Assessment and treatment planning of lateral intracranial dural arteriovenous fistulas in 3 T MRI and DSA: A detailed analysis under consideration of time-resolved imaging of contrast kinetics (TRICKS) and ce-MRA sequences

Ertl, Lorenz; Brückmann, H.; Kunz, Mathias; Patzig, Maximilian; Brem, Christian; Forbrig, Robert; Fesl, Gunther

doi:10.1007/s00330-016-4335-1

Cited by 7 publications

(14 citation statements)

References 9 publications

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“…Contrary to brain arteriovenous malformations, only a few studies documented treated DAVFs, and they concerned limited numbers of patients. 3,6,[9][10][11] The value of 4D-MRA in posttreatment follow-up is, therefore, currently not well-defined. Meckel et al 9 evaluated the diagnostic performance of MRA using a timeresolved 3D contrast-enhanced technique with 18 examination pairs (9 in a diagnosis group and 9 in a posttreatment follow-up group).…”

Section: Discussionmentioning

confidence: 99%

Assessment of 4D MR Angiography at 3T Compared with DSA for the Follow-up of Embolized Brain Dural Arteriovenous Fistula: A Dual-Center Study

Dissaux

Eugène

Gauvrit

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: 4D contrast-enhanced MRA in the follow-up of treated dural arteriovenous fistulas has rarely been evaluated. Our aim was to evaluate its diagnostic performance at 3T in the follow-up of embolized dural arteriovenous fistulas using DSA as the standard of reference. MATERIALS AND METHODS: Patients treated for dural arteriovenous fistulas in 2 centers between 2008 and 2019 were included if they met the following criteria: 1) dural arteriovenous fistula embolization, and 2) follow-up imaging with ,6 months between DSA and 4D contrast-enhanced MRA. Two readers reviewed the 4D contrast-enhanced MRA images, first independently, then in consensus to detect any residual/recurrent dural arteriovenous fistula and to grade cases according to the Cognard classification system. Interobserver and intermodality agreement for the detection of a residual dural arteriovenous fistula and stratification of bleeding risk (0-I-IIa; IIb-IIa+b-III-IV-V) was calculated using k coefficients. RESULTS: A total of 51 pairs of examinations for 44 patients (median age, 65 years; range, 25-81 years) were analyzed. Interobserver agreement for the detection and stratification of bleeding risk was, respectively, k ¼ 0.8 (95% CI, 0.6-1) and k ¼ 0.8 (95% CI, 0.5-1). After consensus review, the sensitivity and specificity of 4D contrast-enhanced MRA for the detection of residual/recurrent dural arteriovenous fistula was 63.6% (95% CI, 40.7%-82.8%) and 96.6% (95% CI, 82.2%-99.9%), respectively. The positive and negative predictive values of 4D contrast-enhanced MRA were 93.3% (95% CI, 68.1%-99.8%) and 77.8% (95% CI, 60.8%-89.9%). Intermodality agreement for the detection and stratification of bleeding risk was good, with k ¼ 0.60 (95% CI, 0.3-0.8). CONCLUSIONS: 4D contrast-enhanced MRA at 3T is of interest in the follow-up of treated dural arteriovenous fistulas but lacks the sensitivity to replace arteriography.

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Section: Discussionmentioning

confidence: 99%

Assessment of 4D MR Angiography at 3T Compared with DSA for the Follow-up of Embolized Brain Dural Arteriovenous Fistula: A Dual-Center Study

Dissaux

Eugène

Gauvrit

et al. 2020

AJNR Am J Neuroradiol

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“…In a follow-up consultation four years later, the patient reported recurrent headache behind the left ear, intermittent chemosis, pulsatile tinnitus and occasional diplopia. The patient underwent a control angiography (DSA) and several MRI checks including contrast-enhanced time-resolved MR angiography sequences which are known to reliably detect intracranial fistulas [19]. No recurrent fistula could be detected in any of the studies.…”

