{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T23:29:01Z","timestamp":1789601341627,"version":"build-2803163510"},"reference-count":60,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Spinal dural arteriovenous fistulas (SDAVFs) often go undiagnosed, leading to irreversible spinal cord dysfunction. Although digital subtraction angiography (DSA) is the gold standard for diagnosing SDAVF, DSA is invasive and operator dependent, with associated risks. MR angiography (MRA) is a promising alternative. This study aimed to evaluate the performance of MRA as an equal alternative to DSA in investigating, diagnosing, and localizing SDAVF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Prospectively collected data from a single neurosurgeon at a large tertiary academic center were searched for SDAVFs. Eligibility criteria included any patient with a surgically proven SDAVF in whom preoperative DSA, MRA, or both had been obtained. The eligible patients formed a consecutive series, in which they were divided into DSA and MRA groups. DSA and MRA were the index tests that were compared to the surgical SDAVF outcome, which was the reference standard. Accurate diagnosis was considered to have occurred when the imaging report matched the operative diagnosis to the correct spinal level. Comparisons used a two-sample t-test for continuous variables and Fisher-Freeman-Halton\u2019s exact test for categorical variables, with p &lt; 0.05 specifying significance. Univariate, bivariate, and multivariate analyses were conducted to investigate group associations with DSA and MRA accuracy. Positive predictive value, sensitivity, and accuracy were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 27 patients with a mean age of 63 years underwent surgery for SDAVF. There were 19 male (70.4%) and 8 female (29.6%) patients, and the mean duration of symptoms at the time of surgery was 14 months (range 2\u201348 months). Seventeen patients (63%) presented with bowel or bladder incontinence. Bivariate analysis of the DSA and MRA groups further revealed no significant relationships between the characteristics and accuracy of SDAVF diagnosis. MRA was found to be more sensitive and accurate (100% and 73.3%) than DSA (85.7% and 69.2%), with a subanalysis of the patients with both preoperative MRA and DSA showing that MRA had a greater positive predictive value (78.6 vs 72.7), sensitivity (100 vs 72.7), and accuracy (78.6 vs 57.1) than DSA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>In surgically proven cases of SDAVFs, the authors determined that MRA was more accurate than DSA for SDAVF diagnosis and localization to the corresponding vertebral level. Incomplete catheterization at each vertebral level may result in the failure of DSA to detect SDAVF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2023.12.focus23749","type":"journal-article","created":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T07:00:41Z","timestamp":1709276441000},"page":"E10","source":"Crossref","is-referenced-by-count":14,"title":["Evaluating the diagnostic accuracy of 3D contrast-enhanced magnetic resonance angiography versus digital subtraction angiography in spinal dural arteriovenous fistulas"],"prefix":"10.3171","volume":"56","author":[{"given":"Adham M.","family":"Khalafallah","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Yunga Tigre","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Rady","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mount Sinai Medical Center, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Starke","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efrat","family":"Saraf-Lavi","sequence":"additional","affiliation":[{"name":"Neuroradiology, University of Miami Miller School of Medicine, Miami; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan D.","family":"Levi","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"J Cerebrovasc Endovasc Neurosurg","first-page":"203","article-title":"Pathophysiology and classification of intracranial and spinal dural AVF","volume":"24","author":"Sim SY","year":"2022","unstructured":"Sim SY. Pathophysiology and classification of intracranial and spinal dural AVF. J Cerebrovasc Endovasc Neurosurg. 