The role of time-resolved 3D contrast-enhanced MR angiography in the assessment and grading of cerebral arteriovenous malformations

Oleaga, Laura; Dalal, Shamsher; Weigele, John B.; Hurst, Robert W.; Lee, J.; Voorhees, Abram; Melhem, Elias R.

doi:10.1016/j.ejrad.2009.04.063

Cited by 27 publications

(14 citation statements)

References 11 publications

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“…However, TOF MRA produces only static images of AVMs and lacks haemodynamic information. Another noninvasive technique, contrast-enhanced four-dimensional MRA (4D-MRA), is an emerging new technique without these limitations and demonstrates a good correlation with X-ray angiography with respect to the Spetzler-Martin classification on initial assessment of AVMs prior to treatment [7][8][9][10][11][12][13]. However, the diagnostic accuracy of 4D-MRA for the detection of residual AVMs after GKRS is not well known.…”

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confidence: 99%

Detection of residual brain arteriovenous malformations after radiosurgery: diagnostic accuracy of contrast-enhanced four-dimensional MR angiography at 3.0 T

Lim

Choi²,

Kim³

et al. 2012

The British Journal of Radiology

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Objective: To evaluate the diagnostic accuracy of four-dimensional MR angiography (4D-MRA) at 3.0 T for detecting residual arteriovenous malformations (AVMs) after Gamma Knife j (Elekta Instrument AB, Stockholm, Sweden) radiosurgery (GKRS). Methods: We assessed 36 angiographically confirmed AVMs in 36 patients who had been treated with GKRS. 4D-MRA was performed after GKRS and the time intervals were 39.4¡26.0 months [mean ¡ standard deviation (SD)]. 4D-MRA was obtained at 3.0 T after contrast injection, with a measured voxel size of 16161 mm and a temporal resolution of 1.1 s (13 patients) or a voxel size of 16162 mm and a temporal resolution of 0.98 s (23 patients). X-ray angiography was performed as the standard reference within 53¡47 days (mean ¡ SD) after MRA. To determine a residual AVM, the 4D-MRA results were independently reviewed by two readers blinded to the X-ray angiography results. We evaluated diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 4D-MRA for detection of a residual AVM. Results: A residual AVM was identified in 13 patients (13/36, 36%) on X-ray angiography. According to Readers 1 and 2, 4D-MRA had a sensitivity of 79.6% and 64.3%, a specificity of 90.9% and 100%, a PPV of 84.6% and 100% and an NPV of 90% and 81.5%, respectively, and a diagnostic accuracy of 86.1% for Readers 1 and 2, for detecting residual AVMs after GKRS. Conclusion: The diagnostic accuracy of 4D-MRA at 3.0 T seems high, but there is still the possibility of further improving the spatiotemporal resolution of this technique.

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confidence: 99%

Detection of residual brain arteriovenous malformations after radiosurgery: diagnostic accuracy of contrast-enhanced four-dimensional MR angiography at 3.0 T

Lim

Choi²,

Kim³

et al. 2012

The British Journal of Radiology

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“…However, the most recent evidence on the subject still demonstrates that DSA is substantially more sensitive in surveillance and detection, although these new modalities do have a role in grading and treatment planning for known lesions. 21,25 As we observe in Fig. 1, AVM recurrence in our cohort was at times a very subtle finding, reinforcing the idea that noninvasive modalities for follow-up that are currently available may not be sufficient to detect it.…”

Section: Discussionmentioning

confidence: 54%

Postoperative imaging for detection of recurrent arteriovenous malformations in children

Morgenstern

Hoffman

Kocharian

et al. 2016

PED

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OBJECT The optimal method for detecting recurrent arteriovenous malformations (AVMs) in children is unknown. An inherent preference exists for MR angiography (MRA) surveillance rather than arteriography. The validity of this strategy is uncertain. METHODS A retrospective chart review was performed on pediatric patients treated for cerebral AVMs at a single institution from 1998 to 2012. Patients with complete obliteration of the AVM nidus after treatment and more than 12 months of follow-up were included in the analysis. Data collection focused on recurrence rates, associated risk factors, and surveillance methods. RESULTS A total of 45 patients with a mean age of 11.7 years (range 0.5–18 years) were treated for AVMs via surgical, endovascular, radiosurgical, or combined approaches. Total AVM obliteration on posttreatment digital subtraction angiography (DSA) was confirmed in 27 patients, of whom the 20 with more than 12 months of follow-up were included in subsequent analysis. The mean follow-up duration in this cohort was 5.75 years (median 5.53 years, range 1.11–10.64 years). Recurrence occurred in 3 of 20 patients (15%). Two recurrences were detected by surveillance DSA and 1 at the time of rehemorrhage. No recurrences were detected by MRA. Median time to recurrence was 33.6 months (range 19–71 months). Two patients (10%) underwent follow-up DSA, 5 (25%) had DSA and MRI/MRA, 9 (45%) had MRI/MRA only, 1 (5%) had CT angiography only, and 3 (15%) had no imaging within the first 3 years of follow-up. After 5 years posttreatment, 2 patients (10%) were followed with MRI/MRA only, 2 (10%) with DSA only, and 10 (50%) with continued DSA and MRI/MRA. CONCLUSIONS AVM recurrence in children occurred at a median of 33.6 months, when MRA was more commonly used for surveillance, but failed to detect any recurrences. A recurrence rate of 15% may be an underestimate given the reliance on surveillance MRA over angiography. A new surveillance strategy is proposed, taking into account exposure to diagnostic radiation and the potential for catastrophic rehemorrhage.

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“…This technique has a high temporal resolution, and images are repeatedly acquired from a volume during the passage of contrast agent, which allows multiple 3D data sets from the arterial to the venous phase to be obtained. It is preferred especially when the timing of cerebral venous drainage is of interest, such as detecting early draining veins in arteriovenous malformations and dural arteriovenous fistulas [12][13][14][15][16][17][18][19][20]. The main disadvantage of this technique is having a low spatial resolution compared with the other contrast-enhanced sequences [6,21].…”

Section: Introductionmentioning

confidence: 99%

Time-resolved MR angiography of the intracranial venous system: an alternative MR venography technique

et al. 2011

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The role of time-resolved 3D contrast-enhanced MR angiography in the assessment and grading of cerebral arteriovenous malformations

Cited by 27 publications

References 11 publications

Detection of residual brain arteriovenous malformations after radiosurgery: diagnostic accuracy of contrast-enhanced four-dimensional MR angiography at 3.0 T

Detection of residual brain arteriovenous malformations after radiosurgery: diagnostic accuracy of contrast-enhanced four-dimensional MR angiography at 3.0 T

Postoperative imaging for detection of recurrent arteriovenous malformations in children

Time-resolved MR angiography of the intracranial venous system: an alternative MR venography technique

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