Evaluation of Intracranial Dural Arteriovenous Fistulas: Comparison of Unenhanced 3T 3D Time-of-flight MR Angiography with Digital Subtraction Angiography

Abstract

Purpose: We compared gross characterization of intracranial dural arteriovenous fistulas (DAVFs) between unenhanced 3-tesla 3-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) and digital subtraction angiography (DSA).Methods: We subjected 26 consecutive patients with intracranial DAVF to unenhanced 3T 3D TOF MRA and to DSA. Two independent sets of observers inspected the main arterial feeders, fistula site, and venous drainage pattern on MRA and DSA images. Interobserver and intermodality agreements were assessed by k statistics.Results: Interobserver agreement was excellent for fistula site (¬ = 0.919; 95% confidence interval [CI], 0.805 to 1.000), good for main arterial feeders (¬ = 0.711; 95% CI, 0.483 to 0.984), and very good for venous drainage (¬ = 0.900; 95% CI, 0.766 to 1.000). Intermodality agreement was excellent for fistula site (¬ = 0.968; 95% CI, 0.906 to 1.000) and good for main arterial feeder (¬ = 0.809; 95% CI, 0.598 to 1.000) and venous drainage (¬ = 0.837; 95% CI, 0.660 to 1.000).Conclusion: Gross characterization of intracranial DAVF was similar for both imaging modalities, but unenhanced 3T 3D TOF MRA cannot replace DSA.

Evaluation of cerebral arteriovenous shunts: a comparison of parallel imaging time-of-flight magnetic resonance angiography (TOF-MRA) and compressed sensing TOF-MRA to digital subtraction angiography

“…Time-of-flight (TOF)-MRA has been the most widely used of these in clinical practice. Past studies have identified TOF-MRA as a sensitive tool for detecting AVS without contrast material [23][24][25][26][27][28]. Even with parallel imaging (PI), a widely used method for k-space undersampling, TOF-MRA requires a long scanning time, since both wide scan coverage and high resolution are required in the assessment of AVS due to its complex angioarchitecture and hemodynamics.…”

Prospective motion correction enables highest resolution time‐of‐flight angiography at 7T

“…TOF angiography at clinical field strengths is applied in the brain mainly to detect neurovascular diseases such as intracranial stenosis or unruptured aneurysms . Although the noninvasive diagnosis of small vessels, such as arteriovenous malformations, dural arteriovenous fistulas, and detection of arterial feeders of intracranial tumors, is possible with TOF, digital subtraction angiography (DSA) has been shown to yield superior sensitivity and specificity due to higher spatial resolution and image quality . Thus, DSA remains the gold standard imaging modality for small cranial arteries, regardless of its related radiation exposure for staff and patients; low but significant risks of neurological deficit; complications; or idiosyncratic reactions due to artery puncture, catheter placement, and iodinated contrast agent .…”

Non contrast, Pseudo-Continuous Arterial Spin Labeling and Accelerated 3-Dimensional Radial Acquisition Intracranial 3-Dimensional Magnetic Resonance Angiography for the Detection and Classification of Intracranial Arteriovenous Shunts

“…DSA-imaging was evaluated by a third radiologist. A diagnostic confidence score was used for the presence of abnormalities associated with AV-shunting (1–5). AVMs were characterized using the Spetzler-Martin-scale, AVFs were characterized using the Borden classification.…”