Section: Plos Onementioning

confidence: 99%

Patient reported long-term outcome after endovascular therapy of indirect dural carotid cavernous fistulas

et al. 2020

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PurposePatient-reported long-term follow-up after endovascular treatment of indirect carotid cavernous fistulas is important, but rarely addressed in literature. We report on this issue with a special focus on the patient's view and its impact on the indication evaluation process. MethodsWe retrospectively reviewed the records of all patients (n = 33) with a minimum follow-up interval of at least 36 and up to 166 months after endovascular treatment of an indirect carotid cavernous fistula (Barrow B-D) at our institution (treated from 01/2003 to 06/2015). We determined treatment details including primary therapy success and complication rate and quote the patient's subjective perception of the long-term treatment success using a standardized interview form. ResultsAs a primary result the fistula was completely occluded in 25/33 cases (76%), while a downgrading was achieved in 8/33 (24%) of the cases. Secondary occlusion was observed in three out of eight patients (38%). In the long-term interview (response rate: 91%, median follow-up interval: 114 months) 87% of the patients reported high satisfaction with the longterm therapy result. Endovascular treatment achieved a sustainable relief from all eyerelated symptoms in 89% and from pulsatile tinnitus in 57% of the cases.

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“…In terms of treatment planning, Ertl et al evaluated 24 transverse sinus DAVFs with DSA and CE TR-MRA, and found that CE TR-MRA was better than DSA in evaluating venous drainage and sinus involvement. 9 The authors postulated that, in some cases, hemodynamic effects of DSA can lead to venous sinus pseudoocclusion, and that CE TR-MRA does not suffer from the same hemodynamic effect. In addition, the authors describe how the MRA demonstrated the fistula drainage pattern in relationship to the rest of the intracranial compartment better than the DSA.…”

Section: Cranial Dural Arteriovenous Fistulasmentioning

confidence: 99%

“…Although the authors found a 100% correlation between CE TR-MRA and DSA in terms of DAVF grading, they did find that CE TR-MRA performed worse than DSA in identifying the arterial side of fistula anatomy. 9 Finally, CE TR-MRA is a potentially attractive technique for DAVF follow-up. Noguchi et al evaluated 21 treated transverse-sigmoid DAVFs with both DSA and CE TR-MRA to evaluate for both residual fistulas as well as retrograde venous drainage.…”

Section: Cranial Dural Arteriovenous Fistulasmentioning

confidence: 99%

The use of contrast-enhanced, time-resolved magnetic resonance angiography in cerebrovascular pathology

Grossberg¹,

Howard

Saindane

2019

Neurosurgical Focus

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Digital subtraction angiography (DSA) has long been the imaging gold standard in the evaluation, treatment, and follow-up of cerebro- and spinovascular disorders. However, DSA has the disadvantages of invasiveness, contrast allergy or nephropathy, the impracticality of procedural preparation and recovery, and expense. Contrast-enhanced (CE), time-resolved (TR) magnetic resonance angiography (CE TR-MRA) is a sophisticated, relatively novel imaging modality that provides multiphasic contrast-enhanced visualization of the neurovasculature. Given the crucial role of angiography in all aspects of care for patients with complex neurovascular disorders, it is incumbent on those who care for these patients to understand the usefulness and pitfalls of novel imaging in this arena to ensure best practices, and to deliver cutting edge care to these patients in a way that minimizes cost, but does not compromise quality. CE TR-MRA has the potential to play an expanded role in the workup and follow-up across the spectrum of neurovascular disease, and this review is aimed to help neurosurgeons better understand how CE TR-MRA can be used to better manage patients in this cohort.

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Assessment and treatment planning of lateral intracranial dural arteriovenous fistulas in 3 T MRI and DSA: A detailed analysis under consideration of time-resolved imaging of contrast kinetics (TRICKS) and ce-MRA sequences

Abstract: • DSA is superior to the MRI in detecting LDAVF arterial feeders. • MRI excellently evaluates the venous side of an LDAVF. • MRI can replace DSA in initial diagnosis and monitoring of LDAVF. • MRI and DSA combined are the new gold standard in LDAVF treatment planning.

Cited by 7 publications

References 9 publications

Assessment of 4D MR Angiography at 3T Compared with DSA for the Follow-up of Embolized Brain Dural Arteriovenous Fistula: A Dual-Center Study

Assessment of 4D MR Angiography at 3T Compared with DSA for the Follow-up of Embolized Brain Dural Arteriovenous Fistula: A Dual-Center Study

Patient reported long-term outcome after endovascular therapy of indirect dural carotid cavernous fistulas

The use of contrast-enhanced, time-resolved magnetic resonance angiography in cerebrovascular pathology

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