Usefulness of arterial spin labeling in the postoperative evaluation for dural arteriovenous fistula.

PURPOSE: Arterial spin labeling (ASL) has shown promise in diagnosing, classifying, and evaluating cortical venous reflux in dural arteriovenous fistulas (DAVFs). However, its utility in the postoperative assessment of DAVFs remains underexplored due to limited clinical data. This study aimed to evaluate the diagnostic performance of ASL in the postoperative setting.

METHODS

In this single-center retrospective study, 48 patients with DAVF who underwent perioperative digital subtraction angiography (DSA) and pseudocontinuous ASL between January 2012 and June 2018 were included. ASL images were assessed for abnormal signal in cerebral venous drainage (CVD) areas or the superior ophthalmic vein (SOV) by two independent neurointerventionalists blinded to the DSA findings. Diagnostic performance metrics for ASL were calculated, and interobserver agreement was evaluated using Cohen's kappa (κ).

RESULTS

Postoperative ASL demonstrated a sensitivity of 87.5 % (95 % CI, 81.0 %-94.0 %), specificity of 100 % (95 % CI, 100 %), and overall diagnostic accuracy of 95.8 % (95 % CI, 90.2 %-101.5 %). The positive predictive value was 100 % and the negative predictive value was 94.1 % (95 % CI, 86.2 %-102.0 %). The positive likelihood ratio was infinite, while the negative likelihood ratio was 12.5 (95 % CI, 3.4-45.7). Interobserver reliability was substantial, with κ = 0.70.

CONCLUSION

ASL is a reliable noninvasive tool for postoperative surveillance of DAVF. Given its excellent specificity and high overall accuracy, ASL can serve as a valuable adjunct to DSA in the perioperative management of DAVF patients, although caution is warranted due to occasional false negatives.