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European Radiology
Published in: European Radiology 11/2019

Open Access 01-11-2019 | Angiography | Computed Tomography

High sensitivity and specificity of 4D-CTA in the detection of cranial arteriovenous shunts

Authors: Matthijs in ’t Veld, Rolf Fronczek, Marlise P. dos Santos, Marianne A. A. van Walderveen, Frederick J. A. Meijer, Peter W. A. Willems

Published in: European Radiology | Issue 11/2019

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Abstract

Purpose

In a prospective cohort study, we evaluated the diagnostic accuracy of time-resolved CT angiography (4D-CTA) compared to digital subtraction angiography (DSA) for detecting cranial arteriovenous shunts.

Material and methods

Patients were enrolled if a DSA had been ordered querying either a dural arteriovenous fistula (dAVF) or a cerebral arteriovenous malformation (bAVM). After enrolment, both a DSA and a 4D-CTA were performed. Both studies were evaluated using a standardized form. If a dAVF or bAVM was found, its classification, angioarchitectural details, and treatment options were recorded.

Results

Ninety-eight patients were enrolled and 76 full datasets were acquired. DSA demonstrated a shunting lesion in 28 out of 76 cases (prevalence 37%). 4D-CTA demonstrated all but two of these lesions (sensitivity of 93%) and produced one false positive (specificity of 98%). These numbers yielded a positive predictive value (PPV) of 96% and a negative predictive value (NPV) of 96%. Significant doubt regarding the 4D-CTA diagnosis was reported in 6.6% of all cases and both false-negative 4D-CTA results were characterized by such doubt.

Conclusions

4D-CTA has very high sensitivity and specificity for the detection of intracranial arteriovenous shunts. Based on these results, 4D-CTA may replace DSA imaging as a first modality in the diagnostic workup in a large number of patients suspected of a cranial dAVF or bAVM, especially if there is no doubt regarding the 4D-CTA diagnosis.

Key Points

• 4D-CTA was shown to have a high diagnostic accuracy and is an appropriate, less invasive replacement for DSA as a diagnostic tool for cranial arteriovenous shunts in the majority of suspected cases.
• Doubt regarding the 4D-CTA result should prompt additional DSA imaging, as it is associated with false negatives.
• False-positive 4D-CTA results are rare, but do exist.
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Metadata
Title
High sensitivity and specificity of 4D-CTA in the detection of cranial arteriovenous shunts
Authors
Matthijs in ’t Veld
Rolf Fronczek
Marlise P. dos Santos
Marianne A. A. van Walderveen
Frederick J. A. Meijer
Peter W. A. Willems
Publication date
01-11-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06234-4

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