2022;24(3):203\u2013209."},{"issue":"5","key":"b2","series-title":"Neurosurg Focus","first-page":"E17","article-title":"Clinical presentation and prognostic factors of spinal dural arteriovenous fistulas: an overview","volume":"32","author":"Fugate JE","year":"2012","unstructured":"Fugate JE, Lanzino G, Rabinstein AA. Clinical presentation and prognostic factors of spinal dural arteriovenous fistulas: an overview. Neurosurg Focus. 2012;32(5):E17."},{"issue":"2","key":"b3","series-title":"AJNR Am J Neuroradiol","first-page":"357","article-title":"Long-term outcome of patients with spinal dural arteriovenous fistula: the dilemma of delayed diagnosis","volume":"41","author":"Jablawi F","year":"2020","unstructured":"Jablawi F, Schubert GA, Dafotakis M, Pons-K\u00fchnemann J, Hans FJ, Mull M. Long-term outcome of patients with spinal dural arteriovenous fistula: the dilemma of delayed diagnosis. AJNR Am J Neuroradiol. 2020;41(2):357\u2013363."},{"issue":"10","key":"b4","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1438","article-title":"Spinal dural arteriovenous fistulas: clinical features in 80 patients","volume":"74","author":"Jellema K","year":"2003","unstructured":"Jellema K, Canta LR, Tijssen CC, van Rooij WJ, Koudstaal PJ, van Gijn J. Spinal dural arteriovenous fistulas: clinical features in 80 patients. J Neurol Neurosurg Psychiatry. 2003;74(10):1438\u20131440."},{"issue":"1","key":"b5","series-title":"Cell Signal (Middlet)","first-page":"9","article-title":"Review of spinal dural arteriovenous fistulas: challenges, diagnostics, management, and pathophysiology","volume":"1","author":"Goutnik M","year":"2023","unstructured":"Goutnik M, Reddy R, Yan S, Lucke-Wold B. Review of spinal dural arteriovenous fistulas: challenges, diagnostics, management, and pathophysiology. Cell Signal (Middlet). 2023;1(1):9\u201313."},{"issue":"7","key":"b6","series-title":"Curr Atheroscler Rep","first-page":"335","article-title":"Spinal dural arteriovenous fistulas: a review","volume":"15","author":"Marcus J","year":"2013","unstructured":"Marcus J, Schwarz J, Singh IP,  Spinal dural arteriovenous fistulas: a review. Curr Atheroscler Rep. 2013;15(7):335."},{"issue":"5","key":"b7","series-title":"Neurosurg Focus","first-page":"E11","article-title":"Spinal dural arteriovenous fistulas: outcome and prognostic factors","volume":"32","author":"Cenzato M","year":"2012","unstructured":"Cenzato M, Debernardi A, Stefini R,  Spinal dural arteriovenous fistulas: outcome and prognostic factors. Neurosurg Focus. 2012;32(5):E11."},{"issue":"9","key":"b8","series-title":"AJNR Am J Neuroradiol","first-page":"1814","article-title":"Analysis of 30 spinal angiograms falsely reported as normal in 18 patients with subsequently documented spinal vascular malformations","volume":"38","author":"Barreras P","year":"2017","unstructured":"Barreras P, Heck D, Greenberg B, Wolinsky JP, Pardo CA, Gailloud P. Analysis of 30 spinal angiograms falsely reported as normal in 18 patients with subsequently documented spinal vascular malformations. AJNR Am J Neuroradiol. 2017;38(9):1814\u20131819."},{"issue":"4","key":"b9","series-title":"Neurosurg Clin N Am","first-page":"603","article-title":"Intraoperative imaging for vascular lesions","volume":"28","author":"Fredrickson VL","year":"2017","unstructured":"Fredrickson VL, Russin JJ, Strickland BA, Bakhsheshian J, Amar AP. Intraoperative imaging for vascular lesions. 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Clinical application and diagnostic value of noninvasive spinal angiography in spinal vascular malformations. J Comput Assist Tomogr. 2014;38(3):474\u2013479."},{"issue":"2","key":"b16","series-title":"Eur Radiol","first-page":"429","article-title":"Detection and grading of dAVF: prospects and limitations of 3T MRI","volume":"22","author":"Bink A","year":"2012","unstructured":"Bink A, Berkefeld J, Wagner M,  Detection and grading of dAVF: prospects and limitations of 3T MRI. Eur Radiol. 