Adjunctive value of intra-arterial cone beam CT angiography relative to DSA in the evaluation of cranial and spinal arteriovenous fistulas

Amir R. Honarmand, Joseph J. Gemmete, Michael C. Hurley, Ali Shaibani, Neeraj Chaudhary, Aditya S. Pandey, Bernard R. Bendok, Sameer A. Ansari

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objective: To assess the adjunctive diagnostic value of intra-arterial cone-beam CT angiography (IA-CBCTA) relative to digital subtraction angiography (DSA) in the anatomic identification/localization of intracranial/spinal arteriovenous fistulas (AVFs) and utility for surgical/endovascular treatment planning. Methods: Retrospectively, two blinded observers scored DSA and IA-CBCTA images of 32 patients with intracranial/spinal AVFs based on a qualitative scale. The following parameters were scored: arterial feeders, venous drainers and course, fistula site, and adjacent anatomic landmarks for cross-sectional localization. The total score was defined as the overall diagnostic value. Differences between IA-CBCTA and DSA scores were defined as the IA-CBCTA efficacy value. Observers described the treatment strategy at the end of DSA and IA-CBCTA grading, respectively. Mann-Whitney U test, Wilcoxon's signed rank test, and Kendall's tau (τ) coefficient were used for statistical analysis. Results: Interobserver agreement of overall diagnostic value for IA-CBCTA was good (τ=0.59, p=0.001) with no significant variance between the two observers' IA-CBCTA efficacy values (p=0.2). Significantly higher scores were assigned to IA-CBCTA for overall diagnostic value (both observers: p<0.0001), delineation of fistula site (observer 1: p<0.0001, observer 2: p=0.0003), and adjacent anatomic landmarks (both observers: p<0.0001). Observers found IA-CBCTA helpful, enabling a more confident treatment approach in 30 and 29 cases for observer 1 and observer 2, respectively. Both observers altered the treatment plan in two cases based on IA-CBCTA findings. Conclusions: IA-CBCTA as an adjunctive technique to DSA improves the anatomic delineation of AVFs, particularly for the fistula site and cross-sectional localization, and has the potential to improve treatment planning.

Original languageEnglish (US)
Pages (from-to)517-523
Number of pages7
JournalJournal of neurointerventional surgery
Issue number7
StatePublished - Jul 1 2015

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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