A comparison of arterial spin labelling with catheter angiography in evaluating arteriovenous malformations: a systematic review

Ramachandran, Sanjeev; Mukherjee, Deyashini; Delf, Jonathan; Bown, Matthew J.; Kandiyil, Neghal

doi:10.1259/bjr.20190830

Cited by 3 publications

(3 citation statements)

References 47 publications

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“…17 In our sample of over 120 consecutive pICHs, ASL showed high diagnostic performance with excellent sensitivity (0.90) and near perfect specificity (0.97), superior to other sequences used independently or in combination. Our findings extend previous knowledge that ASL has high sensitivity and specificity for detection of AVS, alone, 11,18–22 or in combination with other sequences. 19,20 Nabavizadeh et al 20 demonstrated a very high sensitivity of ASL for the diagnosis of AVS in children, but their sample was only constituted retrospectively of patients with angiographically confirmed AVS, hence limiting their results applicability in the context of the initial diagnosis workup of pICH.…”

Section: Discussionsupporting

confidence: 90%

Arterial Spin Labeling for the Etiological Workup of Intracerebral Hemorrhage in Children

Hak

Boulouis

Kerleroux

et al. 2022

Stroke

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Background and Purpose: Pediatric nontraumatic intracerebral hemorrhage accounts for half of stroke in children. Early diagnostic of the causative underlying lesion is the first step toward prevention of hemorrhagic recurrence. We aimed to investigate the performance of arterial spin labeling sequence (ASL) in the acute phase etiological workup for the detection of an arteriovenous shunt (AVS: including malformation and fistula), the most frequent cause of pediatric nontraumatic intracerebral hemorrhage. Methods: Children with a pediatric nontraumatic intracerebral hemorrhage between 2011 and 2019 enrolled in a prospective registry were retrospectively included if they had undergone ASL-magnetic resonance imaging before any etiological treatment. ASL sequences were reviewed using cerebral blood flow maps by 2 raters for the presence of an AVS. The diagnostic performance of ASL was compared with admission computed tomography angiography, other magnetic resonance imaging sequences including contrast-enhanced sequences and subsequent digital subtraction angiography. Results: A total of 121 patients with pediatric nontraumatic intracerebral hemorrhage were included (median age, 9.9 [interquartile range, 5.8–13]; male sex 48.8%) of whom 76 (63%) had a final diagnosis of AVS. Using digital subtraction angiography as an intermediate reference, visual ASL inspection had a sensitivity and a specificity of, respectively, 95.9% (95% CI, 88.5%–99.1%) and 79.0% (95% CI, 54.4%–94.0%). ASL had a sensitivity, specificity, and accuracy of 90.2%, 97.2%, and 92.5%, respectively for the detection of the presence of an AVS, with near perfect inter-rater agreement (κ=0.963 [95% CI, 0.912–1.0]). The performance of ASL alone was higher than that of other magnetic resonance imaging sequences, individually or combined, and higher than that of computed tomography angiography. Conclusions: ASL has strong diagnostic performance for the detection of AVS in the initial workup of intracerebral hemorrhage in children. If our findings are confirmed in other settings, ASL may be a helpful diagnostic imaging modality for patients with pediatric nontraumatic intracerebral hemorrhage. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifiers: 3618210420, 2217698.

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Section: Discussionsupporting

confidence: 90%

Arterial Spin Labeling for the Etiological Workup of Intracerebral Hemorrhage in Children

Hak

Boulouis

Kerleroux

et al. 2022

Stroke

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“…However, other studies have shown relatively inferior performance in delineating venous drainage [81,83]. Finally, two of the papers included in this review demonstrated 100% sensitivity of ASL in identifying residual or obliterated AVMs after SRS [84]. In navigating these challenges, ASL offers a noninvasive avenue with undeniable merits, such as functional assessment and arterial feeder identification [85].…”

Section: Limitationsmentioning

confidence: 90%

Current and Future Applications of Arterial Spin Labeling MRI in Cerebral Arteriovenous Malformations

De Simone,

Fontanella,

Choucha

et al. 2024

Biomedicines

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Arterial spin labeling (ASL) has emerged as a promising noninvasive tool for the evaluation of both pediatric and adult arteriovenous malformations (AVMs). This paper reviews the advantages and challenges associated with the use of ASL in AVM assessment. An assessment of the diagnostic workup of AVMs and their variants in both adult and pediatric populations is proposed. Evaluation after treatments, whether endovascular or microsurgical, was similarly examined. ASL, with its endogenous tracer and favorable safety profile, offers functional assessment and arterial feeder identification. ASL has demonstrated strong performance in identifying feeder arteries and detecting arteriovenous shunting, although some studies report inferior performance compared with digital subtraction angiography (DSA) in delineating venous drainage. Challenges include uncertainties in sensitivity for specific AVM features. Detecting AVMs in challenging locations, such as the apical cranial convexity, is further complicated, demanding careful consideration due to the risk of underestimating total blood flow. Navigating these challenges, ASL provides a noninvasive avenue with undeniable merits, but a balanced approach considering its limitations is crucial. Larger-scale prospective studies are needed to comprehensively evaluate the diagnostic performance of ASL in AVM assessment.

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“…ASL imaging has an increasingly established role in the evaluation of intracranial arteriovenous malformations (AVMs). 5 However, there is a relative paucity of evidence on the role of ASL in the imaging of PVMs. To date, there has been one case report highlighting the novel use of ASL in evaluating a forearm AVM, 6 with a further study demonstrating its ability in discriminating between cervicofacial vascular malformations in paediatric patients by detecting differences in intralesional flow.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of arterial spin labeling in evaluating high- and low-flow peripheral vascular malformations: a case series

et al. 2022

Self Cite

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We present a case series highlighting a novel use of arterial spin labeling (ASL), a MRI perfusion technique, to evaluate both high- and low-flow peripheral vascular malformations (PVMs) across a range of anatomical locations. While the role of ASL in assessing intracranial vascular malformations is more established, there is limited evidence for PVMs. Our results provide preliminary evidence for the feasibility of ASL in imaging PVMs and its potential ability to distinguish between high- and low-flow PVMs. In addition, we demonstrate its ability to identify focal high blood flow, which may indicate the nidus in arteriovenous malformations. Together, these findings have important implications for patient management. We also outline the potential benefits and limitations of ASL in the imaging of PVMs, and provide justification for further validation of its diagnostic performance.

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A comparison of arterial spin labelling with catheter angiography in evaluating arteriovenous malformations: a systematic review

Cited by 3 publications

References 47 publications

Arterial Spin Labeling for the Etiological Workup of Intracerebral Hemorrhage in Children

Arterial Spin Labeling for the Etiological Workup of Intracerebral Hemorrhage in Children

Current and Future Applications of Arterial Spin Labeling MRI in Cerebral Arteriovenous Malformations

Feasibility of arterial spin labeling in evaluating high- and low-flow peripheral vascular malformations: a case series

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