Additive Value of 3T 3D CISS Imaging to Conventional M RI for Assessing the Abnormal Vessels of Spinal Dural Arteriovenous Fistulae

Introduction: We investigated the additive value of the 3T 3D constructive interference in steady state (CISS) sequence to conventional MRI for the evaluation of spinal dural arteriovenous fistulae (SDAVF). Materials and Methods: We included 16 consecutive patients (15 men, 1 woman; age range 42-81 years; mean 64 years) with SDAVF who underwent 3T MRI and digital subtraction angiography (DSA) before treatment. Two neuroradiologists independently evaluated the presence of abnormal vessels on 3D CISS-, T-2- and T-1-weighted images (T1WI, T2WI), and contrast-enhanced T1WI using a 3-point grading system. Interobserver agreement was assessed by calculating the kappa coefficient. Results: The SDAVF site was the cervical region in one patient, the thoracic region in 12 patients, the lumbar region in two, and the sacral region in one. For the visualization of abnormal vessels, the mean score was significantly higher for 3D CISS than the other sequences (P < 0.05). In 12 of 16 cases (75%) both readers made definite positive findings on additional 3D-CISS images. Interobserver agreement was excellent for 3D CISS images (kappa = 1.0), good for T1WI (kappa = 0.78; 95% confidence interval [CI] 0.54-1.00) and T2WI (kappa = 0.74; 95% CI 0.48-1.00) and moderate for contrast-enhanced T1WI (CET1WI) (kappa = 0.50; 95% CI 0.21-0.80). Conclusion: For the assessment of abnormal vessels of SDAVF, the 3T 3D CISS sequence adds value to conventional MRI.