• Jinyu Zhu, Wangshu Zhu, Minghua Li, Xiaoer Wei, Zheyi Chen, and Yuehua Li.
• Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600 Yishan Road, Xuhui District, 200233, Shanghai, China.
• World Neurosurg. 2025 Feb 7: 123745123745.

ObjectiveTo investigate the performances of time-resolved angiography with stochastic trajectories (TWIST-MRA) and dual-source CT angiography (CTA), applied independently and in combination, for preoperative assessment of SVM.MethodsA retrospective analysis was conducted on 77 patients with suspected SVM who underwent TWIST-MRA, CTA, and digital subtraction angiography (DSA) between September 2019 and December 2022. Precision recall (PR) curve analysis was used to assess diagnostic performance. The feeding artery and fistula location were evaluated using radiologist confidence level by CTA and TWIST-MRA.ResultsAmong the 77 patients, 71 had DSA-confirmed SVM (cervical, n = 7; thoracolumbar, n = 60; deep lumbosacral, n = 4) and 6 did not have SVM. Both TWIST-MRA and CTA showed excellent accuracy (96.1% vs. 94.8%) and sensitivity (98.6% vs. 97.2%) for diagnosis of SVM subtypes. For identification of the feeding artery and fistula location, TWIST-MRA performed slightly better than CTA (AUC-PR, 0.958 vs. 0.944). Among SVM patients, CTA+TWIST-MRA performed significantly better than TWIST-MRA alone in localizing fistulas (P = .007). The radiologist confidence levels were significantly higher with CTA alone and CTA+TWIST-MRA compared to TWIST-MRA alone for identifying fistulas in the cervical and deep lumbosacral regions (P < .001).ConclusionsBoth TWIST-MRA and dual-source CTA are reliable for diagnosing SVM and localizing the feeding artery and fistula. While TWIST-MRA remains the primary technique for preoperative diagnosis of SVM, the addition of dual-source CTA can improve diagnostic confidence. CTA may be considered as an alternative to TWIST-MRA for SVMs in the cervical and lumbosacral regions.Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.

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