Reliability and Accuracy of Time Resolved Contrast Enhanced Magnetic Resonance Angiography in Hypervascular Spinal Metastases prior Embolization - Sorbonne Université
Journal Articles European Radiology Year : 2021

Reliability and Accuracy of Time Resolved Contrast Enhanced Magnetic Resonance Angiography in Hypervascular Spinal Metastases prior Embolization

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.
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hal-03121093 , version 1 (26-01-2021)

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Kevin Premat, Eimad Shotar, Robert Burns, Natalia Shor, Gauthier Eloy, et al.. Reliability and Accuracy of Time Resolved Contrast Enhanced Magnetic Resonance Angiography in Hypervascular Spinal Metastases prior Embolization. European Radiology, 2021, ⟨10.1007/s00330-020-07654-3⟩. ⟨hal-03121093⟩
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