Accurate pretreatment diagnosis and assessment of spinal vascular malformations using spinal CTA are crucial for patient prognosis, but the postprocessing reconstruction may not be able to fully depict the lesions due to the complexity inherent in spinal anatomy. Our purpose was to explore the application value of the spinal subtraction and bone background fusion CTA (SSBBF-CTA) technique in precisely depicting and localizing spinal vascular malformation lesions.

In this retrospective study, patients (between November 2017 and November 2022) with symptoms similar to those of spinal vascular malformations were divided into diseased (group A) and nondiseased (group B) groups. All patients underwent spinal CTA using Siemens dual-source CT. Multiplanar reconstruction; routine bone subtraction, and SSBBF-CTA images were obtained using the snygo.via and ADW4.6 postprocessing reconstruction workstations. Multiple observers researched the following 3 aspects: 1) preliminary screening capability using original images with multiplanar reconstruction CTA, 2) the accuracy and stability of the SSBBF-CTA postprocessing technique, and 3) diagnostic evaluation of spinal vascular malformations using the 3 types of postprocessing images. Diagnostic performance was analyzed using receiver operating characteristic analysis, while reader or image differences were analyzed using the Wilcoxon signed-rank test or the Kruskal-Wallis rank sum test.

Forty-nine patients (groups A and B: 22 and 27 patients; mean ages, 44.0 [SD, 14.3] years and 44.6 [SD,15.2] years; 13 and 16 men) were evaluated. Junior physicians showed lower diagnostic accuracy and sensitivity using multiplanar reconstruction CTA (85.7% and 77.3%) than senior physicians (93.9% and 90.9%, 98% and 95.5%). Short-term trained juniors achieved SSBBF-CTA image accuracy similar to that of experienced physicians (P > .05). In terms of the visualization and localization of spinal vascular malformation lesions (nidus/fistula, feeding artery, and drainage vein), both multiplanar reconstruction and SSBBF-CTA outperformed routine bone subtraction CTA (P = .000). Compared with multiplanar reconstruction, SSBBF-CTA allowed less experienced physicians to achieve superior diagnostic capabilities (comparable with those of experienced radiologists) more rapidly (P < .05).

The SSBBF-CTA technique exhibited excellent reproducibility and enabled accurate pretreatment diagnosis and assessment of spinal vascular malformations with high diagnostic efficiency, particularly for junior radiologists.

利用脊柱CTA对脊柱血管畸形进行准确的治疗前诊断和评估对于患者预后至关重要，但由于脊柱解剖结构固有的复杂性，后处理重建可能无法完全描绘病变。目的探讨脊柱减影骨背景融合CTA（SSBBF-CTA）技术在精确描绘和定位脊柱血管畸形病变中的应用价值。

在这项回顾性研究中，将具有类似脊髓血管畸形症状的患者（2017年11月至2022年11月）分为患病组（A组）和非患病组（B组）。所有患者均使用西门子双源 CT 进行脊柱 CTA。多平面重建；使用 snygo.via 和 ADW4.6 后处理重建工作站获得常规骨减影和 SSBBF-CTA 图像。多名观察者对以下3个方面进行了研究：1）使用多平面重建CTA的原始图像的初步筛查能力，2）SSBBF-CTA后处理技术的准确性和稳定性，以及3）使用3种后处理对脊髓血管畸形的诊断评估图片。使用接受者操作特征分析来分析诊断性能，而使用Wilcoxon符号秩检验或Kruskal-Wallis秩和检验来分析读取器或图像差异。

对 49 名患者（A 组和 B 组：22 名和 27 名患者；平均年龄，44.0 [SD，14.3] 岁和 44.6 [SD，15.2] 岁；13 名和 16 名男性）进行了评估。初级医师使用多平面重建 CTA 的诊断准确性和敏感性（85.7% 和 77.3%）低于高级医师（93.9% 和 90.9%、98% 和 95.5%）。接受短期培训的青少年获得的 SSBBF-CTA 图像准确性与经验丰富的医生相似 ( P > .05)。在脊髓血管畸形病变（病灶/瘘管、供血动脉和引流静脉）的可视化和定位方面，多平面重建和 SSBBF-CTA 均优于常规骨减除 CTA ( P = .000)。与多平面重建相比，SSBBF-CTA 可以让经验较少的医生更快地获得卓越的诊断能力（与经验丰富的放射科医生相当）（P < .05）。

SSBBF-CTA技术表现出优异的重现性，能够对脊柱血管畸形进行准确的治疗前诊断和评估，诊断效率高，特别是对于初级放射科医生而言。