Application of Spinal Subtraction and Bone Background Fusion CTA in the Accurate Diagnosis and Evaluation of Spinal Vascular Malformations

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FIG 1.
Flow chart of the patient enrollment process and workflow of this study. Asterisk indicates accurate localization of critical lesions which defined as mostly correct when multiple feeding arteries are present, and the identification of drainage veins covering over 70% of the range.
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FIG 2.
Percentage of stacked bar chart of categorization of postprocessing SSBBF reconstruction accuracy. Types 3 and 4 are considered particularly beneficial in aiding clinical diagnosis and treatment.
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FIG 3.
Spinal CTA images in a 28-year-old man with a spinal AVM. The crucial lesions, including nidus (arrowhead), feeding artery (solid arrow), and drainage vein (dotted arrow), are shown in MPR-CTA (A), RBS-CTA (B), SSBBF-CTA (C), and DSA images (D).
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FIG 4.
Spinal CTA images in a 55-year-old woman with a spinal AVF. The crucial lesions, including the fistula (arrowhead), feeding artery (solid arrow), and drainage vein (dotted arrow), are shown in an MPR-CTA image (A), a RBS-CTA image (B), SSBBF-CTA image (C), and a DSA image (D).

Table 1:

Patient characteristics^{^a}

↵a Unless otherwise indicated, data are percentages, with numbers of patients in parentheses.
↵b Age is presented as the mean.
↵c Data are numbers of patients.
↵d The clinical features of groups A and B showed statistically significant differences (P < .05).

Table 2:

Diagnostic efficacy of original images with MPR for primary screening of SVMs by different readers^{^a}

Reader	Sensitivity (%)	Specificity (%)	Accuracy (%)	PPV (%)	NPV (%)	AUC [95% CI]	Youden
Reader 1^{^b}	77.3 (17/22)	92.6 (25/27)	85.7 (42/49)	89.5 (17/19)	83.3 (25/30)	0.849 (0.718–0.935)	0.699
Reader 2	90.9 (20/22)	96.3 (26/27)	93.9 (46/49)	95.2 (20/21)	92.9 (26/28)	0.936 (0.828–0.986)	0.872
Reader 3	95.5 (21/22)	100 (27/27)	98.0 (48/49)	100 (21/21)	96.4 (27/28)	0.977 (0.888–0.999)	0.955

Note:—PPV indicates positive predictive value; NPV, negative predictive value; Reader 1, a radiologist with one year of experience; Reader 2, a junior physician who submitted the original report for the first time;Reader 3, a reviewing physician who also submitted the original report for the first time.
↵a Data in brackets are 95% CIs, and data in parentheses are numbers of patients.
↵b Readers 1 and 3 showed statistically significant differences (P < .05).

Table 3:

Scoring of lesion localization and visualization of SVMs using different postprocessing techniques of CTA images^{^a}

	MPR-CTA	RBS-CTA^b	SSBBF-CTA	P Value^c
Visualization of lesions (total points)	6.00 (1.00)	4.00 (2.75)	6.00 (0.63)	.000
Nidus/fistula	2.00 (0.00)	1.50 (1.00)	2.00 (1.25)	.000
Feeding artery	2.00 (0.63)	1.00 (1.50)	2.00 (0.00)	.000
Drainage vein	2.00 (0.00)	1.00 (1.00)	2.00 (0.00)	.000
Localization of lesions (total points)	6.00 (0.00)	3.25 (3.00)	6.00 (1.00)	.000
Nidus/fistula	2.00 (0.00)	1.00 (1.00)	2.00 (0.00)	.000
Feeding artery	2.00 (0.00)	1.00 (2.00)	2.00 (0.00)	.000
Drainage vein	2.00 (0.00)	1.00 (1.13)	2.00 (0.00)	.00
Overall morphology	4.00 (0.00)	2.75 (2.63)	4.00 (0.50)	.000

↵a The data are presented as median (interquartile range).
b There is a statistically significant difference between RBS-CTA and the other 2 groups (P < .05).
c There is a significant statistical difference among the 3 groups (P < .05).

Table 4:

Assessment of lesions of SVMs and diagnostic time using different postprocessing CTA techniques by different readers^a

Note:—NA indicates not applicable; Reader 1, a radiologist with one year of experience; Reader 4, a radiologist with 4 years of experience.
a The data are presented as median (interquartile range). The visualization and localization of lesions represent the total score of the nidus/fistula, feeding artery, and drainage vein.
↵b There is a significant statistical difference between readers 1 and 4 (P < .05).
↵c There is a statistically significant difference in diagnostic time between the use of MPR-CTA and SSBBF-CTA (P = .000).