Evidence map›Paper›PMID 31089848›Full record

Observational studyEuropean radiology2019

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

Matthijs In 't Veld, Rolf Fronczek, Marlise P Dos Santos, Marianne A A van Walderveen, Frederick J A Meijer, Peter W A Willems

Open access · hybridAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in European radiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 1 pooled it
1.4field-weighted citation impact, top 19% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 1 synthesis or guideline pooled it, 18 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Review
  6. Article
  7. Article
  8. Endovascular Management of Intracranial Dural AVFs: Principles.AJNR. American journal of neuroradiology · 2022
    Review
  9. Article
  10. Article
  11. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 5 institutions in 2 countries.

Matthijs In 't VeldDepartment of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Rolf FronczekDepartment of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
Marlise P Dos SantosDepartment of Medical Imaging, University of Ottawa & Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada.
Marianne A A van WalderveenDepartment of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Frederick J A MeijerDepartment of Radiology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
Peter W A WillemsDepartment of Neurosurgery, Utrecht University Medical Center, Internal Postage G03.124, PO-box 85500, 3584 CX, Utrecht, The Netherlands. p.w.a.willems-4@umcutrecht.nl.
Leiden University Medical Center · NLOttawa Hospital · CARadboud University Medical Center · NLStichting Epilepsie Instellingen Nederland · NLUtrecht University · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeIn 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

methodsPatients 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.

resultsNinety-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.

conclusions4D-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.

Indexed as

Angiography, Digital SubtractionArteriovenous AnastomosisCentral Nervous System Vascular MalformationsComputed Tomography AngiographyFemaleFour-Dimensional Computed TomographyHumansIntracranial Arteriovenous MalformationsMaleMiddle AgedProspective StudiesSensitivity and SpecificityAngiographyArteriovenous malformationsBrain imagingDural arteriovenous fistulaFour-dimensional computed tomography

Identifiers

PMID31089848
PMCPMC6795637
OpenAlexW2945195048

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.