliminary results.
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Affiliation(s)
- Frédéric Clarençon
- Sorbonne Université, Paris, Île-de-France, France .,Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
| | - Stéphanie Lenck
- Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
| | - Eimad Shotar
- Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
| | - Anne-Laure Boch
- Neurosurgery, Hôpital Universitaire Pitié-Salpêtrière, Paris, Île-de-France, France
| | - Etienne Lefevre
- Sorbonne Université, Paris, Île-de-France, France.,Neurosurgery, Hôpital Universitaire Pitié-Salpêtrière, Paris, Île-de-France, France
| | - Kevin Premat
- Sorbonne Université, Paris, Île-de-France, France.,Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
| | - Maria Del Mar Amador
- Neurology, Hôpital Universitaire Pitié-Salpêtrière, Paris, Île-de-France, France
| | - Nader-Antoine Sourour
- Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
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Clarençon F, Shotar E, Boch AL, Rolla-Bigliani C, Al Raasi A, Grabli D, Vicart S, Sourour NA, Chiras J. Spinal Angiogram: A Treacherous Criterion Standard…. AJNR Am J Neuroradiol 2018; 39:E41-E44. [PMID: 29419399 DOI: 10.3174/ajnr.a5470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- F Clarençon
- Department of Neuroradiology Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris Paris, France.,Paris VI University, Pierre et Marie Curie Paris, France
| | - E Shotar
- Department of Neuroradiology Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris Paris, France.,Paris VI University, Pierre et Marie Curie Paris, France
| | - A-L Boch
- Department of Neurosurgery Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris Paris, France
| | - C Rolla-Bigliani
- Department of Neuroradiology Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris Paris, France
| | - A Al Raasi
- Department of Neuroradiology Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris Paris, France
| | - D Grabli
- Paris VI University, Pierre et Marie Curie Paris, France.,Department of Neurology Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris Paris, France
| | - S Vicart
- Department of Neurology Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris Paris, France
| | - N-A Sourour
- Department of Neuroradiology Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris Paris, France
| | - J Chiras
- Department of Neuroradiology Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris Paris, France.,Paris VI University, Pierre et Marie Curie Paris, France
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Amato ACM, Parga Filho JR, Stolf NAG. Predictors of Adamkiewicz artery and anterior spinal artery detection through computerized tomographic angiography. SAGE Open Med 2017; 5:2050312117711599. [PMID: 28616230 PMCID: PMC5459350 DOI: 10.1177/2050312117711599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/02/2017] [Indexed: 11/16/2022] Open
Abstract
Background: The detection of the Adamkiewicz artery and the anterior spinal artery has been associated with the ability to prevent adverse spinal cord outcomes after aortic surgical procedures. Yet, to our knowledge, no previous studies have attempted to use modern predictive models to identify the most important variables in determining artery detectability. Aims: To develop a model to predict the odds of visualizing the Adamkiewicz artery or anterior spinal artery in patients undergoing computerized tomographic angiography. Methods: We conducted a prospective, cross-sectional study. Outcomes of interest were the non-detection of the Adamkiewicz artery and anterior spinal artery, and their corresponding level of origin. Axial images were inspected in high definition in search of two dense spots characterizing the Adamkiewicz artery and anterior spinal artery. A multiplanar three-dimensional reconstruction was then performed using the OsiriX® software. Results: A total of 110 participants were part of this analysis. When evaluating risks for the Adamkiewicz artery being undetectable, significant factors could be classified into three broad categories: risk factors for arterial disease, established arterial disease, and obesity. Factors in the former category included metabolic syndrome, hypertension, and smoking status, while factors in the arterial disease included descending aortic aneurysm, mural thrombi, aortic aneurysm without a dissection, and aortic disease in general. In relation to anterior spinal artery not being detectable, significant risk factors included hypertension, smoking status, and metabolic syndrome, while those associated with arterial disease involved aortic disease and arterial thrombi. When evaluating the importance of individual clinical factors, the presence of higher body mass index was the single most important risk factor. Conclusion: Arterial disease, established arterial disease, and increased body mass index are risk factors in the detection of Adamkiewicz artery and anterior spinal artery. Specific diagnostic protocols should be in place for patients with these underlying conditions, thus enhancing the likelihood of detection when the Adamkiewicz artery is indeed present.
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Affiliation(s)
- Alexandre Campos Moraes Amato
- Post-Graduate Program, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jose Rodrigues Parga Filho
- Cardiovascular Magnetic Resonance and Computed Tomography Sector, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Noedir Antonio Groppo Stolf
- School of Medicine, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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