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

Abstract

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.

Multimodal MRI diagnosis and transvenous embolization of a basicranial emissary vein dural arteriovenous fistula: A case report

“… 18 , 19 , 20 Temporal resolution and intracranial hemodynamics can be ascertained by DCE-MRA, for determining classifications related to venous drainage of DAVFs. 21 DCE-MRA can provide the added value of real time physio-pathological data regarding DAVF hemodynamics. Intracranial high-resolution VW-MRI can help to systematize the evaluation of DAVFs, rendering correct vascular descriptions.…”

Overview of multimodal MRI of intracranial Dural arteriovenous fistulas

“…DCE-MRA can provide temporal resolution and identify intracranial hemodynamics and venous drainage, thus determining Borden or Cognard classifications. 38 , 39 , 40 Venous drainage patterns can predict the risk of ICH and NHND, such as vascular edema and cytotoxic edema. 28 , 32 , 41 , 42 The gold standard for clarifying the direction of DAVF venous drainage remains cerebral angiography based on selective catheter intubation.…”

“…Certain studies comparing DCE-MRA with DSA have demonstrated that DCE-MRA can diagnose DAVFs and identify the direction of venous drainage. 38 , 39 Therefore, DCE-MRA can be used as a preliminary diagnostic pre-surgical tool. 39 , 40 , 43 , 44 In terms of DAVF treatment, the individual needs of specific patients must be analyzed in detail.…”

Use of PETRA-MRA to assess intracranial arterial stenosis: Comparison with TOF-MRA, CTA, and DSA

“…Digital subtraction angiography (DSA) is regarded as the gold standard for measuring intracranial stenosis. However, DSA is an invasive modality and has the risk of ionizing radiation and the incidence of potential subsequent contrast-related complications ( 3 ). Therefore, non-invasive and accurate methods for the assessment of ICAS are gaining promise.…”