目的:高血管脊柱肿瘤患者在肿瘤切除过程中可能出现严重的失血,这增加了围手术期发病率和死亡率的风险。然而,肿瘤血管的术前评估可能具有挑战性;此外,常规术前无创成像获得的数据的可靠性值得商榷.在这项研究中,我们比较了常规磁共振成像(MRI)和减影计算机断层扫描血管造影(CTA)在血管分布评估中的表现.导管数字减影血管造影(DSA)技术用作参考标准。
方法:本研究纳入了123例连续脊柱肿瘤患者,这些患者接受了减影CTA,导管DSA,以及2015年10月至2021年10月之间的后续手术。收集有关定性和半定量减影CTA参数和常规MRI征象的数据,以与通过导管DSA分级的肿瘤血管进行比较。定性CTA的诊断性能,定量CTA,和常规MRI评估脊柱肿瘤血管分布的分析。
结果:就诊断性能而言,定性减影CTA是最佳的无创成像模式(受试者工作特征曲线下面积[AUROC],0.95)。定量CTA相对较差(AUROC,0.87)。MRI结果可靠性低(AUROC,0.51至0.59)。发现瘤内出血和突出的椎间孔静脉丛是血管过多的特异性体征(特异性93.2%)。
结论:定性减影CTA在评估脊柱肿瘤血管分布方面提供了最高的诊断价值,与定量CTA和MRI相比。尽管常规MRI可能不是一种可靠的方法,某些MRI征象可能有很高的特异性,这对于评估脊髓肿瘤的血管分布可能是至关重要的。
OBJECTIVE: Patients with hypervascular spinal tumors may have severe blood loss during tumor resection, which increases the risks of perioperative morbidity and mortality. However, the preoperative evaluation of tumor
vascularity may be challenging; moreover, the reliability of the data obtained in conventional preoperative noninvasive imaging is debatable. In this study, we compared conventional magnetic resonance imaging (MRI) and subtraction computed tomography angiography (CTA) in terms of their performance in
vascularity evaluation. The catheter digital subtraction angiography (DSA) technique was used as a reference standard.
METHODS: This study included 123 consecutive patients with spinal tumor who underwent subtraction CTA, catheter DSA, and subsequent surgery between October 2015 and October 2021. Data regarding qualitative and semiquantitative subtraction CTA parameters and conventional MRI signs were collected for comparison with tumor vascularity graded through catheter DSA. The diagnostic performance of qualitative CTA, quantitative CTA, and conventional MRI in assessing spinal tumor
vascularity was analyzed.
RESULTS: Qualitative subtraction CTA was the best noninvasive imaging modality in terms of diagnostic performance (area under the receiver operating characteristic curve [AUROC], 0.95). Quantitative CTA was relatively inferior (AUROC, 0.87). MRI results had low reliability (AUROC, 0.51 to 0.59). Intratumoral hemorrhage and prominent foraminal venous plexus were found to be the specific signs for hypervascularity (specificity 93.2%).
CONCLUSIONS: Qualitative subtraction CTA offers the highest diagnostic value in evaluating spinal tumor
vascularity, compared to quantitative CTA and MRI. Although conventional MRI may not be a reliable approach, certain MRI signs may have high specificity, which may be crucial for assessing spinal tumor
vascularity.