Value of 4D MR Angiography at 3T Compared with DSA for the Follow-Up of Treated Brain Arteriovenous Malformation

Soize, Sébastien; Bouquigny, F.; Kadziolka, K.; Portefaix, Christophe; Piérot, Laurent

doi:10.3174/ajnr.a3982

Cited by 35 publications

(20 citation statements)

References 32 publications

(44 reference statements)

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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: 55%

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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Section: Discussionmentioning

confidence: 55%

Postoperative imaging for detection of recurrent arteriovenous malformations in children

Morgenstern

Hoffman

Kocharian

et al. 2016

PED

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“…25 Despite that the advancements in MR imaging technique such as 4D-MRA have enabled temporal information to be recorded, its limitations are still prominent. 26,27 Additionally, differences in AVM nidus contouring-derived MR images increase the likelihood of mismatch between the dose contour and the exact nidus volume during treatment planning. Stereotactic 4D-DSA may facilitate the treatment planning by providing the hemodynamics and morphology of AVM/DAVF in 1 stop.…”

Section: Discussionmentioning

confidence: 99%

Application of Time-Resolved 3D Digital Subtraction Angiography to Plan Cerebral Arteriovenous Malformation Radiosurgery

Chen

Guo²,

Yang

et al. 2017

AJNR Am J Neuroradiol

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“…In the case of patients who are being evaluated for a suspected AVM in the absence of intraparenchymal hemorrhage, MRI of the brain with CE-MRA/venography or dynamic MRA/venography is likely to provide the maximum information. Several 4-D MRA/venography techniques are available, all of which at present have a trade-off between spatial and temporal resolution [125,126]. Parenchymal brain imaging using brain MRI with and without contrast is helpful in evaluating the location of the AVM in relation to eloquent brain tissue and can be useful in evaluating for prior hemorrhage within the AVM, both important prognostic factors.…”

Section: Variant 14: Evaluation Of High-flow Vascular Malformationsmentioning

confidence: 99%

ACR Appropriateness Criteria ® Cerebrovascular Disease

Salmela

Mortazavi

Jagadeesan

et al. 2017

Journal of the American College of Radiology

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Diseases of the cerebral vasculature represent a heterogeneous group of ischemic and hemorrhagic etiologies, which often manifest clinically as an acute neurologic deficit also known as stroke or less commonly with symptoms such as headache or seizures. Stroke is the fourth leading cause of death and is a leading cause of serious long-term disability in the United States. Eighty-seven percent of strokes are ischemic, 10% are due to intracerebral hemorrhage, and 3% are secondary to subarachnoid hemorrhage. The past two decades have seen significant developments in the screening, diagnosis, and treatment of ischemic and hemorrhagic causes of stroke with advancements in CT and MRI technology and novel treatment devices and techniques. Multiple different imaging modalities can be used in the evaluation of cerebrovascular disease. The different imaging modalities all have their own niches and their own advantages and disadvantages in the evaluation of cerebrovascular disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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Value of 4D MR Angiography at 3T Compared with DSA for the Follow-Up of Treated Brain Arteriovenous Malformation

Abstract: BACKGROUND AND PURPOSE: Four-dimensional, contrast-enhanced MRA is a useful technique for the diagnosis and classification of brain AVM. The purpose of this study was to evaluate its usefulness in the follow-up of treated brain AVM.

Cited by 35 publications

References 32 publications

Postoperative imaging for detection of recurrent arteriovenous malformations in children

Postoperative imaging for detection of recurrent arteriovenous malformations in children

Application of Time-Resolved 3D Digital Subtraction Angiography to Plan Cerebral Arteriovenous Malformation Radiosurgery

ACR Appropriateness Criteria ® Cerebrovascular Disease

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