2012;22(2):429\u2013438."},{"key":"b17","series-title":"Eur J Radiol","first-page":"110755","article-title":"High diagnostic performance of time-resolved MR angiography in spinal arteriovenous shunts","volume":"161","author":"Cao L","year":"2023","unstructured":"Cao L, Feng Y, Yu J,  High diagnostic performance of time-resolved MR angiography in spinal arteriovenous shunts. 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Neurosurg Focus. 2009;26(1):E9."},{"issue":"7","key":"b24","series-title":"AJNR Am J Neuroradiol","first-page":"1249","article-title":"Value and limitations of contrast-enhanced MR angiography in spinal arteriovenous malformations and dural arteriovenous fistulas","volume":"28","author":"Mull M","year":"2007","unstructured":"Mull M, Nijenhuis RJ, Backes WH, Krings T, Wilmink JT, Thron A. Value and limitations of contrast-enhanced MR angiography in spinal arteriovenous malformations and dural arteriovenous fistulas. AJNR Am J Neuroradiol. 2007;28(7):1249\u20131258."},{"issue":"1","key":"b25","series-title":"J Neuroradiol","first-page":"17","article-title":"Dynamic contrast-enhanced magnetic resonance angiography for the localization of spinal dural arteriovenous fistulas at 3T","volume":"44","author":"Zhou G","year":"2017","unstructured":"Zhou G, Li MH, Lu C,  Dynamic contrast-enhanced magnetic resonance angiography for the localization of spinal dural arteriovenous fistulas at 3T. 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AJNR Am J Neuroradiol. 2017;38(9):1814\u20131819."},{"issue":"4","key":"b9","series-title":"Neurosurg Clin N Am","first-page":"603","article-title":"Intraoperative imaging for vascular lesions","volume":"28","author":"Fredrickson VL","year":"2017","unstructured":"Fredrickson VL, Russin JJ, Strickland BA, Bakhsheshian J, Amar AP. Intraoperative imaging for vascular lesions. Neurosurg Clin N Am. 2017;28(4):603\u2013613."},{"issue":"2","key":"b10","series-title":"Neurosurgery","first-page":"242","article-title":"Diagnostic and surgical management of spinal dural arteriovenous fistulas","volume":"43","author":"Lee TT","year":"1998","unstructured":"Lee TT, Gromelski EB, Bowen BC, Green BA. Diagnostic and surgical management of spinal dural arteriovenous fistulas. 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AJNR Am J Neuroradiol. 1995;16(10):2029\u20132043."},{"issue":"2","key":"b13","series-title":"J Neurointerv Surg","first-page":"135","article-title":"Contrast-enhanced time-resolved MRA for pre-angiographic evaluation of suspected spinal dural arterial venous fistulas","volume":"7","author":"Saindane AM","year":"2015","unstructured":"Saindane AM, Boddu SR, Tong FC, Dehkharghani S, Dion JE. Contrast-enhanced time-resolved MRA for pre-angiographic evaluation of suspected spinal dural arterial venous fistulas. J Neurointerv Surg. 2015;7(2):135\u2013140."},{"issue":"4","key":"b14","series-title":"J Neurosurg Spine","first-page":"664","article-title":"Spinal arteriovenous shunts: accuracy of shunt detection, localization, and subtype discrimination using spinal magnetic resonance angiography and manual contrast injection using a syringe","volume":"24","author":"Unsrisong K","year":"2016","unstructured":"Unsrisong K, Taphey S, Oranratanachai K. Spinal arteriovenous shunts: accuracy of shunt detection, localization, and subtype discrimination using spinal magnetic resonance angiography and manual contrast injection using a syringe. J Neurosurg Spine. 2016;24(4):664\u2013670."},{"issue":"3","key":"b15","series-title":"J Comput Assist Tomogr","first-page":"474","article-title":"Clinical application and diagnostic value of noninvasive spinal angiography in spinal vascular malformations","volume":"38","author":"Cao JB","year":"2014","unstructured":"Cao JB, Cui LL, Jiang XY, Gao SJ, Sun WG, Xu K. Clinical application and diagnostic value of noninvasive spinal angiography in spinal vascular malformations. 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